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February 2016

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CDC Study Says Most People Seeing Chiropractors Are Paying for Care

A January 2016 report released by the Centers for Disease Control and Prevention's National Center for Health Statistics showed that even though insurance affects how people purchase healthcare, more people than ever are choosing to pay for their chiropractic care. The report was based upon the National Health Interview Survey (NHIS) taken in the years 2002 and 2012.

The study reported on usage for what the researchers termed as "complementary health approaches" which included acupuncture, massage, and chiropractic. They checked the usage of these three services specifically in the years 2002 and 2012. Researchers also looked to see if those surveyed had insurance that covered those services, and if insurance coverage affected the amount of usage of those services.

The results showed that there was increased utilization in all three services from 2002 compared to ten years later in 2012. The rates of utilization in 2002 were: acupuncture 1.1%, massage 5.0%, and chiropractic 7.5%. These figures all increased ten years later to: acupuncture 1.5%, massage 6.9%, and chiropractic 8.3%.

When examining who had insurance coverage, it was noted that the group with insurance coverage did not show an increase in utilization, while those without insurance, who would have to pay for their care, showed a statistically significant increase in utilization. This means that having insurance did not cause more people to seek out these three services. The study stated, "Although increases were observed in the percentage of adults who saw a practitioner for acupuncture, chiropractic, or massage therapy and did not have health insurance coverage for these visits, no changes were observed among those who saw a practitioner and had coverage for these complementary health approaches."

For chiropractic, the study noted that 18.7% of those who sought those services had full insurance coverage. Partial coverage for chiropractic made up 41.4% of those who went to the chiropractor, while 39.9% had no chiropractic insurance coverage at all. Both acupuncture and massage had considerably less insurance coverage than chiropractic.

In their summary the authors of the CDC study noted, "Increased use of acupuncture, chiropractic, and massage therapy between 2002 and 2012 was previously noted. There was a significant increase in the percentage of adults who saw a practitioner for acupuncture, chiropractic, or massage therapy but did not have health insurance coverage for these approaches. No change in use was observed among those with insurance coverage. These data suggest that consumers are increasingly willing to pay out of pocket for the use of acupuncture, chiropractic, and massage."

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Study Suggests Most Subluxations Do Not Cause Symptoms

A study published in the January 28, 2016, issue of the Annals of Vertebral Subluxation Research showed that most subluxations do not cause symptoms of any kind. The study was conducted in Germany using a survey of chiropractic offices.

The definition of subluxation according to the Association of Chiropractic Colleges is: "A subluxation is 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." In simpler terms, a subluxation (a.k.a. Vertebral Subluxation) is when one or more of the bones of the spine (vertebrae) move out of position and create pressure on, or irritate, spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in the spine. This pressure or irritation on the nerves then causes those nerves to malfunction and interfere with the signals traveling over those nerves.

The study reports that the International Federation of Chiropractors and Organizations (IFCO) considers subluxations by themselves to be sufficient reason for chiropractic care. "The correction of vertebral subluxation is appropriate for anyone exhibiting evidence of its existence regardless of the presence or absence of symptoms and/or disease. Therefore, the determination of the presence of vertebral subluxation stands as a sole rationale for care."  The Council of Chiropractic Education also notes, "Vertebral subluxation may be asymptomatic, yet still exert various physiological effects."

In this study, a survey was sent to 25 German chiropractic offices asking them several questions. Nineteen offices responded to the questions including, "How many of the patients that you treat every day have asymptomatic subluxations?" The intention of this question was not to look for patients that had no symptoms at all, but rather to look for patients with subluxations that were not causing the patient any symptoms. The survey also asked the offices how many patients they saw each week. 

The results of the survey showed that, on average, 93.73% of patients who went to the chiropractor had some asymptomatic subluxations.  These subluxations could have been in addition to subluxations that were causing the patient symptoms. The offices surveyed represented a variety in the number of patients that were seen with the average being 172 patient visits per week.

In their conclusion, the authors noted the importance of detecting subluxations that may not show symptoms by stating, "From the analysis of the collected data it appears that asymptomatic subluxations that are not consciously perceived are common among patients presenting in chiropractic offices in Germany. This lends support to the widespread belief among chiropractors that people should be checked for subluxations regardless of conscious symptoms being present."

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Chronic Ear Infections Resolved with Chiropractic According to Case Report

The Journal of Pediatric, Maternal & Family Health published a case study in their January 14, 2016, issue documenting the case of a young girl with otitis media being resolved with chiropractic care. Otitis media is the technical term for ear infections.

The study estimates that approximately 40% of children suffer from otitis media (OM) before the age of five years. Commonly children who suffer with this problem have reoccurring episodes and are often prescribed antibiotics as medical treatment. The authors report that in an acute phase, OM is often associated with ear pain, fever, headaches, irritability, and listlessness.  Otitis media is the most common infection for which antibiotics are prescribed for children in the United States, with medical costs being about 3 billion dollars a year.

In this case, a 4-year-old boy suffering from chronic earaches was taken to the chiropractor by his mother to see if chiropractic could help.  The boy's history showed that he had been suffering with otitis media since age three. In an effort to medically treat his problem, tubes had been inserted in his ears which fell out nine months later. After the failed medical care, the boy, who was scheduled to have a second ear tube surgery in less than one month, was brought to the chiropractor. The boy's mother reported that her son would regularly pull on his ear, and she observed that his ear was red and had excessive wax buildup.

A chiropractic examination was performed which included palpation of the child's spine, range of motion, as well as basic inspection and physical signs. From his examination, it was determined that the boy had subluxations in his upper neck area.

Specific chiropractic adjustments were given to address the boy's subluxations. The boy was seen three times per week for the first two weeks of care, followed by a visit frequency of twice per week.  Following the first adjustment, the boy's mother reported that her son experienced relief for the entire day.  She did notice fluid coming out of his ears as well as a runny nose. It was reported that he slept better that night and was less irritable.

After three visits, the mother reported that her son had improved enough that she decided to cancel her son's second ear tube surgery. When the initial portion of the chiropractic care was completed, the boy's parents decided to continue their son's care on a wellness basis.

In their conclusion, the study authors offered, "This case report opens for the possibility that children with otitis media and failed medical care in the way of tympanostomy tubes may benefit from chiropractic care vis a vis chiropractic adjustment."

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Infant's Constipation Resolved After Chiropractic

The Journal of Pediatric, Maternal & Family Health published a case study on February 1, 2016, documenting the case of a baby boy suffering from constipation being helped by chiropractic. The study reports that constipation is a common pediatric problem affecting about 3% of children.

According to the Mayo clinic website, constipation in infants and toddlers is not determined by the frequency of bowel movements but rather by the difficulty, pain and consistency of the movement. Their website describes how to detect painful movement in an infant. "Infants experiencing painful bowel movements might arch their backs, tighten their buttocks or cry. Keep in mind that infants have weak abdominal muscles and often strain during bowel movements."

The authors of the study note that most medical approaches to constipation are not very effective. They explain, "When one considers the perspective that approximately 30% of children beyond puberty continue to struggle with symptoms of constipation, new therapeutic strategies are necessary thus making alternative therapies an attractive care option for children suffering from the disorder."

In this case, an 8-month-old baby boy was brought to the chiropractor by his mother to see if he could be helped with his constipation. The infant's mother noted that her son had not had a bowel movement for five days and was in obvious pain and discomfort. She observed that her son would strain for a bowel movement without success. The baby was given fluids and not given any medications.

A chiropractic examination consisting of heat readings, static and motion palpation was performed. It was determined that subluxations were present, and with the consent of the mother, specific corrective chiropractic adjustments were begun.

The effects of the chiropractic adjustment were immediate. The case study reports, "As the mother and son were in their car to leave the clinic parking lot, the patient proceeded to have a very large bowel movement while sitting in his car seat. The mother phoned the clinic two hours later to inform that the patient had proceeded to have an additional two bowel movements since they had left the chiropractic clinic." The mother also reported that her infant son's disposition had greatly improved.

In their conclusion the authors wrote, "We described the successful chiropractic care of an infant suffering from constipation. In addition to resolving the child's presenting complaint, the patient's quality of life improved significantly as reported by his mother."

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Erb's-Duchenne Palsy Resolved with Chiropractic - Case Study

In the January 21, 2016, issue of the Journal of Pediatric, Maternal & Family Health is a published case study of a baby girl suffering with Erb's-Duchenne Palsy who completely recovered under chiropractic care. Erb's-Duchenne Palsy is also known as Brachial plexus palsy or simply Erb's Palsy.

According WebMD, "Brachial plexus palsy, also known as Erb's palsy, is a paralysis or weakness of the arm caused by an injury to one or more nerves that control and supply the muscles of the shoulder and upper extremities (upper brachial plexus). It is more commonly seen in newborns (neonates) and is often the result of a difficult delivery."

The authors of the study report that most of the cases of Erb's Palsy are medically managed with either physiotherapy or surgery. The results of this care show that 30% recovered with minimal defects by six months of age, while 55% had moderate residual deficits by 12 months, and 15% had long-term significant handicaps.

In this case, a 5-month-old infant diagnosed with Erb's Palsy was brought in for chiropractic evaluation. The mother reported a difficult delivery lasting 12 hours. She mentioned that during delivery the head and shoulders "got stuck." Therefore, a vacuum extraction was performed. Immediately after birth, it was noticed that the infant had a diminished range of motion in her right arm and a diagnosis of Erb's Palsy was made, and physiotherapy recommended. The therapy was not successful in helping the infant.

The chiropractic examination confirmed the severe lack of motion and care was initiated for correction of subluxations found in the infant girl's spine. Specially modified chiropractic adjustments were used due to the infant's size, age, and condition.

On the second visit, a slight improvement was noted in the range of motion of the infant's arm. By the third visit, the change was even more noticeable and was confirmed by the physiotherapist who pointed out the improvement to the parents. By the seventh visit, the infant's range of motion was much improved and the infant was observed using her right arm to reach for toys. On the ninth visit, the infant girl no longer had any noticeable difference in the range of motion between her right and left arm and was able to use both normally. A follow-up examination weeks later continued to show total recovery from her Erb's Palsy.

In their conclusion the researchers stated, "This case chronicles the care and subsequent resolution of Erb-Duchenne Palsy in a five-month-old female with chiropractic care. This case report suggests that chiropractic care may be benefit infants with Erb-Duchenne Palsy."

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Common Heartburn Drugs Linked with Kidney Disease

The headline above is from a January 11, 2016, CBS News story reporting the research link between acid reflux medications and kidney disease. The original research was published in the February 2016 edition of JAMA Internal Medicine.

In the original study, more than 10,000 people who were taking part in a national study on hardening of the arteries were reviewed to see the rate of kidney disease in those taking heartburn drugs versus those who did not. The results showed that in two different trials those taking the drugs had a 20% to 50% higher risk of chronic kidney disease compared with those who did not take the drug.

Proton-pump inhibitors, or PPI, are one of the most common types of medications used by Americans today. It is estimated that 15 million people take these drugs . These drugs include such popular brand names as Prilosec, Nexium and Prevacid which are used to treat heartburn by lowering the production of stomach acid.

In numerous news reports on this study, Dr. Morgan Grams, an epidemiologist at the Johns Hopkins Bloomberg School of Health who led the research commented, "There appears to be mounting observational evidence that PPIs – historically a class thought to be extremely safe – have some adverse effects." Dr. Grams also stated, "We found there was an increasing risk associated with an increasing dose. That suggests that perhaps this observed effect is real."

In a NY Times Health section article on the research, Dr. Todd Semla, a pharmacist at the Feinberg School of Medicine at Northwestern University, and past president of the American Geriatrics Society commented, "I don't see Larry the Cable Guy saying, ‘If you take this drug often, your kidneys may be affected or you could break a hip.'"

The study authors point out that 70% of the prescriptions for these drugs were given out inappropriately. They also note that 25 % of those taking these drugs long-term could stop taking the medication without noticing an increase in heartburn or acid reflux.

Dr. Adam Schoenfeld of the University of California wrote an editorial in JAMA on this issue and was quoted in the Huffington Post. The Post article quoted him, "Doctors must weigh the risks and benefits before recommending PPIs and this study adds chronic kidney disease to the risk of rare, but serious side effects associated with PPI use."

Schoenfeld also pointed out that many people with indigestion and heartburn do not need the medications. He suggested lifestyle changes such as proper diet and exercise, which he points out are just as effective than the drugs.

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