By Michael Smith, North American Correspondent, MedPage Today Published: March 21, 2011 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
More than one in 10 people in a prospective cohort developed chronic widespread pain over a four-year period and most of them were involved in a traumatic event during that time, researchers reported.
Among those who reported new, widespread chronic pain, 43% said they had experienced a traffic accident, surgery, or broken bones over the same period, according to Gareth Jones, PhD, of the University of Aberdeen in Aberdeen, Scotland, and colleagues.
In contrast, only 36% of those who remained pain-free reported such an incident, Jones and colleagues reported online in Arthritis Care & Research.
Note that among those who reported new, widespread chronic pain, 76% said they had experienced a traffic accident, surgery, or broken bones over the same period.
Explain that traffic accidents alone was a significant predictor of new chronic widespread pain but lost significance after further adjustment for anxiety and sleep problems.
Much of the difference – which approached but did not reach statistical significance — was driven by traffic accidents, workplace injuries and fractures, Jones and colleagues reported.
Chronic widespread pain, according to the American College of Rheumatology, is pain above and below the waist, or on both the left and right sides of the body, for three months or longer.
Earlier research has suggested the prevalence of the condition a primary characteristic of fibromyalgia — is about 11% to 13%. People with chronic widespread pain often attribute it to a single precipitating condition, such as a car accident, but there is little evidence to support that, Jones and colleagues noted.
To help fill the gap, they turned to the EpiFunD Study (for Epidemiology of Functional Disorders), a large prospective cohort study in northwest England.
At the start of the study, 6,290 people were recruited from three general practices in Manchester, England and were asked to fill out a questionnaire, part of which asked about chronic pain.
For this study, the researchers asked the same questions four years later of those who had been chronic pain-free at baseline. All told, 4,444 were known to be available for follow-up and 2,069 completed a second questionnaire, Jones and colleagues reported.
Of those, 241 — or 11.6% — said they now had chronic widespread pain and 37.2% reported at least one traumatic event over the same period, including traffic accident, workplace injury, surgery, fracture, inpatient treatment for any other reason, and, in women, childbirth.
More people with chronic widespread pain reported a traumatic event — 88 of 203 versus 596 of 1,638 — and the crude odds ratio was 1.34 with a 95% confidence interval from 0.996 to 1.80. While that approached significance, the researchers noted, adjustment for age, sex, baseline pain status, and the general practice from which participants were recruited attenuated the odds ratio even further.
In an analysis adjusted for age, sex, general practice and baseline pain status, traffic accidents alone remained a significant predictor of new chronic widespread pain.
The odds ratio was 1.84, with a 95% confidence interval from 1.10 to 3.11, Jones and colleagues reported, but it lost significance after further adjustment for anxiety and sleep problems.
Nonetheless, they argued, there is “some evidence to suggest that involvement in a road traffic accident, specifically, may confer an increase in the risk” of the condition.
Future research should try to determine what specific aspects of traffic accidents might be responsible, they concluded.
The researchers cautioned that the loss of more than half of the cohort to follow-up reduced the study’s statistical power. And, they added that it was not possible to tell which came first chronic pain or a traumatic event.
BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.
PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.
STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.
PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).
OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.
METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.
RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).
CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.
Objectives: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).
Method: A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.
Results: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).
Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.
Journal of Occupational & Environmental Medicine:
April 2011 – Volume 53 – Issue 4 – p 396–404
I think we like to have internal civil wars between our brains and our bodies. Even though they are intimately connected, I think the brain has a superiority complex. I see this battle when it comes to the desk jockey. This is the person who sits all day, every day, and that is how they make their money, by sitting and doing computer-desk work. I realize that this is unavoidable and can be very taxing on the body, but if I had a choice, I think I would rather be a stunt man and take my injuries one by one vs. slowly becoming a mongoloid like cave dweller chained to one position. Heck, even prisoners have more freedom than desk jockeys.
This internal war starts with the body revolting, sending messages to the brain to move, squirm, readjust, get up, take a break, stretch, and so on. The mind recognizes the bodies check engine signals, but overcomes them with rationalization. The mind tells the body to take it, and keep on sitting. The mind realizes the importance of surviving, but also keeps in minds that whole must keep working to earn that oh so precious dollar.
At one point the mind might give a little and do more exercise outside of the working hours, but sometimes this is not enough. With some minds, there is recognition of the importance of the work space ergonomics. The chair is always recognized as very important. Here comes the problem. Some minds will start to think that sitting on a huge ball will help keep them upright for endless hours that their job demands. They think that the ball will magically strengthen their core to a point that they can sit forever without fatigue, like some sort of superhero. Short periods of large ball sitting are okay, but endless sitting will short circuit the system. This is when they find me, a Denver chiropractor, and the one they seek for help. Their brain has recognized its own inability to protect itself, its civil war has lost, and the body is battered and can no longer cooperate.
Well, I want to help all of the professional sitters sit better, to be able to sit longer, and sit without fatigue. I recently have had more than a normal amount of people come to the clinic and tell me they have neck and back pain, and they want me to fix them. When there are no obvious injuries, I have to play a bit of Sherlock Holmes. I usually suspect with a high degree, the job category, especially if they sit all day. When it comes out that they are using a large ball to sit on, I have to pull my teacher hat out.
Most people like to think they have good ergonomics. This of course is natural for the professional sitter. Let me tell you why sitting on a ball all day is wreaking havoc on your body.
Sitting requires using your muscles to some degree. It you are using the same set of muscles to sit for extended time, that is, more than 30 minutes, your muscles will fatigue. Think of holding a bowling ball like a waiter holds a tray. With the weight directly over the hand and weight, it is not so bad, because it requires a high degree of balancing versus strength. This is the concept that the ball sitters are using, but it is flawed. For a short time this version of sitting will work, but certain muscle groups will fatigue at one point.
The goal of sitting well is to shift the strain on muscles, and not have one group of muscle bearing the burden. This is what happens with ball sitting, one group of muscles are doing all the work while the rest are sitting back and taking a nice vacation.
Shifting the load on muscle groups to different muscle groups is the key to prevent one set muscles from fatiguing, and using a ball to do this is impossible. With a ball, you cannot rest your arms; your arms are endlessly hovering to type and mouse. The muscles that do this are what many people call their shoulders. This is the Upper Trapezious, Levator scapulae, Rhomboids, Splenius Capitus, and many others that share connections with the neck and back. The muscles in your low back share the same burden, they never get to rest, because they are always engaged.
By using these muscles continuously, you will put a tremendous amount of strain on the upper back, low back, and the neck. Using a ball also prevents you from resting your neck. Having a chair where you can tilt back and rest your noggin, and rest your arms while you take or make a call is just what the body wants, a shift in muscle group use.
Prolonged use of any muscle will put the check engine light on. Using over the counter non steroidal, like Ibuneverworkuprofin, or Tyandnotfixanol will never cure your problem. You are just putting tape over the check engine light. After a while of body revolt, your joints will be out of alignment, trigger points and muscle adhesions will develop. This will show as low back pain, upper back pain, shoulder pain, neck pain, and headaches.
If you keep repeating the pattern of using your ball to sit on while you are developing neck and back pain, your problem will become much harder, longer, and much costlier to fix than buying a good ergonomic chair. Do your body a favor and get rid of that six dollar Walmart ball that you are using.
Next time you sit on your ball, become aware of what muscles you are actively using. Next, think of how long those same muscles can keep contracted without fatigue. Listen to your body, it will tell […]
Cold Laser Treatment
We are still far away from hover boards, and time machines, but our advances in laser therapy to treat pain and injuries has come a long way. Our chiropractic clinic in Denver has the latest advancement in laser therapy. We utilize the MR4 Super Pulsed Laser.
This one piece of equipment utilizes a combination of 5 different therapies. It includes in one treatment, 1. A super pulsed laser, 2. Pulsed broad band infrared, 3. Pulsed red light, 4. Static Magnetic field, and 5. Electric stimulation. This is a very powerful combination, that is used to treat over 300 different conditions.
One of the coolest advances with cold laser equipment, is that it has TARGET technology. Which stands for Treatment Area Recognition and Guidance Enchanced Technology. We use the device to scan an area, and it recognizes areas of increased impedence. This is the area we treat. We pull the trigger, and therapy starts, once the impedence improves, the device stops therapy.
One of the big advantages of this type of cold laser therapy is how deep the laser can penetrate. The laser is able to reach 5 inches of tissue depth. This is amazing, and unique in that other modalities cannot achieve this reach.
Clinical effects of the 5 therapies include:
1. activation of RNA and DNA synthesis
2. increased cell metabolism in the form of ATP
3. improvement of microcirculation
4. reinforcement of collagen synthesis and reduced fibrous tissue formation
5. anti-inflammatory response
6. edema reduction
7. pain reduction
8. stimulation of T-cell production
9. increased levels of prostaglandin synthesis
10. gentle heating of surface tissue layer
11. acts upon receptors in the skin and reduces pain
12. microcirculation activation
13. stimulates epithelial cell growth and regeneration
14. reinforces laser penetration into target tissues
15. localized pain relief
16. reduction in swelling
Laser therapy can be a perfect adjunct to the visit to the chiropractor. I schedule 15-20 minute appointments that include any combination of services that we provide to ensure the most impact.
Laser therapy has over 4,000 clinical trials world wide to document the effects. It is used in over 3,000 hospitals, and used in over 10,000 private practices. It can be used on just about any part of the body, and it has relatively few contraindications.
Olympic athletes, the special forces, US major league soccer team, NBA & NFL players, National soccer team, and chronic pain sufferers all utilize the MR4 Super Pulsed Laser.
The laser can treat a multitude of conditions such as
1. acute, sub-acute, and chronic pain
2. back pain
3. neck pain
4. carpal tunnel symptoms
5. arthritis pain
7. ligament sprains
9. tennis elbow
10. soft tissue injuries
11. muscle strain
This is just a partial list of conditions that the cold laser treats. It is used to treat over 300 different conditions. Cold laser treatments range from 1 time per week for 5 weeks to 2-3 times per week for 6-15 weeks. The frequency of visits is determined by the magnitude of the condition. Treatment by the laser usually lasts between 5-15 minutes.
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
Many of the patients that walk into my Denver chiropractic clinic after being in a car accident in Denver, do not have a lawyer. Most of the time they are unsure if they need one or not. Some of these people do, and some these people do not need a lawyer.
How do you know if you need a lawyer or not. It is not always clear cut, and most likely if you are unsure if you need an attorney, you probably do need one.
Consults with a personal injury attorney in Denver are usually free, and can occur over the phone. I always recommend you take advantage this, they are not in business to make cases out of nothing. If they feel you could benefit, or be protected from their services, then you absolutely need a lawyer.
Do not make the mistake of trying to negotiate your case yourself, especially if there is lots of property damage, and serious injuries. You are not an expert in legal matters. This can be the biggest mistake you could make in dealing with your auto accident. Medico-legal matters can be very complex, and if you do not know the rules, you will be shortchanging yourself.
I think one big mistake that people make, is that they get greedy. They think that if they hire an attorney, that they will not get as much money for their pain and suffering. Typically this is the opposite, the work of your attorney will more than pay for itself. Do you really think that you can negotiate better than a lawyer?
Since not all car accidents are the same, lets look at some scenarios that you most definitely need a lawyer.
1. If it is not clear cut who’s fault the accident is, you need a lawyer.
2.If there is more than $1000 of property damage, you need a lawyer.
3. If the other driver is uninsured, or leaves the scene of the accident, then you need a lawyer.
4. If you are unable to work, or find it difficult to work or carry out your normal activities, then you need a lawyer.
5. If there is any emotional distress among the witnesses, then you need a lawyer.
6. If it difficult for you to carry out a normal sex life, then you need a lawyer.
7. If the insurance company is harassing you, or offering you very little for your car’s damage, or a very low settlement amount, then you need a lawyer.
8. If there are inaccuracies in the police report, then you need a lawyer.
9. If the insurance company denies your claim, or delays your claim, then you need a lawyer.
10. If you had a prior medical condition, and the car accident has made this condition worse, then you need a lawyer.
11. If you have low limits on you auto policy, you probably need a lawyer.
12. If you have no insurance, or unpaid premiums, then you need a lawyer.
13. If the insurance company starts employs a special investigations unit, then you need a lawyer.
Usually, the sooner you hire an attorney, the better. Every bit of communication you have with the insurance company will in part determine your case. Insurance companies have been found to act in bad faith, so don’t get trapped into thinking that your insurance company is out for your best interests. After all, they are a company that specifically designed to make money, and they just might want to take advantage, especially if you are playing cowboy.
Most personal injury attorneys work on a contingent basis. This means if the case goes south, then you do not owe them a dime.
There are lots of car accident lawyers in Denver, and if you have decided that you do need one, then the next question is, which one. This is a whole other topic, and if you are wanting advice in this area, we can give you a list of trusted professionals.
Deciding to know if you need a personal injury lawyer in Denver or not, is not my specialty. Consults are easy, get professional advice from the experts. Why would you not take advantage of a free consult?
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
No matter how well you think you drive, odds are, you will have a car accident. Being prepared for such is your only offense when road conditions turn from perfect to dangerous. When you are caught in such conditions it is critical to be prepared, especially in winter driving conditions.
Besides having the necessary just in case you become stranded emergency equipment in your car, you should also have an accident information checklist in your glove compartment box. This will help protect your rights, and ensure that all information that needs to be collected, does get collected.
As a Denver chiropractor that treats auto accident patients, it is very common for the new patient to not have all the necessary information. Do not get caught in this situation. Having an easy to follow checklist in your glove compartment is an easy solution. If you would like a free checklist, I would be happy to send one to you in the mail.
The information you collect from your Denver car accident will help the at fault insurance company in determining how much your claim is worth. It will also help your doctor to understand the special directional forces transmitted to your body through vehicle collision vectors. If you need a Denver personal injury lawyer, the information will also help them to properly convey and represent your case to the insurance company.
First off, check yourself for injuries. The adrenaline rush you experience from the crash will often overide your awareness of your injuries. Next, check your passengers for injuries. If anyone is injured, call an ambulance right away!
You should also make a quick determination if your situation is prone to cause another nearby crash that might put you in more danger. It might be best to move your car to a safe postion, out of the way of traffic.
You should always call the police. The police will help get information about the other driver, and also possibly issue a ticket. Without a police report, or an issued ticket, it leaves room for the other insurance company to wiggle out of accepting fault. Always call the police, no matter what the other driver says!
Collect the other drivers information. This includes their address, home phone, cell phone, insurance company, policy number, work phone, email, license plate number, make, model, color, date, time, year of cars involved, and even insurance coverage limits, if they have the policy. Get the witnesses information as well. This can help protect you if there is any doubt of who is at fault.
When the police arrive, be sure to get the officers name, badge number, and city. Always treat the officers and emergency personnel with great respect. You might be angered by the situation, but remember that they are there to help and assist you.
Take pictures of everything! Document the damage to your car, the other peoples cars, intersections, skid marks, and even the position of your head rest. If you can, take video as well, this always adds dimension.
If you are injured at all, I suggest you go to the emergency room, or urgent care. This helps document your injuries, as well as protect you from serious underlying problems you might not be aware of. After this visit, you should schedule a visit to a medical doctor or chiropractor that is specifically trained in documenting and treating auto injuries. This is imperative! Going to a doctor that does not have additional training in auto injury accidents puts your case in jeopardy, and could put you in a position of increasing your risk for long term chronic pain.
I would also advise you to seek counsel from a well respected car accident lawyer. They can help you determine if you need a lawyer or not.
If you have any questions at all, or would like a free accident checklist, please call our office.
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
Does your car get more maintenance than you? Just recently I had two new patients the same week, that upon meeting them, exclaimed to me that they do not want to be hooked, or dependent on chiropractic. I told them in a jokingly manner, that I’ll have to see them three times per week for the rest of their lives. Chiropractic maintenance in Denver is not like this.
I see where they are coming from, especially from a perspective of a person that has never seen a chiropractor. There is a misconception out there that, once you see a chiropractor, you have to see them for the rest of their life. I suppose this concept depends largely on how you take care of yourself. There are lots of people that understand the benefits of getting maintenance care, and so do so.
So, when a chiropractic virgin talks to a regular, it might seem overboard to them, or strange that a person goes to the chiropractor in Denver on a regular basis. I suppose it all depends on how you want to treat your body. Some could care less about how healthy they are, this is not the chiropractic patient.
The chiropractic patient wants to get better, stay better, and live better. So, if you enjoy living in your body, and want to take full advantage of its capabilities, then regular maintenance care should be part of your life.
Our American culture is somewhat askew. Large powerful corporations with a seemingly endless amount of marketing monies impress a lifestyle of materialistic goods, and quick fixes. I see people dump their hard earned money in to customizing their car, yet they have no health insurance.
Or, they have the latest smart phone technology, yet they feed their body with empty calories that come from the fast food corner junk stand. It is time to take a stand and value what maters. Our health!
The chiropractor is well versed in well being, and prevention. We get more education in nutrition, and exercise than the medical doctor. Our specialty revolves around making you feel better without drugs, and without surgery.
I find it ironic that some people that have never been to a chiropractor regularly adjust themselves. Yet they will not spend the minimal amount of cost to have a professional adjust them. By the way, most people of self adjust are not completely addressing the misalignment, and can be making their spine worse. Getting adjusted by a professional will keep you aligned much longer, and you will have that feeling of needing to self adjust much less. We are happy to provide services regarding chiropractic maintenance in Denver.
Feed your body well, move your body well, and be well.
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd. Unit 1
Denver, CO 80211