Chiropractic + Naturopathic Doctor • October 2016 • Roundup

Can an increased risk of chronic pain be transmitted from parents to children?Several factors may contribute, including genetics, effects on early development, social learning and more, according to a report in the journal Pain, the official publication of the International Association for the Study of Pain (IASP).

Amanda Stone of Vanderbilt University, in Nashville, Tenn., and Anna Wilson of Oregon Health & Science University, in Portland, Ore., present a conceptual model of transmission of chronic pain, including potential mechanisms and moderating factors.

Knowing that offspring of parents with chronic pain are at increased risk of developing the same condition, Stone and Wilson developed an “integrative conceptual model” to explore possible explanations for this risk.

The researchers identify five “plausible mechanisms” to explain the transmission of chronic disease risk from parent to child:

Genetics. Children of parents with chronic pain might be at increased genetic risk for sensory as well as psychological components of pain. Research suggests that genetic factors may account for roughly half of the risk of chronic pain in adults.

Early neurobiological development. Having a parent with chronic pain may affect the features and functioning of the nervous system during critical periods in early development.For example, a baby’s development might be affected by the mother’s stress level or health behaviors during and after pregnancy.

Pain-specific social learning. Children may learn “maladaptive pain behaviors” from their parents, who may act in ways that reinforce those behaviors.Catastrophizing – exaggerated responses and worries about pain – might be one key factor.

General parenting and health habits. Chronic pain risk could be affected by parenting behaviors linked to adverse child outcomes; for example, permissive parenting or lack of consistency and warmth.

Exposure to stressful environment. There may be adverse effects from growing up in stressful circumstances related to chronic pain; for example, financial problems or parents’ inability to perform daily tasks.

The model also identifies some “moderators” that might explain when and under what circumstances children are at highest risk of developing chronic pain.These include chronic pain in the other parent; the timing, course and location of the parent’s pain; and the children’s characteristics, including their personal temperament.

Stone and Wilson note.They hope their model will provide a framework to guide future research – toward the goal of developing effective prevention and treatment approaches for children of parents with chronic pain.

Our latest survey of Canadian chiropractors provides a snapshot of current practice environments in Canada

It’s the most common reason people go to their doctors – back pain.According to the U.S. National Institutes of Health, 80 per cent of adults will experience low back pain some time in their lives. In fact, chronic low back pain, lasting 12 weeks or longer, affects nearly onethird of the population.

Laura Donlon, 48, of Monroe, Michigan, had been dealing with low back pain for five years before she found out about a back pain study at Beaumont Hospital in Royal Oak, Michigan. The flight attendant says her pain was unbearable at times, especially when sitting. Seeking relief from her pain, caused by a degenerative disc, she contacted the orthopedic research team at Beaumont for details.

Treatments for low back pain range from noninvasive to invasive: physical therapy, pain medications to major surgery, such as spinal fusion.Now a minimally invasive, nerve ablating procedure, recently cleared by the U.S. Food and Drug Administration, may give some people with chronic low back pain a new treatment option.

“In 25 years of practicing orthopedics, this is the most important clinical study I’ve ever done,” said Dr. Jeffrey Fischgrund, chairman, Orthopedics, Beaumont Hospital, Royal Oak and principal investigator of the FDA-approved Relievant SMART trial.

“The system is proven to be safe and effective in clinical trials. It is much less invasive than typical surgical procedures to treat low back pain.”

A spine expert and orthopedic surgeon, Fischgrund helped design the research study. Research teams in the United States and Germany recruited 225 participants, with 150 receiving the minimally invasive, ablation treatment and 75 receiving the placebo.

Donlon was told she met the trial criteria and enrolled in the study. In December 2014, she had an outpatient spine procedure by Beaumont physicians. Because she did not know if she received the minimally invasive trial procedure or a placebo, she had to guess based upon results.

“After the procedure, I went home and within 24 hours I could touch my toes,” said Donlon, a running enthusiast and marathon competitor. “That’s when I figured I had the study procedure. Within 48 hours, I was back to work.” One year later, the research team confirmed what she suspected; she had undergone the nerve ablation treatment.

The treatment uses radio frequency energy to disable the targeted- nerve responsible for low back pain. Under local anesthesia with mild sedation, through a small opening in the patient’s back, an access tube is inserted into a specific bony structure of the spine, called a vertebral body. Radio frequency energy is transmitted through the device, creating heat, which disables the nerve. The access tube is then removed. The minimally invasive, implant-free procedure takes less than one hour.

“This is a new way to treat back pain. This type of treatment has never been done before,” said Fischgrund. “It’s revolutionary, compared to more traditional therapies; the odds of success are much greater.”

Patients eligible for this new procedure typically are candidates for more invasive back surgery or take strong pain medications, like opioids. Those research participants that had the radio frequency ablation procedure noticed significant improvement in their back pain within two weeks of surgery.

The nerve ablation procedure and technology was developed by Relievant Medsystems Inc., a California-based medical device company.

Nineteen months after Donlon’s minimally invasive nerve ablation treatment, she said, “Today, I have no back issues. I’m pain free. In fact, since my procedure, the pain has not recurred. I’m extremely grateful for the care and treatment I’ve received through my participation in the lower back pain study.”

Researchers at Lawson Health Research Institute in London, Ont., have developed clinical practice guidelines for managing neuropathic pain with patients who have experienced a spinal cord injury (SCI).Lawson Health claims the document is the first of its kind in Canada.

Neuropathic pain is complex and chronic, and is the most common complication reported by people following SCI. The research team worked with care providers at Parkwood Institute, part of the St. Joseph’s Health Care London family, and an international panel to address the complex and unique challenges for managing pain during recovery and rehabilitation.

In 2003, Dan Harvey sustained a spinal injury after falling off a trampoline. Using his personal experience, as well as his experiences meeting with newly injured people, Harvey contributed to the development of the new guidelines.

“Neuropathic pain – and pain in general – affects every person with a spinal cord injury very differently.Some people have it, some people don’t. But for those who do have it, it can make rehabilitation and recovery much more difficult,” explains Harvey.

Dr. Eldon Loh, Lawson researcher and physical medicine and rehabilitation specialist at St. Joseph’s, and his team recognized that pain can be an overlooked part of a spinal cord injury and plays a major factor in the success of rehabilitation.

“This is a starting point for us to standardize how we approach pain in the clinic.We have identified gaps and offered recommendations to not only manage the pain, but also ensure that our patients can fully benefit from rehabilitation,” Loh says.

The results of the threeyear process led to recommendations for screening and diagnosis, treatment and models of care. Important clinical considerations accompany each recommendation.

“For those in hospital following an injury, it’s about making sure they can be as independent as possible before discharge. Over time, we want to keep pain levels under control so that they are able to live life to the fullest,” Loh adds. The research will inform new tools and resources for care providers and patients.

Harvey believes the guidelines will have a tremendous impact for patients whose pain may have been overlooked.

The new guidelines have been published in the international journal Spinal Cord.The Ontario Neurotrauma Foundation and Rick Hansen Institute provided funding for the research.

Lawson Health Research Institute is the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, and works in partnership with Western University.

Women who do the same tasks as men often face a higher risk of musculoskeletal disorders (MSDs) in their neck and upper limbs, according to a researcher from McGill University in Montreal.

That higher risk may be due to both biological (sex) differences as well as differences in social roles, activities and behaviours (gender), and it’s important that these differences be examined and understood in order to develop effective injury prevention approaches.

Dr. Julie Côté, associate professor and chair of the department of kinesiology and physical education at McGill University, conveyed these findings to about 400 delegates at the 9th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders (PREMUS 2016). Côté delivered the keynote entitled, “Can using a sex/gender lens provide new insights into MSD mechanisms?” Côté also holds a Canadian Institutes of Health Research chair in gender, work and health.

Women report pain, discomfort and other symptoms of musculoskeletal disorders in the neck and upper limbs about twice as often as men, whereas men are more likely to experience low-back injuries. Sex/gender differences may be the reasons why, she said.

“Sex and gender have their own operational definitions, but there is significant interaction between them, with aspects of biology influencing psychosocial roles and attitudes, and vice versa,” Côté said. “That’s why we have come to use the expression, ‘sex/gender differences,’ to recognize the integration of these influences.”

The sex/gender differences between men and women go beyond their different physical strengths to include differences in the types of muscle fibre found in men and women. For example, women have higher proportion of what’s called type 1 muscle fibres than men, fibres that give women higher endurance but can also lead them to perform tasks for longer duration.

Added to this are the repetitive and invariable nature of the tasks that women are more likely to perform, and the fact that women compensate for their weaker strength by engaging muscles at levels that are close to their maximum capacity. The interaction between these different factors could be the reason for the greater risk of muscle overload among women, leading to a higher risk of injury, said Côté.

Other sex/gender differences that may explain women’s higher rates of neck and shoulder injury include differences in how women and men move, respond to fatigue, perceive pain and adapt to stress at the physiological level.Also, differences in job assignment, job control and social roles outside of work may also come into play.

“In sum, the question we need to ask may not be, ‘Are men and women different?’ but ‘How much so?’” said Côté. “This question is all the more pertinent when considering making workplace adaptations to prevent work-related MSDs.”

Held every three years since 1992, PREMUS is the primary conference of the Musculoskeletal Disorders Scientific Community of the International Commission of Occupational Health. PREMUS 2016 was held in Toronto in June and was hosted by the Institute for Work & Health.

WASHINGTON, D.C. – A new Gallup study highlights the extent to which neck and back pain affect American adults, with one in four reporting that they have seen a health-care professional for significant neck or back pain within the past year and nearly two-thirds (65 per cent) saying they have done so at some point in their lives.

These findings come from a nationally representative Gallup Panel study of U.S. adults, aged 18 and older, conducted via web and mail from Feb. 8 to March 11, 2016. This is the second annual Gallup study commissioned by Palmer College of Chiropractic.

“Many Americans reported dealing with significant neck or back pain,” said Cynthia English, Gallup research consultant in charge of the study. “Among U.S. adults who sought professional care for neck or back pain, seven in 10 (71 percent) tell us they have been to a doctor of chiropractic.”

The poll asked all respondents for their impressions of the effectiveness of five treatment options for neck and back pain: physical therapy, chiropractic care, prescription pain medication, back surgery and self-care. Roughly four in 10 U.S. adults (41 per cent) say physical therapy is “very effective,” while nearly three in 10 (29 per cent) say the same about chiropractic care. Twenty-two percent describe prescription pain medication as “very effective,” and 15 per cent say this about back surgery. U.S. adults view self-care as the least effective option, rated “very effective” by just nine per cent.

When factoring in those who consider each approach either “somewhat” or “very” effective, majorities of Americans perceive all five types of care – including self-care – to be of some value.

Americans are least certain of the effectiveness of back surgery, with 36 per cent saying they “don’t know” how effectively it treats significant neck or back pain. Nineteen per cent say they “don’t know” the effectiveness of chiropractic care – more than double the percentage who say the same about physical therapy or prescription pain medication. Americans are least likely, at five per cent, to say they “don’t know” the effectiveness of self-care.

All treatment methods for significant neck or back pain come with some risk to a patient’s health. In light of this, Gallup asked American adults to assess the safety of each of five medical treatments for neck and back pain: physical therapy, chiropractic care, back surgery, prescription pain medication and over-the-counter pain medications.

Physical therapy receives the highest safety ratings, with 68 per cent of Americans describing it as “very safe.” Chiropractic care is next, with 33 per cent of U.S. adults describing it as “very safe,” followed by over-the-counter medications (23 per cent), prescription medication (12 per cent) and back surgery (six per cent). All options except for back surgery are rated at least “somewhat safe” by a majority of Americans. While 49 per cent of Americans rate back surgery as “very” or “somewhat” safe, 37 per cent rate it as unsafe and 14 per cent say they “don’t know.”

Notably, nearly a third of U.S. adults say prescription pain medication is either “not very safe” (23 per cent) or “not safe at all” (eight per cent), possibly reflecting recent medical attention to the risks of opioid addiction. Less than 15 per cent of Americans rate over-the-counter medications, chiropractic care or physical therapy as unsafe.

Gallup asked respondents to think about their preferred treatment if they were to experience neck or back pain, assuming availability and costs of each treatment would be the same. Among five specific healthcare providers – a medical doctor, chiropractor, physical therapist, massage therapist or acupuncturist – more than half (53 per cent) of U.S. adults say they would most like to see a medical doctor about their neck or back pain. Ranking second, 28 per cent of Americans say they would most like to see a chiropractor, while far fewer would most like to see a massage therapist (seven per cent), a physical therapist (six per cent) or an acupuncturist (one per cent).

During National Chiropractic Health Month (NCHM) in October, the American Chiropractic Association (ACA) is building on its ongoing efforts to raise awareness of the value of a conservative approach to pain management in the face of the U.S. opioid epidemic with the theme and hashtag #Chiropractic1st.

“Chiropractic services are an important first line of defense against pain and, in some cases, can lessen a patient’s reliance on addictive painkillers or prevent their use altogether,” said ACA president David Herd,DC. “It makes sense to exhaust conservative forms of treatment such as chiropractic before moving on to riskier, potentially addictive pain medications.”

Statistics show that as many as one in four patients who receive prescription opioids long-term for non-cancer pain in primary care settings struggles with addiction. In addition, every day more than 1,000 people are treated in the emergency room for misusing prescription opioids.

Using treatments such as spinal manipulation, chiropractic physicians take a drug-free approach to treating back pain, neck pain and other musculoskeletal disorders. High-quality research has found spinal manipulation to be effective for acute and chronic musculoskeletal pain.

In the wake of the opioid epidemic, many respected health care organizations now recommend non-drug treatments. For example, the Centers for Disease Control and Prevention, in its 2016 guidelines for prescribing opioids, notes that nonpharmacologic therapies are preferred for treating chronic pain. In addition, the National Pain Strategy, an initiative by several federal agencies, recognizes chiropractic’s value as a method for pain management.

The Canadian Memorial Chiropractic College successfully held its inaugural Bat Crackers fundraising softball tournament on August 28 at Milliken Mills Park in Markham, Ont. The Green Sox team (in lime green shirts), comprising of all Year 1 (class of 2020) students, came in first place. The Humber Family Wreckers team took home the best sportsmanship award.

Dr. Melissa Tancredi, who earned her doctorate of chiropractic degree from Logan University, is part of the Canadian women’s soccer team who took home the bronze medal at the 2016 Olympics in Rio de Janeiro last August. Tancredi made her debut in the Canadian national soccer team in 2004 and has won several medals with the Canadian team since then, including in two Olympic games – London, 2012 and Rio, 2016.

Dr. James (Jamie) Laws, 1979 CMCC graduate, was inducted into the Hall of Fame of the Canadian Athletic Therapists Association at its 50th annual conference on May 28, 2016. Laws graduated from York University with a BA, Specialized Honours in Physical Education and Geography in 1973. He was in the first cohort to pass the CAT(C) certification exams in 1975 and, upon graduating from CMCC in 1979, became the first athletic therapist in Canada to also earn a doctor of chiropractic degree. He became a fellow of the Royal College of Chiropractic Sports Sciences in 1981. He is also a founding member of the Acupuncture Council of Ontario. In his chiropractic practice, he successfully combines his expertise in athletic therapy and chiropractic to offer specialized care for a very diverse patient base. He is trusted by many Olympic and professional athletes as well as dancers from the National Ballet for advice and management of their unique health care needs and to treat and rehabilitate their athletic injuries.

New York Chiropractic College (NYCC) has announced its president Frank Nicchi will retire on August 31, 2017, after 36 years of continued service to the school. Nicchi has been president of NYCC for the last 17 years. Under his leadership, the college evolved from being a single-purpose chiropractic college to a premier institution for educating and training natural health-care professionals and academicians, the school said. Nicchi earned his Baccalaureate degree from St. John’s University (NY) in 1973, his Doctor of Chiropractic degree from NYCC in 1978, and a Master of Science degree in management (with honours) at Roberts Wesleyan College in 2005. He has been a member of the faculty of New York Chiropractic College since 1980, instructing clinical diagnosis and chiropractic technique, and serving as a clinician at the college’s outpatient health center in Levittown. The Succession Committee of the Board of Trustees has been actively involved in the process of identifying a new president to succeed Nicchi. As soon as a selection has been made and approved by the Board of Trustees, an announcement will be made.

The Chiropractic Awareness Council is changing its name and has launched the new Alliance for Chiropractic (AFC). The association also recently appointed Dr. Craig Hazel as the new president.The board of directors say the AFC is still committed to supporting the public and their membership in understanding the benefits of principled, neurologically-based chiropractic care. Director Dr. Angelo Santin states, “recent research in the profession is confirming what we all knew for years, which is the body heals most proficiently when there is less nervous system interference. Therefore we feel it is important for the profession to support proficiency in the examination and adjustment of subluxation and to continue to support further research to understand its effect on the human body.” The AFC also launched a brand new website: www.allianceforchiropractic.com, and will be holding its Fall Conference on November 11 and 12, 2016 at the Weston Bristol Hotel in Toronto. Details on the event can be found at www.allianceforchiropractic.com/fallcon.