Posts for: June, 2017

Glucose Metabolic Changes in the Brain and Muscles of Patients with Nonspecific Neck Pain Treated by Spinal Manipulation Therapy:

A [18F] FDG PET Study {a radioactive glucose PET scan study}. Evidence-Based Complementary and Alternative Medicine Volume 2017

The study has four important findings:

• The brain is affected by chiropractic adjusting

• Chiropractic adjusting inhibits pain

• Chiropractic adjusting inhibits muscle tone, improving ranges of motion

• Chiropractic adjusting inhibits sympathetic tone, a key influence on immunity and other factors in systemic wellness

 

PET (positron emission tomography) scan is a powerful neuroimaging technique to investigate neuronal activity in the human brain and muscles.

18F-labeled fluorodeoxyglucose (FDG) is a radioactive analogue of glucose, and is an excellent imaging marker of brain glucose consumption (brain metabolic activity).

A PET scan can visualize brain metabolic changes induced by spinal manipulative therapy (SMT). The aim of this study was to investigate changes in brain and muscle glucose metabolism using positron emission tomography with fluorodeoxyglucose.

Twenty-one male volunteers were recruited for the present study. Spinal manipulative therapy (SMT) was applied using an Activator in accordance with the Activator Methods protocols. The Activator applied impulses to specific vertebrae or joints. “SMT was performed on the subject in a prone position without movements such as cervical rotation, lateral flexion, and extension, in order to prevent the muscular FDG uptake due to muscle contractions during the therapeutic procedure. SMT was carried out on the whole spine, the scapulae, the ilium, and the sacrum, as necessary for each subject. The mean number of SMT adjusted sites was 8 per subject.”

Glucose metabolism of the brain and skeletal muscles was measured. Also measured was salivary amylase levels as an index of autonomic nervous system (ANS) activity, muscle tension, and subjective pain intensity. “Other measurements indicated relaxation of cervical muscle tension, decrease in salivary amylase level (suppression of sympathetic nerve activity), and pain relief after SMT.” “SMT on all subjects was performed by the same Chiropractor, who was an advanced practitioner of Activator Methods.”

KEY POINTS FROM THIS STUDY

1) Spinal manipulation therapy (SMT) has “been applied mainly to musculoskeletal problems such as neck pain or low back pain.”

2) Previous studies have shown that “SMT has beneficial clinical effects, including pain relief and reduction of blood pressure.”

3) “The intensity of subjective pain was evaluated using a 0–10 visual analog scale (VAS) before and after SMT in the treatment condition.”

4) “Cervical muscle tension was measured bilaterally at the superior part of the trapezius muscle using a tissue hardness meter.”

5) “Salivary amylase levels were measured for each subject using an amylase monitor to evaluate changes in autonomic nervous system (ANS) function.”

6) “Salivary 

Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial Annals of Thoracic Surgery

(The Society of Thoracic Surgeons)

 

January 18, 2017; Vol. 16 [epub]

Vittorio Racca, MD, Bruno Bordoni, MS, Paolo Castiglioni, PhD, Maddalena Modica, MS, Maurizio Ferratini, MD

 

Cardiology Rehabilitation Center and Biomedical Technology Department, Santa

 

Maria Nascente Institute-IRCCS, Don C. Gnocchi Foundation, Milan, Italy

The aim of this study was to assess whether osteopathic manipulative treatment

 

(OMT) contributes to post heart surgical sternal pain relief and “improves

postoperative outcomes.”

 

Eighty post-sternotomy patients were randomly allocated to receive a standard ,cardiorespiratory rehabilitation program alone (control group) or standard cardiorespiratory rehabilitation with spinal manipulation. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation.

 

KEY POINTS FROM THIS ARTICLE:

 

1) “Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs.” Postoperative pain

“diminishes patients’ ability to cooperate, delays recovery and may lead to worse outcomes.”

2) “Inadequately controlled postoperative pain negatively affects the immune system, wound healing, and pulmonary function.”

3) Pain can “activate the sympathetic system, increasing demands on cardiac function and favoring cardiac complications such as tachycardia, arrhythmia, or myocardial ischemia.”

4) “Uncontrolled postoperative pain is often responsible for neurologic

complications, episodes of delirium, and other acute confusional states with a multifactorial pathogenesis.”

5) “In addition to discomfort and suffering, pain may cause sleep deprivation, may delay return to normal functioning, and may have nociception-induced adverse effects on cardiovascular functioning and pulmonary morbidity.”

6) Pain intensity was measured using a 10-cm visual analogue scale (VAS)

ranging from “no pain at all” to “unbearable pain.”

7) The improvement in respiratory function was more marked in the

[manipulation] group. “The inspiratory volume was significantly greater in the [manipulation] group.”

8) “Hospitalization was significantly shorter in the [manipulation] group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days).”

9) “Anti-inflammatory drugs may impair renal function, interact with platelet

aggregation, and increase the risk of gastrointestinal damage and bleeding;

analgesic drugs have detrimental neurologic effects and negatively affect visceral motility; and opioids may decrease survival during in-hospital resuscitation and increase duration of hospitalization.”

10) The manipulation in this study began the day after being discharged from the surgery department, and was administered for 5 days.

11) At the end of rehabilitation:

• The manipulation group had a lower Visual Analogue Scale score.

• The manipulation group had higher mean inspiratory volume.

• The manipulation group had shorter stays.

 

“At the end of the rehabilitation program, the reduction in perceived pain was more marked in the [manipulation] group and the VAS score was significantly lower in [manipulation] patients than in controls.”

 

13) “The combination of standard care with [manipulation] is effective in

inducing pain relief and functional recovery, and significantly improves the

management of patients after heart surgery with sternotomy.”

14) These authors reference articles that show spinal manipulation does the

following:

• “Intervenes in the process that transforms nociceptive information into the

subjective experience of pain.”

• “Controls pain after abdominal surgery.”

• “Facilitates recovery of functional ability after coronary artery bypass graft

surgery.”

• “Improves cardiac function.”

• “Reduces analgesia that patients with musculoskeletal problems need after

elective knee or hip arthroplasty.”

15) Of the patients who took pain medications, side effects occurred in

22.5%; these side effects included nausea, vomiting, dizziness, difficulty

concentrating, drowsiness, light-headedness, abdominal discomfort, constipation, dry mouth, itching, rash, and blurred vision.

16) Nonsteroidal anti-inflammatory drugs “may increase the risk of thrombotic cardiovascular events, including myocardial infarction, and of gastrointestinal bleeding.”

17) “Overuse of opioid analgesics induces side effects that can delay recovery and worsen the outcome.”

18) “This is the first randomized controlled trial evaluating the effect of OMT on both pain perception and functional outcomes after heart surgery.”

19) “The main results of our study are that OMT treatment decreases dramatically the level of perceived pain, and substantially improves the functional capacity in terms of inspiratory volumes.”

20) “We also observed a reduced hospitalization, on average by more than 2

days, in the OMT-treated group, that could be consequence of the improved

functional capacity.”

21) The gating mechanism of spinal manipulation would have an “analgesic effect, reducing somatic reactivity and muscle spasms.”

22) “The lower pain intensity in the OMT group at discharge suggests that OMT had a direct analgesic effect.” “The shorter duration of hospitalization

in the OMT group might suggest a more rapid functional improvement.”

23) “It can be hypothesized that the pain-relieving action of [manipulation]

enables lower doses of analgesic drugs.” “Our study suggests that [manipulation] may reduce the use of analgesic drugs, lowering the risk of adverse effects during rehabilitation programs.”

24) “The efficacy of [manipulation] on rehabilitation outcomes can therefore be summarized in terms of a more pronounced reduction in pain intensity and a greater improvement in rib cage mobility, both factors that might have played a role in shortening hospitalization.”

25) “Manipulative treatment is safe, free of side effects, and well

accepted by patients. Moreover, it is relatively inexpensive and only moderately time consuming. For these reasons, cardiac rehabilitation programs should include MT.”

26) Manipulation “should begin before the development of the respiratory

sequelae associated with reduced chest and diaphragm mobility.”

27) “We believe that adding [manipulation] to traditional care programs 1 week after surgery is neither too soon nor too late.”

28) These authors suggest that postoperative manipulation “can be expected to improve the quality of patient care and its cost efficiency, by leading to better and more rapid outcomes and by reducing morbidity.”

 

COMMENTS

 

This amazing study supports that all post surgical patients should start spinal manipulation within 5 days of surgery, during the rehabilitation process. The benefits include:

 

• Significantly reduced pain

• Significantly improved function

• Reduced hospital stay and it associated reduced costs

• Avoidance of drugs and all the risks (complications and side effects)

associated with pharmacology