Research Review – The American Chiropractor

Landmark Upper Cervical Safety and Efficacy Study Published

:dropcap_open:A:dropcap_close:dding to the growing body of evidence supporting the safety, efficacy, efficiency and patient satisfaction regarding upper cervical chiropractic techniques is the recent publication of “Symptomatic reactions, clinical outcomes and patient satisfaction associated with upper cervical chiropractic care: A prospective, multicenter, cohort study.” This latest research project, by the prolific orthospinologists Kirk Eriksen, D.C. and Roderic “Bo” Rochester, D.C., uniquely validates and differentiates upper cervical chiropractic care from other chiropractic techniques and spinal manipulative therapy (SMT) while further documenting its remarkable effectiveness and efficiency.

Though chiropractic procedures have an enviable safety record, some studies have associated the risk of cerebral vascular incidents (stroke) with neck rotation and manipulation. This incidence has been estimated at 1 in 300,000 to 1 in 5.85 million manipulations, with some studies showing no causal relationship. No study has examined the incidence of adverse reactions following upper cervical spinal adjustments and the associated clinical outcomes. The Eriksen study is the first to clearly document the safety of multiple upper cervical techniques with a population of 1,090 patients receiving 2,653 upper cervical adjustments over an average of 17 days. Eighty-three doctors in four countries participated in this exclusively upper cervical study with Orthospinology, Grostic Procedure, NUCCA, Atlas Orthogonal, Advanced Atlas Orthogonal, Blair, Knee Chest, Duff, Toggle and SONAR techniques represented. Each doctor documented the response to care for 10 consecutive new patients for the two week period, with subjects ranging from 18 to 85 years of age with the mean age being 46.1 years. Females outnumbered males 699 (64.1%) to 391 (35.9%) and 95% of patients studied presented with headaches or musculoskeletal pain. No adjunct procedures such as full spine manipulation, mobilization, physical therapy or massage were utilized by the participating doctors, in order to maintain this study as purely upper cervical.

Adverse events (AEs) have been used to describe unfavorable outcomes with various health care interventions. In this study, the authors chose to document symptomatic reactions (SRs) instead, in order to differentiate changes in a patient’s symptoms that in the clinical sense may represent the process of healing or shifts in posture that, while adverse to the patient, are not considered negative in the short term. A SR was defined as a new complaint or worsening of a presenting complaint by greater than 30%, less than 24 hours after initiation of upper cervical care. The Neck Disability Index (NDI), Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were used to assess the patient’s response to care and the impact of their pain on activities of daily living (ADLs). The intensity of the SR was graded on the 11 point NRS with “0” being no pain and “10” being the worst possible pain. An “intense” SR was defined as greater than 8 on the NRS. The initiation of the SR beginning in less than 30 minutes, .5 to 4 hours, 4 to 24 hours or more than 24 hours was recorded as was the duration of the SR as lasting less than 10 minutes, 10 minutes to 1 hour, 1 hour to 24 hours or more than 24 hours.

Chief complaints distributed into 28 categories with 80.9% being spinal pain or dysfunction, and headaches. The majority of complaints were listed as chronic, associated with mild to moderate disability and moderate pain.

Some of the outstanding clinical outcomes of the study include noted improvement in headache pain at 62.8%, in cervical spine pain at 56.8%, in thoracic spine pain at 58.6% and in lumbar spine pain at 57.0% in the two week period.. Thirty-one percent of patients required only one adjustment, 28.6% required two adjustments, 19.4% required three adjustments, and 11.6% required 4 adjustments while the remaining 9.3% had more than 4 adjustments. On average, patients were treated for 17 days, had 4.5 visits and received 2.4 adjustments. At follow-up, 62.2% of neck pain patients, 68.0% of headache patients, 67.9% of thoracic pain patients and 62.1% of low back pain patients returned to sub-clinical status in the approximate 2-week trial. Significant improved outcomes using NDI and OSW for those patients with disabilities relative to activities of daily living suggest clinical efficacy for patient function following upper cervical care.

:dropcap_open:Some of the outstanding clinical outcomes of the study include noted improvement in headache pain:quoteleft_close:

SRs were reported by 338 (31%) patients, with 23% of those reactions rated at 0 or 1 and only 56 (5.1%) rated above or equal to 8 on the NRS. Fifty-four percent occurred within 24 hours and 43.8% met the definition of SR (a new symptom not present at baseline or a worsening of a presenting complaint by greater than or equal to 30% occurring less than or equal to 24 hours). Nearly all (95.9%) were nervous, circulatory or musculoskeletal system related with a mean of roughly 3.5 on the NRS. The most frequent SRs meeting the accepted definition were: tiredness, radiating pain, neck pain, dizziness and headache in descending order of frequency. Most SRs were mild in intensity, with short duration of less than 24 hours with little effect on daily activities. There were no reports of serious SRs or AEs.

Patients reported a very high degree of satisfaction with UC chiropractic care, scoring a mean of 9.1/10 on the NRS. Patients that experienced SRs were most likely to rate satisfaction lower, though the study points out the 9.1 score ranks highest among similar satisfaction rates of 7.1, and 5.4 for chiropractic and medical care respectively in the noted Hertzman-Miller study. The study also compares the number of adjustments required and the follow-up period with other chiropractic studies reporting similar or better outcome levels.

This study documents the major strengths of upper cervical chiropractic on safety, effectiveness, efficiency and satisfaction across a broad spectrum of patients distributed over a wide geographical region and engaging in various UC techniques delivered by a relatively large group of doctors. It is yet another testament to the power of this unique approach to health.

Drs. Eriksen and Rochester, with consulting and statistical help from Eric Hurwitz, D.C., PhD, and the contributions of 83 upper cervical chiropractors, have produced a milestone study for the chiropractic profession. The results of this study underscore the importance of UC chiropractic and the magnitude of the contributions to research available when chiropractors work together. The authors and the Board of Chiropractic Orthospinology sincerely thank all the participating doctors for their immense contribution to the growing body of research validating this unique approach to health care.

The entire study may be viewed at: http://www.biomedcentral.com/1471-2474/12/219

Dr. Craig York is a 1989 Life University graduate certified in Orthospinology. He currently serves on the Advisory board for The Society of Orthospinology and authors their website, orthospinology.org and The Atlas newsletter. He maintains a private practice in Morrilton, AR and can be reached at: [email protected]

Red Blood Cell Omega-3 Fatty Acid Levels and Markers of Accelerated Brain Aging Neurology

Z.S. Tan, MD, MPH; W.S. Harris, PhD; A.S. Beiser, PhD; R. Au, PhD; J.J. Himali, MS; and 7 more.
This study was done at Boston University School of Medicine.

Docosahexaenoic acid = DHA
Eicosapentaenoic acid = EPA

:dropcap_open:T:dropcap_close:hese authors note that the most accurate assessment of omega-3 fatty acids is by looking at the membranes of the red blood cells (RBCs). These authors examined the relation of red blood cell (RBC) fatty acid levels DHA and EPA in 1,575 dementia-free participants to standard performance on cognitive tests and to volumetric brain MRI assessment.

KEY POINTS FROM THIS STUDY:

1. “Higher fish intake has been associated with a reduced risk of cardiovascular mortality and stroke.”

2. In an earlier Framingham cohort study, participants in the top quartile of plasma docosahexaenoic acid (DHA) levels had 47% lower risks of Alzheimer’s disease (AD) and all-cause dementia.

3. This study related RBC fatty acid composition to subclinical markers of future dementia. “We related RBC omega-3 fatty acid levels to recognized MRI and cognitive markers of subclinical AD and vascular pathology and of risk for dementia in a large, community-based sample.”

A. The brain MRI assessment included:

Brain volume

White matter hyperintensity volume

B. The cognitive evaluation included:

Neuropsychological assessment, including recall time, verbal memory, visuospatial memory, abstract reasoning skills, etc.

4. “We found that lower levels of RBC, DHA and EPA in late middle age were associated with markers of accelerated structural and cognitive aging.” [Key Point]

5. “Fatty acids are integral components of biological membranes, and influence membrane fluidity, ion transport, and other functions. The neuronal cell membrane is no exception; the CNS has the highest concentration of phospholipids in the body.”

6. The omega-3 PUFA DHA is “very inefficiently synthesized from shorter-chain dietary precursor alpha-linolenic acid” and therefore is best obtained preformed from the diet. [Important for strict vegetarians]

7. “The biosynthesis of EPA and DHA from their precursor alpha-linolenic acid appears to decrease with age.”

8. Dietary intake of fatty fish is the main source of the omega-3s DHA and EPA.

9. “DHA and EPA exert several favorable effects on the vasculature, including blood pressure reduction, lowering the risk of thrombosis, reducing inflammation, and lowering serum triglyceride levels. Since vascular risk factors, cerebral atherosclerosis, and stroke have been associated with a higher risk of incident dementia, omega-3 PUFAs may delay cognitive and structural brain aging by some combination of these mechanisms.”

10. The omega-3 PUFAs influence membrane function and the activities of membrane-bound proteins. [Very Important]

11. Omega-3 PUFAs may be “directly linked to the neurodegenerative pathogenesis of AD, including reduction of amyloid-B production, synaptic protection by reducing neuroinflammation and oxidative damage, by increasing levels of brain derived neurotrophic factor, and through reduction of potentially excitotoxic arachidonic acid (omega-6) levels.”

COMMENTS FROM DAN MURPHY

This study adds to the evidence that preformed long-chain EPA and DHA omega-3 fatty acids are crucial for brain function. For years I and many colleagues have routinely tested patient RBC levels of EPA and DHA, and our findings are very concerning: our average patients are critically low in these essential fatty acids.

Healthcare costs are threatening to bankrupt our nation. It is projected that my generation, the Baby Boomers (born 1946-1964), will give our nation nearly 14 million cases of Alzheimer’s Disease; the cost of managing Alzheimer’s alone is projected to exceed $1 trillion per year, creating an unconceivable burden on our citizens. It is imperative for ourselves, our families, our patients and our nation for each of us to consume adequate levels of long-chain preformed EPA and DHA omega-3 fatty acids, and it is easy to do: supplement.

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.

Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain Molecular Neurobiology

Artemis P. Simopoulos
This article has 116 references
LA = linoleic acid (plant derived omega-6 fatty acid)
ALA = alpha linolenic acid (plant derived omega-3 fatty acid

From Abstract

:dropcap_open:S:dropcap_close:everal sources of information suggest that human beings evolved on a diet that had a ratio of omega-6 to omega-3 fatty acids (FA) of about 1/1. Today, Western diets have a ratio of 10/1 to 20–25/1, indicating that Western diets are deficient in omega-3 FA compared with the diet on which humans evolved and their genetic patterns were established. Docosahexaenoic acid (DHA) is essential for the normal functional development of the brain and retina, particularly in premature infants. DHA accounts for 40% of the membrane phospholipid FA in the brain. The balance of omega-6 and omega-3 FA is important for homeostasis and normal development throughout the life cycle.

KEY POINTS FROM THIS STUDY:

Nutrition is an environmental factor that influences gene expression.
Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed.
“Our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.”
“Humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”
“The increase in trans-fatty acids is detrimental to health.”
“The beneficial health effects of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were described first in the Greenland Eskimos who consumed a high seafood diet and had low rates of coronary heart disease, asthma, type 1 diabetes mellitus, and multiple sclerosis. Since that observation, the beneficial health effects of omega-3 fatty acids have been extended to include benefits related to cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, and mental health.”
The change of omega-6/omega-3 ratio in the food supply of Western societies has occurred over the last 150 years.
“During evolution, omega-3 fatty acids were found in all foods consumed: meat, wild plants, eggs, fish, nuts, and berries.”
Today in Western societies the omega-6/omega-3 ratio is very high due to the high intake of soybean oil, corn oil, sunflower, safflower, and linseed oil.
The conversion of ALA to EPA and DHA “appears to be limited and variable.”
The omega-6/omega-3 ratio is associated with normal “growth and development, as well as in the outcome of hypertension, cancer, arthritis, mental health, allergies and other autoimmune diseases,” as well as the “pathophysiology of atherosclerosis, inflammation, and aging.”
“DHA is found in high amounts in the membranes of the brain and retina and is critical for proper neurogenesis, neurotransmitter metabolism, neuroprotection and vision. The consumption of high amounts of DHA has been associated with multiple health benefits including brain and retinal development, aging, memory formation, synaptic membrane function, photoreceptor biogenesis and function, and neuroprotection. DHA is essential for pre-natal brain development.”
Omega-3s cause apoptotic death in cancer cells whereas omega-6s allow cancer cells to continue to proliferate.
Psychologic stress in humans causes an overproduction of proinflammatory cytokines, which are minimized with adequate levels of omega-3s.
Diets with a high omega-6/omega-3 ratio may enhance the risk for both depression and inflammatory diseases.
“LA more than any other nutrient is associated with shorter telomeres and shorter telomeres are associated with aging, cancer and coronary heart disease.”
Cognitive performance improves with omega-3s.
“Positive effects of omega-3s on dementia, schizophrenia, and other central nervous system diseases have been reported.”
Omega-3s can affect not only cognitive functions, but also mood and emotional states and may act as a mood stabilizer. Omega-3s have beneficial effects in some neurological diseases in addition to the chronic fatigue syndrome.
Omega-3 deficiency in childhood delays brain development and produces irreversible effects, while the same deficiency in aging accelerates the deterioration of brain function.
Omega-3 intake from ALA does not provide adequate intakes of EPA and DHA.
Daily administration of 3 g of omega-3s for 3 months significantly decreased feelings of anger, anxiety and aggression.
“Western diets are characterized by high omega-6 and low omega-3 fatty acid intake, whereas during the Paleolithic period when human’s genetic profile was established, there was a balance between omega-6 and omega-3 fatty acids. Therefore, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”
“The balance of omega-6/omega-3 fatty acids is an important determinant in maintaining homeostasis, normal development, and mental health throughout the life cycle.”
“A low AA/EPA ratio has been proposed as an index of the beneficial effects of omega-3s which have been shown in animal and clinical experiments.”
Omega-3 deficiency in the brain is associated with “decreased learning ability, with a lower synaptic vesicle density in the hippocampus; whereas, chronic administration of omega-3s improves reference memory-related learning probably due to increased neuroplasticity of the neural membranes.”
Omega-3 fatty acids have positive effects in patients with dementia, schizophrenia, depression and other central nervous systems diseases.
Omega-3 fatty acid supplementation could play a role in [reduced] hostility and violence.
“In humans, the brain is the most outstanding organ in biological development: it follows that the priority is brain growth and development, and in the brain the balance between omega-6 and omega-3 PUFA metabolites is close to 1:1. This ratio should be the target for human nutrition.”
“In Western diets, the omega-6/omega-3 ratio has increased to between 10:1 and 20:1. This high omega-6 proportion is largely made up by LA, is far from optimal and is highly inappropriate for normal growth and development.”
“The ratio of omega-6/omega-3 fatty acids in the brain between 1:1 and 2:1 is in agreement with the data from the evolutionary aspects of diet and genetics.”
“A ratio of 1:1 to 2:1 omega-6/omega-3 fatty acids should be the target ratio for health.”

Low Back Pain: Chiropractic Adjustments vs. Skeletal Muscle Relaxants

Chiropractic had a better outcome in 24% of the patients, therefore saving public and private insurers and the American people $10,843,261,761 in skeletal muscle relaxant costs.

Low back pain is one of the most common maladies among the general population and the incidence of occurrence was reported by Ghaffari, Alipour, Farshad, Yensen, and Vingard (2006) to be between 15% and 45% yearly, with Becker et al. reporting the incidence to be between 15% to 30% yearly. Hoiriis et al. (2004) reported it to be between 75% and 85% over an adult lifetime in the United States. Chou (2010) writes that, “Back pain is also the fifth most common reason for office visits in the US, and the second most common symptomatic reason…” (p. 388). Historically and based upon this authors 3+ decades of treating low back pain with treatment options that range from heating pads, ice packs, over-the-counter drugs, prescription drugs, surgery, acupuncture and beyond, the most important questions are, “What works? What’s proven and what has the best results with the least side effects allowing the patient to regain a normal lifestyle as quickly as possible?”

As mentioned, low back pain is one of the most common conditions encountered in clinical practice and medications are the most commonly used type of treatment, and muscle relaxers are a common drug that has been prescribed by medical doctors for years for nonspecific low back pain, according to Chou (2010). Chou went on to report, “The term ‘skeletal muscle relaxants’ refers to a diverse collection of pharmacologically unrelated medications, grouped together because they are approved by regulatory agencies for treatment of spasticity or for musculoskeletal conditions such as tension, headache or back pain.” They are drugs that have been long studied and the effects and side effects have been well documented. Van Tudlar, Touray, Furlan, Solway, and Bouter (2003) concluded that, “Muscle relaxants are effective in the management of nonspecific low back pain, but the adverse effects require that they be used with caution”(p. 1978).

Chou (2010) also stated that, “Skeletal muscle relaxants are an option for acute nonspecific low back pain, although not recommended as first-line therapy because of a high prevalence of adverse effects” (p. 397). He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10. Simply put, if a patient had a pain scale of 9, one could expect the muscle relaxers prescribed to bring the pain to an 8 or 7 at best and include all of the side effects. According to Drugs.com, side effects of muscle relaxants include:

More common

Blurred or double vision or any change in vision; dizziness or lightheadedness; drowsiness

Less common

Fainting; fast heartbeat; fever; hive-like swellings (large) on face, eyelids, mouth, lips, and/or tongue; mental depression; shortness of breath, troubled breathing, tightness in chest, and/or wheezing; skin rash, hives, itching, or redness; slow heartbeat (methocarbamol injection only); stinging or burning of eyes; stuffy nose and red or bloodshot eyes

Less common or rare

Abdominal or stomach cramps or pain; clumsiness or unsteadiness; confusion; constipation; diarrhea; excitement, nervousness, restlessness, or irritability; flushing or redness of face; headache; heartburn; hiccups; muscle weakness; nausea or vomiting; pain or peeling of skin at place of injection (methocarbamol only); trembling; trouble in sleeping; uncontrolled movements of eyes (methocarbamol injection only)

Rare

Blood in urine; bloody or black, tarry stools; convulsions (seizures) (methocarbamol injection only); cough or hoarseness; fast or irregular breathing; lower back or side pain; muscle cramps or pain (not present before treatment or more painful than before treatment); painful or difficult urination; pain, tenderness, heat, redness, or swelling over a blood vessel (vein) in arm or leg (methocarbamol injection only); pinpoint red spots on skin; puffiness or swelling of the eyelids or around the eyes; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; swollen and/or painful glands; unusual bruising or bleeding; unusual tiredness or weakness; vomiting of blood or material that looks like coffee grounds; yellow eyes or skin (http://www.drugs.com/cons/skeletal-muscle-relaxants.html)

Becker et al. (2010) reported the incidence of low back pain in the United States at 22.5% of the population. According to the United States Census Bureau on September 11, 2011, the population of the United States is exactly 312,227,241. If you factor in the 22.5% of patients that experience low back pain, that equates to 70,251,129 people yearly having low back pain.

According to the Oklahoma Healthcare Advisory (2009), skeletal muscle relaxants for low back pain are indicated for 90 days at a cost averaging $441 (more or less depending upon the brand utilized). If 35% of primary care physicians, as previously noted, utilize muscle relaxants as the primary drug of choice, that equates to $10,843,261,761 in skeletal muscle relaxant costs.

A study by Legorreta et al. (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed when chiropractic care was pursued, the average cost of treatment per back pain episode was reduced by 28% for patients with chiropractic coverage versus those without chiropractic coverage. Again, for patients with chiropractic coverage versus those without, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%!

When comparing chiropractic spinal adjustments to muscle relaxants for low back pain, it first must be clarified that we are not discussing physical therapy or osteopathic manipulation. While different specialists render tremendous benefits to patients specific to various diagnoses, this research review is limited to the chiropractic spinal adjustment.

:dropcap_open:He reported that muscle relaxants had a moderate success rate defined by a 1-2 decrease in pain scales rated out of 10.:quoteleft_close:

Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. “The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions” (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.

Within that group of 457% falls patients cared for by muscle relaxants. Hoiriis et al. (2004) reported in their raw data that the chiropractic groups responded 24% better in reducing pain and concluded that, “Statistically, the chiropractic group responded significantly better than the control group with respect to decrease in pain scores” (p. 396). This was done in “blinded randomized clinical trials, which are considered the gold standard of experimental design” (Hoiriis et al., 2004, p. 396).

While chiropractic was reported by Legorreta (2004) to reduce the cost of treatment by 28%, the total cost of muscle relaxants are unnecessary due to outperforming treatment outcomes in comparative analyses. Therefore, chiropractic could be saving public and private insurers and the American people $10,843,261,761 in skeletal muscle relaxant costs, not including the costs of managing side effects of the drugs, hospitalization, ancillary requirements and absenteeism costs that occur due to poorer outcomes.

REFERENCES

Ghaffari, M., Alipour, A., Farshad, A. A., Yensen, I., & Vingard, E. (2006). Incidence and recurrence of disabling low back pain and neck-shoulder pain. Spine, 31(21), 2500-2506.
Becker, A., Held, H., Redaelli, M., Strauch, K., Chenot, J. F., Leonhardt, C.,…Donner-Banzhoff, N. (2010). Low back pain in primary care: Costs of care and prediction of future health care utilization. Spine, 35(18), 1714-1720.
Hoiriis, K. T., Pfleger, B., McDuffie, F. C., Cotsonis, G., Elsangak, O., Hinson, R., & Verzosa, G. T. (2004). A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics, 27(6), 388-398.
Chou, R. (2010). Pharmacological management of low back pain. Drugs, 70(4), 387-402.
Drugs.com, (2004). Skeletal muscle relaxants (systemic). Retrieved from http://www.drugs.com/cons/skeletal-muscle-relaxants.html
Van Tudlar, M. W., Touray, T., Furlan, A. D., Solway, S., & Bouter, L. M. (2003). Muscle relaxants for nonspecific low back pain: A systematic review within the framework of the cochrane collaboration. Spine, 28(17), 1978-1992.
Census.gov. (2011, September 11) U.S. & World Population Clocks. U.S. Census Bureau, Retrieved from: http://www.census.gov/main/www/popclock.html
Consumer Reports Best Buy Drugs, The Muscle Relaxants (2009) Retrieved from: http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/BBD_Muscle_Relaxants_2Pager.pdf
Legorreta, A.P., Metz, R. D., Nelson, C. F., Ray, S. Chernicoff, H. O., & Dinubile, N. A. (2004). Comparative analysis of individuals with and without chiropractic coverage: Patient characteristics, utilization, costs. Archives of Internal Medicine, 164(18), 1985-1992.
Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.

Evolutionary Aspects of Diet: The Omega-6/Omega-3 Ratio and the Brain

Molecular Neurobiology

January 29, 2011 [epub]

Artemis P. Simopoulos

This article has 116 references

LA = linoleic acid (plant derived omega-6 fatty acid)

ALA = alpha linolenic acid (plant derived omega-3 fatty acid)

Abstract

Several sources of information suggest that human beings evolved on a diet that had a ratio of omega-6 to omega-3 fatty acids (FA) of about 1/1. Today, Western diets have a ratio of 10/1 to 20–25/1, indicating that Western diets are deficient in omega-3 FA compared with the diet on which humans evolved and their genetic patterns were established. Omega-6 and omega-3 FA are not interconvertible in the human body and are important components of practically all cell membranes.

Studies with nonhuman primates and human newborns indicate that docosahexaenoic acid (DHA) is essential for the normal functional development of the brain and retina, particularly in premature infants. DHA accounts for 40% of the membrane phospholipid FA in the brain. Both eicosapentaenoic acid (EPA) and DHA have an effect on membrane receptor function and even neurotransmitter generation and metabolism.

There is growing evidence that EPA and DHA could play a role in hostility and violence in addition to the creating beneficial effects on substance abuse disorders and alcoholism. The balance of omega-6 and omega-3 FA is important for homeostasis and normal development throughout the life cycle.

KEY POINTS FROM THIS STUDY:

1) Nutrition is an environmental factor that influences gene expression.

2) Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed.

3) “Our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.”

4) “Humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”

5) The major changes that have taken place in our diets in the past 10,000 years include:

A) An increase in energy intake and decrease in energy expenditure

B) An increase in saturated fat

C) An increase in omega-6 fatty acids

D) An increase in trans-fatty acids

E) An increase in cereal grains

F) An increase in fruit and vegetable intake

G) A decrease in omega-3 fatty acid intake

H) A decrease in complex carbohydrate intake

I) A decrease in fiber intake

J) A decrease in protein

K) A decrease in antioxidants

L) A decrease in vitamin D

M) A decrease in calcium intake

6) “The increase in trans-fatty acids is detrimental to health.”

7) “The beneficial health effects of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were described first in the Greenland Eskimos who consumed a high seafood diet and had low rates of coronary heart disease, asthma, type 1 diabetes mellitus, and multiple sclerosis. Since that observation, the beneficial health effects of omega-3 fatty acids have been extended to include benefits related to cancer, inflammatory bowel disease, rheumatoid arthritis, psoriasis, and mental health.”

8) The change of omega-6/omega-3 ratio in the food supply of Western societies has occurred over the last 150 years.

9) “During evolution, omega-3 fatty acids were found in all foods consumed: meat, wild plants, eggs, fish, nuts, and berries.”

10) Today in Western societies the omega-6/omega-3 ratio is very high due to the high intake of soybean, corn, sunflower, safflower, and linseed oils.

11) “LA is found in high amounts in grains with the exception of flaxseed, chia, perilla, rapeseed, and walnuts that are rich in ALA.”

12) The green leaves of plants are higher in ALA than LA.

13) The conversion of LA to EPA and DHA “appears to be limited and variable.”

14) The omega-6/omega-3 ratio is associated with normal “growth and development, as well as in the outcome of hypertension, cancer, arthritis, mental health, allergies and other autoimmune diseases,” as well as the “pathophysiology of atherosclerosis, inflammation, and aging.”

15) “DHA is found in high amounts in the membranes of the brain and retina and is critical for proper neurogenesis, neurotransmitter metabolism, neuroprotection and vision. The consumption of high amounts of DHA has been associated with multiple health benefits, including brain and retinal development, aging, memory formation, synaptic membrane function, photoreceptor biogenesis and function, and neuroprotection. DHA is essential for pre-natal brain development.”

16) Powerful anti-inflammatory molecules are derived from omega-3 fatty acids: Lipoxins, Resolvins, Protectins and Neuroprotectins. These molecules “function in the resolution of inflammation by activating specific mechanisms to promote homeostasis.”

:quoteright_open:The omega-6/omega-3 fatty acid ratio is innately critical for brain function, heart health, immunity, joint health, pain syndromes and more.:quoteright_close:

17) Omega-3s cause apoptotic death in cancer cells whereas omega-6s allowed the cancer cells to continue to proliferate.

18)Psychological stress in humans causes an overproduction of pro-inflammatory Cytokines, which are minimized with adequate levels of omega-3s.

19)Diets with a high omega-6/omega-3 ratio may enhance the risk for both depression and inflammatory diseases.

20) “LA more than any other nutrient is associated with shorter telomeres and shorter telomeres are associated with aging, cancer and coronary heart disease.”

21)“Clinical studies show that cognitive performance improves with omega-3s.”

22) “Positive effects of omega-3s on dementia, schizophrenia, and other central nervous system diseases have been reported.”

23) Omega-3s can affect not only cognitive functions, but also mood and emotional states and may act as a mood stabilizer. Omega-3s have beneficial effects in some neurological diseases in addition to chronic fatigue syndrome.

24) Omega-3 deficiency in childhood delays brain development and produces irreversible effects, while the same deficiency in aging accelerates the deterioration of brain function.

25) Omega-3 intake from ALA does not provide adequate intakes of EPA and DHA.

26) Substance abusers have low omega-3 fatty acid intakes due to poor dietary habits. Omega-3s are helpful in the treatment of cocaine dependence and alcoholism because they can stabilize neuron membranes.

27) Daily administration of 3 g of omega-3s for 3 months significantly decreased feelings of anger, anxiety and aggression.

28) “Western diets are characterized by high omega-6 and low omega-3 fatty acid intake, whereas during the Paleolithic period when human’s genetic profile was established, there was a balance between omega-6 and omega-3 fatty acids. Therefore, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected.”

29) “The balance of omega-6/omega-3 fatty acids is an important determinant in maintaining homeostasis, normal development, and mental health throughout the life cycle.”

30) “It is known that the relative amounts of omega-6 and omega-3 in the cell membrane are responsible for affecting cellular function as the AA competes directly with EPA for incorporation into cell membranes.”

31) “A low AA/EPA ratio has been proposed as an index of the beneficial effects of omega-3s which have been shown in animal and clinical experiments.”

32) The balance of omega-3 and omega-6 fatty acids to the “developing brain may be necessary for normal growth and functional development.”

33) Omega-3 deficiency in the brain is associated with “decreased learning ability, with a lower synaptic vesicle density in the hippocampus; whereas, chronic administration of omega-3s improves reference memory-related learning probably due to increased neuroplasticity of the neural membranes.”

34) “Cognitive performance improves with omega-3’s supplementation, possibly due to increased hippocampal acetylcholine levels, the anti-inflammatory effects of omega-3s, decreased risk of cardiovascular disease or increased neuroplasticity.”

35) Omega-3 fatty acids have positive effects in patients with dementia, schizophrenia, depression and other central nervous systems diseases.

36) Omega-3 fatty acid supplementation could play a role in [reduced] hostility and violence.

37) “In carrying out clinical intervention trials, it is essential to increase the omega-3 and decrease the omega-6 fatty acid intake in order to have a balanced omega-6 to omega-3 intake.”

38) “In humans, the brain is the most outstanding organ in biological development: it follows that the priority is brain growth and development, and in the brain the balance between omega-6 and omega-3 PUFA metabolites is close to 1:1. This ratio should be the target for human nutrition.”

39) “In Western diets, the omega-6/omega-3 ratio has increased to between 10:1 and 20:1. This high omega-6 proportion is largely made up by LA, is far from optimal and is highly inappropriate for normal growth and development.”

40) “The ratio of omega-6/omega-3 fatty acids in the brain between 1:1 and 2:1 is in agreement with the data from the evolutionary aspects of diet and genetics.”

41) “A ratio of 1:1 to 2:1 omega-6/omega-3 fatty acids should be the target ratio for health.”

COMMENTS FROM DAN MURPHY

The omega-6/omega-3 fatty acid ratio is innately critical for brain function, heart health, immunity, joint health, pain syndromes and more. I believe that everyone should have the AA/EPA ratio tested to see if they are in the “target ratio” of 1-2/1, AA/EPA.

The lab we use to test the AA/EPA ratio is Metametrix, at (800) 221-4640.

The test is called Bloodspot Fatty Acids 0241.

The test is a finger prick draw, not venipuncture.

The omega-3 oils I take are from Nutri-West; I believe their ratios of ALA, EPA, DHA, and GLA are optimal: (800) 443-3333.

Nutri-West has a children’s formula, and both capsules and a liquid for adults:

CompleteChildren’s EPA/DHA (8 per day)

CompleteOmega-3 Essentials (6 per day), or

CompleteHi-Potency Omega-3 Liquid (1 teaspoon per day) for adults

To achieve the “target ratio” most adults need to consume 3,000 mg/d of EPA+DHA.

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series

Journal of the American Board of Family Medicine

January–February 2009; Vol. 22; No. 1; pp. 69 –74

Gerry Schwalfenberg, MD; from the Department of Family Medicine, University of Alberta, Canada.

KEY POINTS FROM THIS CASE SERIES:

1) This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice.

2) Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency.

3) Vitamin D insufficiency is common; repletion of vitamin D to normal levels in patients who have chronic low back pain or have had failed back surgery may improve quality of life or, in some cases, result in complete resolution of symptoms.

4) “Back pain is the most common neurological complaint in North America, second only to headache.”

5) “Low back pain (LBP) and proximal myopathy are also common symptoms of vitamin D deficiency and osteomalacia.”

6) In this report, there were 4 patients who had chronic back pain for more than a year and 2 patients who suffered for more than 3 years from failed back surgery.

7) “Repletion of inadequate vitamin D levels (>80 nmol/L) demonstrated significant improvement or complete resolution of chronic LBP symptoms in these patients.”

8) “Vitamin D is required for the differentiation, proliferation, and maturation of cartilage cells and for the production of proteoglycan synthesis in articular chondrocytes.”

9) “Patients who have chronic, nonspecific LBP or have had failed back surgery may have an underlying vitamin D insufficiency/deficiency.”

10) Risk factors for persistence or recurrence of LBP after surgery include infection, smoking and low vitamin D levels.

11) “All patients had tried various pain treatments, including physiotherapy, visiting a chiropractor, acupuncture, or visit to a pain management clinic, all without much benefit.”

12) Physicians should have a high index of suspicion for low vitamin D levels in patients with LBP.

13) “The patients in this study who responded best used between 4000 and 5000 IU of vitamin D3/day.”

14) “This case series supports information that has recently become apparent in the literature about vitamin D deficiency and its influence on back pain, muscle pain, and failed back surgery. Doses in the range of 4000 to 5000 IU of vitamin D3/day may be needed for an adequate response.”

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series

January–February 2009; Vol. 22; No. 1; pp. 69 –74

Gerry Schwalfenberg, MD; from the Department of Family Medicine, University of Alberta, Canada.

KEY POINTS FROM THIS CASE SERIES:

1) This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice.

2) Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency.

4) In this report, there were 4 patients who had chronic back pain for more than a year and 2 patients who suffered for more than 3 years from failed back surgery.

5) “Repletion of inadequate vitamin D levels (>80 nmol/L) demonstrated significant improvement or complete resolution of chronic LBP symptoms in these patients.”

6) “Vitamin D is required for the differentiation, proliferation, and maturation of cartilage cells and for the production of proteoglycan synthesis in articular chondrocytes.”

7) “Patients who have chronic, nonspecific LBP or have had failed back surgery may have an underlying vitamin D insufficiency/deficiency.”

8) Risk factors for persistence or recurrence of LBP after surgery include infection, smoking and low vitamin D levels.

9) “All patients had tried various pain treatments, including physiotherapy, visiting a chiropractor, acupuncture, or visit to a pain management clinic, all without much benefit.”

10) Physicians should have a high index of suspicion for low vitamin D levels in patients with LBP.

11) “The patients in this study who responded best used between 4000 and 5000 IU of vitamin D3/day.”

12) “This case series supports information that has recently become apparent in the literature about vitamin D deficiency and its influence on back pain, muscle pain, and failed back surgery. Doses in the range of 4000 to 5000 IU of vitamin D3/day may be needed for an adequate response.”

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.

Autism and Vitamin D

On the Aetiology of Autism

Acta Paediatrica

August 2010, Vol. 99, No. 8, pp. 1128–1130

John J. Cannell

BACKGROUND FROM DAN MURPHY, D.C.

The world standard for blood levels of vitamin D uses nmol/l, while US standard uses mg/dl.

For vitamin D, to convert mg/dl to nmol/l, divide the mg/dl by 2.5.

For vitamin D, to convert nmol/l to mg/dl, just multiply by 2.5.

In 2008, this author, John Cannell, published an article in the Journal Medical Hypothesis, titled: “Autism and Vitamin D,” Medical Hypotheses, Volume 70, Issue 4, 2008, Pages 750-759.

In this newer article, Cannell updates his hypothesis of the link between low levels of vitamin D3 and the incidence of autism, reviewing the studies that have appeared in the literature since his 2008 publication.

KEY POINTS FROM THIS ARTICLE:

1) “The primary environmental trigger for autism is not vaccinations, toxins or infections, but gestational and early childhood vitamin D deficiency.”

2) An article in Scientific American (2009) and two articles in Acta Paediatrica (2010) support the evidence that “vitamin D deficiency—either during pregnancy or early childhood—may be an environmental trigger for the genetic disease of autism.”

3) Currently, there is an epidemic of gestational vitamin D deficiency. Prenatal supplementation with 400 IU of vitamin D3/day “is virtually irrelevant in preventing” this gestational deficiency. “The Canadian Paediatric Society cautioned pregnant women that they may require not 400 IU⁄day but 2000 IU⁄day, or more, to prevent gestational vitamin D deficiency.”

4) The increased incidence of autism in the children of richer college-educated, wealthy parents might be explained by noting that such parents are more likely to “practice sun avoidance and use of sun block.”

5) The melanin found in darker skin is an effective sun block. Consequently, dark skinned people have a higher incidence of autism.

6) Environmental toxins are more likely to damage the genome of those who are deficient in vitamin D. Vitamin D “protects the genome from damage by toxins.”

7) A 2008 study (Journal of Autism and Developmental Disorders) found that boys with autism have reductions in metacarpal thickness; this is consistent with a deficiency of vitamin D during a stage of development.

8) A 2008 study (Archives of Pediatric and Adolescent Medicine) indicated that autism rates are higher in regions with more rainy/cloudy days. “Clouds and rain retard vitamin D-producing ultraviolet B light from penetrating the atmosphere.”

9) Autism is more prevalent in cities than in rural settings. “City life affords less vitamin D because of tall buildings, indoor occupations and increased air pollution, all of which block ultraviolet B light from penetrating the atmosphere.”

10) Studies published in the journal Neurology (2008 and 2009) indicate increased autism in the children of mothers who took antiepileptic drugs. “Antiepileptic drugs are one of the few classes of drugs that consistently and significantly interfere with vitamin D metabolism, lowering vitamin D3 levels.”

11) Autism rates are higher in children born in the winter, when vitamin D from sun exposure is low.

12) Autism has a genetic contribution. The current epidemic maternal and early childhood deficiency of vitamin D may “allow the genetic tendency for autism to express itself.”

13) Theoretically, prevention and perhaps treatment of autism with physiological doses of vitamin D3 “is so simple, so safe, so inexpensive, so readily available and so easy, that it defies imagination.”

14) “Children with chronic illnesses such as autism, diabetes and/or frequent infections should be supplemented with higher doses of sunshine or vitamin D3, doses adequate to maintain their 25(OH) D levels in the mid-normal of the reference range [65 ng/mL {USA} or 162 nmol/L {global}]—and should be so supplemented year round.”

15) “To some real but unknown extent, autism is an iatrogenic disease, caused by governments, organizations, committees, newspapers and physicians who promulgated the current warnings about sun exposure for pregnant women and young children without any understanding of the tragedy they engendered.”

Anatomicophysiological Aspects of Injuries to the Intervertebral Disc

Journal of Bone and Joint Surgery (American)

April 1947, Vol. 29, No. 2, pp. 461-534

Verne T. Inman and John B. de C. M. Saunders

1) “Herniation of the nucleus pulposus or protrusion of the disc is now firmly established as a pathological mechanism associated with low-back pain and sciatica.”

2) “The majority will agree that the treatment of many of these cases by laminectomy and nerve-root decompression has been disappointing.”

3) “Destroy the disc and you destroy spinal mechanics. Therefore, in disc derangement, we are dealing with a dual problem:”

A) Deranged spinal mechanics

B) The effects of spinal nerve-root irritation and compression

[Spinal nerve root irritation and compression are often very different physiologically. Compression reduces nerve function and, hence, is associated with things such as muscle atrophy and reduced sensation. Irritation increases (denervation supersensitivity {Gunn}) nerve function and, hence, is associated with things such as increased pain, increased muscle tone and spasm.]

4) Both “deranged spinal mechanics,” nerve root irritation, and nerve root compression, cause pain.

5) Patients with deranged spinal mechanics” should not be surgically managed. [“Deranged spinal mechanics” appears to be synonymous with chiropractic subluxation.]

6) The normal nucleus pulposus is a semifluid substance, being 80% water and, thus, is “incompressible.”

7) The normal semifluid nucleus transmits forces to the elastic spinal ligamentous structures. “The critical feature in the disturbance of spinal mechanics and in the production of pain is the effect on the ligamentous structures, caused by the loss of water or nuclear substance following injury or degeneration.” [Key Point]

8) “An individual getting up in the morning is taller than when he [she] goes to bed at night:” men by ¾ inch, women by ½ inch. This is because the nucleus loses fluid in an upright gravity environment. This exchange of fluid helps the nucleus and annulus of the disc to remain healthy.

9) With age, the cartilaginous end-plate becomes less permeable to fluid, the free exchange of water is suppressed, resulting in “progressive desiccation of the nucleus.”

10) Small rents in the annulus allow the nucleus to escape, reducing fluid pressure and altering spinal mechanics, and pain.

[Sounds like Gonstead’s internal disc derangement.]

11) The resiliency of the spine and the motions permitted to it are primarily due to the elastic nature of the annulus fibrosis.

12) “The loss of the fluid pressure in the nucleus pulposus leads to grave derangements in the physiology of the disc.”

13) “The decrease in the vertical height of the intervertebral disc spaces leads to subluxation of the interarticular zygapophysial joints, in which degenerative changes develop as the result of the abnormal forces acting upon them.” [Subluxation]

14) “The ligamentous structures of the body are the most sensitive to pain.”

15) Ligaments can initiate pain from chemical irritants or from “mechanical displacement of the collagenous fibers.” This pain is deep, dull aching and poorly localized. [Chiropractic Subluxation]

16) Ligament pain ebbs and wanes, and can be accompanied by “vasovagal responses, such as nausea, sweating, and fall in blood pressure.”

17) Deep ligament pain arises embryologically from the mesoderm. This type of pain is termed “sclerotogenous” pain, meaning it does not follow a dermatomal distribution.

18) Deep sclerotogenous pain can occur in the absence of direct irritation of the peripheral nerve or nerve root.

19) “The annulus fibrosus has been shown to possess a rich nerve supply,” allowing it to initiate “sclerotogenous” pain.

20) Distortion of the annulus and other spinal ligaments can cause not only local pain, but also sclerotomal pain that radiates down the posterior thigh. This is not sciatica, because there is no irritation to the nerve roots.

21) When the lumbar nerve roots exit the intervertebral foramen, they carry with it the spinal dura, doubling their diameter as compared to the cauda equina roots in the subarachnoid space.

22) Since each nerve root is firmly attached to the spinal dura, “traction upon the nerve will produce deformation of the dural sac without transmission of the tension to the fibers of the cauda equina.”

23) Deeper spinal structures primarily initiate slow pain, which is characterized as being dull and aching, and poorly localized.

24) Nerve compression primarily affects large nerve fibers, which are associated with proprioceptive and motor function.

25) Pain fibers are smaller, and are more likely to fire in response to chemical (inflammatory) stimulus than to mechanical pressure.

26) Disc herniation without nerve compression is characterized first by pain and then a deep ache radiating into the leg in a sclerotomal pattern.

27) Disc herniation with nerve compression is characterized by loss of vibratory sense, muscle weakness, reduced tendon reflexes, and hyperesthesia/pain in a dermatomal pattern. The pain is sharper from chemical inflammation in the region.

28) This all indicates that patients can be placed into three categories:

A)) Mechanical spinal derangement: [chiropractic subluxation]

These patients have deep spinal irritations but no nerve compression.

These patients have “backache and local signs and symptoms of injury to the vertebral ligamentous structures, have radiating pain, deeper in character, extending down one or both extremities. The extent of the radiation is indicative in some measure of the degree of irritation or injury to the ligamentous structures.”

B)) Nerve root compression from disc herniation:

The “pressure will interrupt nerve conductivity in a precise sequential fashion:”

The larger nerve fibers conveying proprioception and motor impulses are affected first.

The nerve fibers conveying pressure, touch and fast pain are affected second.

The nerve fibers conveying temperature sense and deep pain are lost last.

These patients usually also have spinal ligamentous irritation that causes local backache and the “radiation of deep pain to the extremities.” Surgery to decompress the nerve root will often leave the patient with the ligamentous back pain and deep extremity referred pain radiation, and the patient will often be disappointed.

C)) Nerve root compression from spinal cord tumor:

The major lesion is nerve compression, but local ligamentous irritation is minimum or lacking. There are outstanding signs of nerve compression, including muscle weakness with atrophy, “definite and unequivocal loss of sensation over the appropriate dermatome, and reflex changes.” Backache is mild or lacking. Radiation of pain to the lower extremity is not extensive. This is typically caused by a spinal cord tumor, and only rarely from a disc herniation. Surgical removal and decompression of the nerve usually results in complete and dramatic recovery.

DISCUSSION BY WILLIAM JASON MIXTER:

29) “Motor weakness should be considered a definite emergency and the patient should be operated upon at once. If the motor weakness is left untreated for a considerable time [6-12 months], the strength never returns.”

DISCUSSION BY BARNES WOODHALL:

30) 40% of disc herniation patients with nerve compression have only motor signs, they “possessed no defecit in the common sensory modalities of pain, light touch, heat and cold, or sense of position.”

Dr. Dan Murphy graduated magna cum laude from Western States Chiropractic College in 1978. He received Diplomat status in Chiropractic Orthopedics in 1986. Since 1982, Dr. Murphy has served part-time as undergraduate faculty at Life Chiropractic College West, currently teaching classes to seniors in the management of spinal disorders. He has taught more than 2000 postgraduate continuing education seminars. Dr. Murphy is a contributing author to both editions of the book Motor Vehicle Collision Injuries and to the book Pediatric Chiropractic. Hundreds of detailed Article Reviews, pertinent to chiropractors and their patients, are available at Dr. Murphy’s web page, www.danmurphydc.com.

Low Back Pain-Arthritis Link with Resultant Hospital vs. Chiropractic Costs: A Retrospective Analysis and Prospective Solution for Saving the Economy of the United States

The American Chiropractic Association (2010) reported that 31 million Americans experience low back pain. This is an epidemic at a staggering rate because what most of the public and doctors alike do not understand is what that sets the patient up for later in life that can be prevented. Stupar, Pierre, French and Hawker (2010) found that 49% of the general population reported a 6 month prevalence of low back pain, with 11% reporting the back pain to be so significant that it seriously limited their activities.

Low back pain and arthritis have now been linked. According to Dawson and Shaffrey (2009), the most common form of arthritis is called osteoarthritis, also known as degenerative joint disease and affects more than 20 million American adults. Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint.

As Stupar et al. (2010) reported, osteoarthritis or OA has been long associated with back pain and reported comorbidity (they exist together.) 40% of hip or knee osteoarthritis patients have had low back pain. The 2010 study concluded hip osteoarthritis and low back pain is a conclusive predictor for future leg pain and disability and suggested that alleviating low back pain may positively impact future hip pain and function. This will result in preventing disability and alleviating the financial burden to the government, industry and insurers.

Clinically, the author has seen in patients with low back instabilities and persistent pain and degeneration of the spine and hips over a lifetime. This has been termed “subluxation degeneration” The Association of Chiropractic Colleges has defined subluxation as “…a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health” (The Association of Chiropractic Colleges, 2010, http://www.chirocolleges.org/paradigm_scope_practice.html). Simply put, subluxation is a diagnostic entity that denotes the vertebrate is out of position, is fixed or stuck in the wrong position to some degree and has a negative neurological effect. Once the vertebrate is out of position, the body automatically tries to stabilize the spine and mobilizes calcium to use as cement, or glue to prevent further malpositions. This is one of the causes of the degeneration or osteoarthritis as a sequella to malpositions of the vertebrate.

A 2009 study by Aspegren, Enebo, Miller, White, Akuthota, Hyde, & Cox concluded that 81.5% of workers with an acute injury causing low back or neck pain reported immediate post-treatment (manipulative-chiropractic adjustment) relief. That doesn’t take into account those patients who got better over time.

In 2009, Painter reported that Consumer Reports conducted an independent survey of 14,000 subscribers who rated hands-on therapy as the #1 treatment of choice for low back pain. The report went on to say that 88% of those who tried a chiropractic adjustment reported positive outcomes.

Research has concluded that there is a definitive clinical correlation between low back pain and osteoarthritis as a prognostic indicator of significant future problems if the low back pain is not resolved. Research has also concluded that chiropractic care is a safe, highly effective treatment choice for low back pain patients and as a result, low back pain cannot be ignored, especially in light of the fact that it can be treated in a cost-effective manner.

In 2009, Russo, Weir and Elixhauser reported that hospital stays for low back pain were 3.9 out of every 1000 people aged 55-64 years and Osteoarthritis was the #2 reason for hospital stays and fell only behind coronary atherosclerosis. This indicates both of these conditions have reached epidemic proportions in society.

According to Virginia Healthcare and Hospital Association (2010), the average non-surgical hospital stay in Virginia in 2009 was $15,059, while the average hospital stay in Virginia with surgery was $77,107, not including the doctors’ fees and post surgical care. A 2007 study by North, Kidd, Shipley and Taylor revealed that the cost to use spinal cord stimulation to treat failed back surgery syndrome was $117,901 and unsuccessful attempts at reoperation cost $260,584. These are staggering numbers considering that we now have the data and the ability to prevent many of these surgeries; not underwriting the costs of procedures that could have been avoided.

“MEDSTAT is an independent study of the cost of treating many common neuro-musculoskeletal conditions conducted recently under the direction of Miron Stano, Ph.D., a health care economist and Professor at the School of Business, Oakland University, Rochester, MI.” MEDSTAT, as reported by Chiropractic Lifecare of America (2009), concluded that the average chiropractic case is $3,799, far less than our medical counterparts and significantly less than any hospital stay (factoring in the cost of drugs, supports, specialist and rehabilitation referrals and surgeries for both.) It was also found that the percentages of hospital admissions are 29% for medicine and 19% for chiropractic patients.

With governmental agencies in fiscal crisis, including the Federal Government, the Obama administration has taken an unprecedented step to reign in healthcare costs and spending. According to Senate Budget Committee member Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, as reported in the Washington Post, “…bills crafted by House leaders and the Senate health committee does not propose ‘the sort of fundamental changes’ necessary to rein in the skyrocketing cost of government health programs, particularly Medicare” (Montgomery & Murray, 2009, http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/ AR2009071602242.html).

Whether you are a pro-President Obama Democrat, an anti-President Obama Republican or you fall somewhere in the middle, there is one thing that America can agree on; the health care system is broken and needs to be fixed. Too many sick people are not getting the care needed and doctors that sacrifice their lives for these patients are not getting a fair and equitable reimbursement.

The problem for the public is clear, but for doctors who are getting reimbursed at $20-$30 or less per visit because the carriers have exploited many loopholes in coverage will not be in the profession much longer for financial reasons, nor will they recommend that the future’s brightest minds in the nation go into healthcare. Who will care for our children or our children’s children when they are sick? Who will be available to the public to offer these cost saving, life changing options to the public?

We have established that chiropractic treats and prevents back pain and, therefore, will also mitigate many arthritic conditions as evidenced in the above research. If chiropractic helps only 20-30% of the arthritics and back pain patients (which, based on 30 years of clinical experience is woefully low), then we can rescue the economy on the United States with chiropractic alone by keeping billions of local, federal and insurance money in the system by either preventing needless care and surgeries or trading more expensive care for significantly lower costs with better scientifically and statistically proven outcomes; that is the chiropractic solution.

Dr. Mark Studin is the President of the Academy of Chiropractic (www.TeachChiros.com ) and consults doctors nationally on personal injury practices. He is also a researcher and the clinical director of the US Chiropractic Directory (www.USChiroDirectory.com ,) the largest chiropractic entity in the world that offers research and doctors credentials to the public.

References:

Retrieved from https://www.acatoday.org/level2_css.cfm?T1ID=13&T2ID=68

Retrieved from http://www.spineuniverse.com/conditions/spondylosis/ osteoarthritis-degenerative-spinal-joint-disease

4. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional Scores and subjective responses of injured worker with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics, 32(9), 765-771.

Retrieved from http://www.chiro.org/LINKS/ABSTRACTS/Hands_on_Therapies.shtml

Retrieved from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp

from http://www.vapricepoint.org/Report_INP.aspx

9. North, R. B., Kidd, D., Shipley, J. & Taylor, R. S. (2007). Spinal cord stimulation versus reoperation for failed back surgery syndrome: A cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery, 61(2), 361-368.

Retrieved from http://www.clahealthcare.com/ learning/index.html

Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2009/07/ 16/AR2009071602242.html