Archives of Integrative Clinical Practice
Volume 5, Issue 1, January 6, 2017
Previously Published – Free Content
- The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea
- Can intractable discogenic back pain be managed by low-level laser therapy without recourse to operative intervention?
- Healthy Maternal Diet Linked to Lower Premature Birth Risk
- Frank’s Sign
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The effect of spinal manipulation on pain and prostaglandin levels in women with primary dysmenorrhea
kjohn K , Schmid DM , Triano JJ , Brennan PC
Research Department, National College of Chiropractic, Lombard, IL 60148-4583.
Journal of Manipulative and Physiological Therapeutics [1992, 15(5):279-285]
Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov’t
Abstract
OBJECTIVE: The primary objectives of this study were to compare the effect of spinal manipulation vs. sham manipulation on a) circulating plasma levels of the prostaglandin F2a metabolite, 15-keto-13,14-dihydroprostaglandin (KDPGF2a), b) perceived abdominal and back pain and c) perceived menstrual distress in women with primary dysmenorrhea. DESIGN: This randomized clinical pilot study investigated the outcome measures before and after either a spinal manipulation treatment (SMT) or a sham manipulation. SETTING: All subjects were treated at the National College Chiropractic clinic, a private chiropractic clinic in the suburban Chicago area. PARTICIPANTS: Forty-five women with a history of primary dysmenorrhea were recruited from the local community. The volunteers ranged in age from 20-49 (mean age = 30.3 yr), and were entered into the study between April 1990 and January 1991. Twenty-four were randomly assigned to the spinal manipulation group and 21 were assigned to the sham group. INTERVENTIONS: Subjects treated with spinal manipulation were placed in a side-lying position with the bottom leg straight and the top leg flexed at the knee and hip. They received a high-velocity, short lever, low-amplitude thrust to all clinically relevant vertebral levels within T10 and L5-S1 and the sacroiliac joints. In the sham manipulation, subjects were placed in a side-lying position with both hips and knees flexed. Their manipulation consisted of a similar thrust administered to the midline base of the sacrum. OUTCOME MEASURES: Perceived abdominal and back pain were measured with a visual analog scale, and menstrual distress was measured with the Menstrual Distress Questionnaire. Both were administered 15 min before and 60 min after treatment. Blood samples were collected by venipuncture for the determination of plasma levels of KDPGF2a at the same times. The plasma was then assayed for KDPGF2a by radioimmunoassay. RESULTS: Analysis of covariance and paired Student’s t tests were used for the statistical evaluation. Immediately after treatment, the perception of pain and the level of menstrual distress were significantly reduced by SMT. This reduction was associated with a significant reduction in plasma levels of KDGPF2a in the SMT group. A significant and similar reduction in plasma KDPGF2a also occurred in the sham group, indicating that a placebo effect was associated with a single sham intervention. CONCLUSIONS: This randomized pilot study suggests that SMT may be an effective and safe nonpharmacological alternative for relieving the pain and distress of primary dysmenorrhea. However, the large change in KDPGF2a observed in both treatment groups clearly indicates that further studies with more subjects, studied over a longer time frame, are needed to resolve the question of a placebo effect.
Can intractable discogenic back pain be managed by low-level laser therapy without recourse to operative intervention?
Journal of Pain Research
Published 26 May 2015 Volume 2015:8 Pages 253—256
Objective: The aim of the study reported here was to investigate the possible clinical role of low-level laser therapy (LLLT) in discogenic back pain patients who failed to respond to a conventional physical therapy program to avoid recourse to operative intervention.
Methods: The paper reports on the long-term mean 5-year prospective follow-up of a patient cohort of 50 unselected patients visiting our tertiary referral pain center for discogenic back pain who had had a single-level lesion documented by magnetic resonance imaging followed by subsequent discography to confirm the affected disc being the pain generator. All of the patients who entered the study had failed response to a combination of nonsteroidal anti-inflammatory agents and had had not less than 3 months of conventional physical therapy. LLLT, at a wavelength of 810 nm wavelength emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed. The treatment regimen consisted of three sessions of treatment per week for 12 consecutive weeks.
Results: All but one patient had significant improvement in their Oswestry Disability Index score, from a mean of 50% score to a mean of 10% score, at the end of treatment at 12 weeks. In addition, surprisingly, the improvement was found maintained at follow-up assessments 1 year and 5 years later. The one patient among the 50 patients who failed to respond eventually required surgery, while the others did not require surgery.
Conclusion: We conclude that LLLT is a viable option in the conservative treatment of discogenic back pain, with a positive clinical result of more than 90% efficacy, not only in the short-term but also in the long-term, with lasting benefits.
Healthy Maternal Diet Linked to Lower Premature Birth Risk
Laurie Barclay, MD
March 04, 2014
Maternal “traditional” or “prudent” diets rich in vegetables, fruit, whole grains, and fish were linked to lower risk for preterm delivery, supporting advice to eat a balanced diet, according to findings from a large prospective cohort study published online March 4 in BMJ.
Preterm delivery, defined as delivery at gestational age less than 37 weeks, accounts for nearly three quarters of newborn deaths and has many adverse effects in the short and long term.
Frank’s Sign
George Griffing, M.D.
N Engl J Med 2014; 370:e15 March 6, 2014 DOI: 10.1056/NEJMicm1213868
A 59-year-old man with long-standing hypertension presented with exertional chest pain. An electrocardiogram and cardiac stress testing were unremarkable. Coronary angiography, however, revealed substantial stenosis, and two stents were placed. The patient’s recovery was uneventful, and he has returned to the clinic with no further chest pain. The patient was noted to have bilateral Frank’s sign, which is a diagonal crease in the earlobe that runs backward from the tragus at a 45-degree angle across the lobule to the rear edge of the auricle and may be a predictor of coronary artery disease. Frank’s sign is thought to indicate premature aging and loss of dermal and vascular elastic fibers. Although it has limited sensitivity, the sign is more useful diagnostically in persons younger than 60 years of age than in older persons.
George Griffing, M.D.
Saint Louis University, St. Louis, MO
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