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June 2016

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• Chiropractic: A Safer Strategy Than Opioids
• Resolution of GERD in an Infant Following Chiropractic Care
• Improvements in Autism Spectrum Disorder Following Chiropractic Care
• Neck Curve Improved with Chiropractic After Fusion Surgery
• Meniere's Disease with Vertigo Helped by Chiropractic According to Study
• Chiropractic Safety Documented by Study

The Foundation for Chiropractic Progress (F4CP) issued a news release on  June 6, 2016, highlighting the publication of an encompassing white paper titled, "Chiropractic: A Safer Strategy Than Opioids."

According to the F4CP news release, the white paper "...articulates the value of a conservative, non-pharmacologic approach as an important option for pain management -- particularly for back, low back and neck pain, headaches, neuro-musculoskeletal and other related conditions."

The 28-page white paper begins by stating the growing concern about the problem, and offers a solution. "The United States has awakened on every level to the crushing impact of the opioid use/abuse epidemic. Calls have come from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Institute of Medicine (IOM) for a shift away from opioid use toward non-pharmacologic approaches to address chronic pain. An important non-pharmacologic approach in helping to solve this crisis is chiropractic care."

Co-author of the white paper, Laura Carabello, Principal, CPR Strategic Marketing Communications, commented in the news release by saying,  "According to a study reported by the Agency for Healthcare Quality and Research, the problem remains that opioids frequently are prescribed for acute and subacute low back pain, despite low quality or inconclusive supporting evidence for their use in this circumstance."

To help with the opioid problem, the F4CP white paper listed five calls to action.

• Prescribers should heed CDC guidelines and begin prescribing safer alternatives such as chiropractic care for chronic pain management.
• Pharmaceutical manufacturers should institute more responsible marketing and physician education that will result in improved prescribing habits.
• Hospital emergency rooms should evaluate their options for managing patients' pain without the use of opioid painkillers.
• Payers and plan sponsors – both government and commercial – should make chiropractic care an accessible, affordable, option for chronic pain relief, with reimbursement of DCs as covered providers.
• Chiropractic services should be expanded in the Department of Defense and veteran’s health care systems since neuro-musculoskeletal pain is one of the leading causes of disability in the active military and veteran populations.

White paper co-author Gerard Clum, DC, President Emeritus, Life Chiropractic College West and Director, The Octagon, Life University, concluded the news release with an overview by saying, "The United States has awakened on every level to the crushing impact of the opioid use/abuse epidemic. This examination offers a greater understanding of the issues driving overprescribing of narcotics with corresponding initiatives that will help to extricate ourselves from this current, dangerous and often fatal reality."

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The Journal of Pediatric, Maternal & Family Health published a study on May 19, 2016, documenting the case of an infant with gastroesophageal reflux disease, (GERD) being helped with chiropractic. According to the Mayo Clinic, "Gastroesophageal reflux disease (GERD) is a chronic digestive disease. GERD occurs when stomach acid or, occasionally, stomach content, flows back into your food pipe (esophagus)."

The study authors note that GERD is the most common reason for visits to a gastroenterology clinic in North America.  They report that the prevalence of GERD is highest in North America at between 18.1 to 27.8% of the population having the condition. In Europe, the rate is about 9.8–18%, while in Asia, the rate is the lowest at only 5% of the population suffering from GERD at some point.

There has been an increase in alternative healthcare usage, such as chiropractic, for children with problems like GERD. In August of 2008, a study published in Pediatrics noted that, "Almost 40% of parents of pediatric gastroenterology patients are turning to complementary and alternative medicine for their child. Lack of effectiveness of conventional therapy, school absenteeism, and adverse effects of allopathic medication are more important predictors of complementary and alternative medicine use than the type of gastrointestinal disease." 

In this case, a 1-month-old baby girl was brought to the chiropractor. According to her mother, the infant had been suffering with GERD since birth. Her symptoms included gurgling at night, wakeful sleep, and the appearance of a facial grimace. The symptoms were worse at night, but occasionally appeared during the day. 

An examination was performed and a determination was made that subluxations were present in the child's spine. Specific adjustments were given over the following weeks to address the subluxations found by examination.

The study reported that the infant responded well to chiropractic care with the infant showing relief early in care. The length of time the relief was noted got longer as time under care progressed. In rating her child's improvement, the mother recorded that her child was "...a very great deal better."

The authors also reviewed a number of other case studies of GERD being helped by chiropractic. This body of evidence adds to the documented effectiveness of chiropractic care for patients with GERD. In their conclusion, the authors wrote, "We reported the successful chiropractic care of a 1-month old female with subjective complaints consistent with GERD. This study opens the possibility that similar patients may benefit from chiropractic care."

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A study published on May 26, 2016, in the Journal of Pediatric, Maternal & Family Health documented the case of a 4-year-old boy with Autism being helped with chiropractic. The study authors begin by explaining, "Autism Spectrum Disorder (ASD) is an early developmental disorder characterized by deficits in social communication and interaction, with restrictive, repetitive behaviors, causing significant impairment in social, occupational, or other areas of function, that are not better explained by intellectual disability."

The study points out that the diagnosis of ASD has dramatically increased over the past decade. They report, "In 2014, the Centers for Disease Control (CDC) reported that 1 in 68 children are classified as having ASD, up from 1 in 110 in 2006. ASD affects more than 400,000 children in the United States and is the third most common developmental disorder in children."

The current medical treatments for children with ASD involve antidepressants, antipsychotics, and anti-seizure medications. Other studies show that over 50% of children diagnosed with ASD have received at least one form of complementary and alternative medicine (CAM) such as chiropractic. Over seventy-five percent of those showed some improvement.

In this case, a 4-year-old boy diagnosed with autism spectrum disorder was brought to a chiropractic clinic by his mother and father. Their son was language delayed and was unable to formulate words or communicate but was able to cry out and make guttural sounds. The boy could hear commands but would only respond with temper tantrums.  He was also frequently hurting himself on purpose but would exhibit no pain. Since birth, the boy also regularly suffered from the flu, frequent colds, ear infections and allergies. He was frequently on antibiotic medications.

A chiropractic examination was performed on the boy and a determination was made to correct the subluxations that were found.  Initially, the child was seen 15 times over the course of 8 weeks.

After the first adjustment, the child made his first eye contact with the chiropractor. By the third visit, his parents reported that their son seemed to be understanding direction better, but overall had been acting more aggressively.   By the fourth visit, the boy was trying to verbalize but was unsuccessful at that time. By the sixth visit, the child started using some single words such as eat, car, or Auntie. On the eighth visit, the boy asked his father for a hug.

On the 15th visit, the boy's mother was given a standardized test to evaluate her son's autism improvement. The results showed that the boy had a 34.8% improvement in his speech/language/communication score; his sociability score improved by 50%; he showed a 50% improvement in his sensory/ cognitive awareness score;  and a 31.4% improvement in his health/physical/behavior score.

In their conclusion the authors wrote, "With a growing body of case studies on chiropractic and ASD, this study serves to strengthen the relationship between reduction of vertebral subluxation and improvements in function in patients with ASD."

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From the scientific journal, the Annals of Vertebral Subluxation Research, comes a study published on May 12, 2016, showing that chiropractic helped a patient improve their neck curvature even after having spinal fusion surgery.  A normal neck, when viewed on x-ray from the side, has a normal forward curvature.

The study begins by noting that a loss of the normal neck curve is a common finding in a chiropractic office. The study points out that once a neck curvature starts to decrease or reverse, the condition, if left untreated, makes itself worse over time. Many health issues seem to follow the progression of a loss of neck curvature. These problems include low back pain, disc degeneration, spondylosis, ossification of spinal ligaments, adolescent idiopathic scoliosis, improper rib cage expansion, early osteoarthritis, osteoporosis, vertebral compression fractures and spondylolisthesis.

Problems from a loss of curve basically fall into two categories. These problems are either musculoskeletal in nature or neurological in nature. The musculoskeletal problems stem from an altered structure that affects posture and the mechanic of the spine. The neurological problems can affect the spinal cord itself as it gets stretched over a neck that is curving the wrong way.

In this study, a 43-year-old woman went to the chiropractor with a long history of severe neck pains. This problem was so severe that she had even had spinal fusion surgery on the lower parts of her neck.  This surgery, however, did not yield the desired result, which caused the woman to seek chiropractic care. She was also suffering from mid-back pain as well as pain in the lower back.

A chiropractic examination was performed that included palpation, thermographic heat studies, and both static and motion x-rays. Her neck curve was almost totally reversed compared to a normal neck curvature. In addition, several areas of the neck did not have normal motion when examined with motion x-rays.

From the examination, a determination was made that subluxations were present. Specific chiropractic adjustments were given to address the subluxations and reversal of the neck curve.

After 9 visits, the study reports that follow up x-rays showed close to a 50% improvement in the woman's neck.  Additionally, the woman reported that most of her symptoms were significantly reduced.

In their conclusion, the authors sum up the importance of  restoring a more normal cervical curve with chiropractic care. "Loss of spinal sagittal curves, specifically the cervical curve is a significant health risk, not only directly to the spinal cord via anoxia, leading to atrophy, but also the entire body since the nervous system is the control center for all bodily functions."

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On June 3, 2016, the Journal of Upper Cervical Chiropractic Research published a study showing chiropractic helping patients with Meniere’s disease (MD). According to the National Institutes of Health website, "Meniere's disease is a disorder of the inner ear that causes severe dizziness (vertigo), ringing in the ears (tinnitus), hearing loss, and a feeling of fullness or congestion in the ear. Meniere's disease usually affects only one ear."

The study reports that  a diagnosis of Meniere's disease is reached when all other possible diseases with the same symptoms are ruled out. The study author reports that, "According to the Prosper Meniere Society a diagnosis of Meniere's disease requires at least two spontaneous episodes of vertigo, each lasting 20 minutes or longer, hearing loss verified by a hearing test on at least one occasion, tinnitus or aural fullness and exclusion of other known causes of these sensory problems."

In this study, 300 patients suffering from Meniere's disease  underwent a chiropractic examination. This included a case history, a physical and postural examination, thermographic heat studies and spinal x-rays of the upper portion of the neck. In all 300 of these patients, it was reported that there was some sort of prior neck trauma, such as whiplash, years earlier.

In each of the cases, a conclusion of the presence of subluxations in the upper neck area was made. With this information, specific forms of chiropractic adjustments appropriate to each of the patients was made when indicated.

Patients in this study were asked to rate their condition on a scale of 0 to 10,  with 0 being no symptoms and 10 being the worst imaginable. Prior to the study, the average rating given by the participants was 8.5 out of 10. Most patients reported that their condition made daily activities such as driving, working or socializing difficult to engage in.

After six weeks of chiropractic care, the average score lowered from 8.5 down to 3.0. In long-term follow-ups, the scores continued to improve reducing to 2.0 after one year, 1.4 after two years, 0.9 after three years, and eventually leveling off at a rating of only 0.8 thereafter. In 291 of the participants, chiropractic care had a profoundly positive effect on their condition and their lives, improving their ability to work, drive and have a better relationship with their spouse. 

In the study conclusion the author wrote, "One hundred percent of three hundred consecutive patients medically diagnosed with Meniere’s disease also having suffered a whiplash trauma is unlikely coincidental." He continued, "All patients with a history of vertigo should be questioned about a history of trauma, especially whiplash from an automobile accident, contact sports injury, or serious falls. Patients often forget these accidents, thinking that they were not hurt because they did not break any bones and were not bleeding."

Based on the findings in this study, the author recommends that all patients suffering from vertigo with a history of some sort of trauma should be evaluated by a chiropractor.

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On May 30, 2016, the  the Annals of Vertebral Subluxation Research published a study titled, "Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation."  The researchers evaluated the evidence related to chiropractic manipulation and the form of stroke known as CAD. They found no causation.

On a number of occasions, chiropractors have claimed that a smear campaign was being waged on their profession by baseless claims that chiropractic could cause strokes. This study looked at the actual scientific evidence to see if there was a causal relationship shown anywhere in the scientific data.

The study points out that there have been a number of case studies of patients who had CAD strokes following a chiropractic adjustment. However, this alone does not mean that the CAD was a result of the adjustment. As an example, there were probably also a number of people who have had car accidents at some point after a chiropractic adjustment. This would not mean that the chiropractic care caused the auto accident.

The researchers looked at the raw data to see what real scientific evidence there was for the claims. As the researchers stated,  "We sought to examine the strength of evidence related to this question by performing a systematic review, meta-analysis, and evaluation of the body of evidence as a whole."

Researchers did extensive searches for any references to chiropractic care and  stroke. In so doing, they found 253 articles on the subject. Of these 77 articles were non-relevant and excluded.  The remaining studies were reviewed for the strength of the evidence and the methodology leading to the results. Some studies showed no relationship with chiropractic and stroke, while some studies suggested that the risk was due to the condition that the patient had prior to the chiropractic care. In these studies, the stroke risk was the same, regardless if the patient went to a chiropractor or a medical doctor.

After reviewing all available studies, the researchers concluded that there was no evidence to suggest that chiropractic caused stoke. "We found no evidence for a causal link between chiropractic care and CAD." They further explained the impact of their findings by noting, "This is a significant finding because belief in a causal link is not uncommon, and such a belief may have significant adverse effects such as numerous episodes of litigation."

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