Neck pain and anxiety do not always go together

Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). Although a highly statistically significant difference (p = 0.000) was subsequently observed with respect to pain intensity, in the resulting sub-groups, none such a difference was noted with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made

A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity.

BACKGROUND: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made in these ICA reports. MAIN BODY: We reviewed the two reports posted by the ICA on their website on March 20 and March 28, 2020. We explored the method used to develop the claim that chiropractic adjustments impact the immune system and discuss the scientific merit of that claim. We provide a response to the ICA reports and explain why this claim lacks scientific credibility and is dangerous to the public. More than 150 researchers from 11 countries reviewed and endorsed our response. CONCLUSION: In their reports, the ICA provided no valid clinical scientific evidence that chiropractic care can impact the immune system. We call on regulatory authorities and professional leaders to take robust political and regulatory action against those claiming that chiropractic adjustments have a clinical impact on the immune system

"Methodological and epistemological challenges for the chiropractic profession in health care - a study of the history, status quo and future of research and clinical practices."

Thesis (DPhil)--University of Stellenbosch, 2005.ENGLISH ABSTRACT: Although a legitimate provider of manipulative therapy, chiropractic largely functions outside mainstream health care in South Africa. A narrow research focus, poor institutional representation and inadequate professional integration all contribute to its undetermined role in health care. This study exploratory, qualitative study sought to investigate the state of the art of chiropractic with respect to beliefs, philosophy, research methods and clinical practices. Semi-structured, interviews were used to extract responses from ten chiropractors, six patients and four researchers. The results were interpreted on three levels; thematically, in relation to chiropractic’s discipline and profession and as a function of the ‘3 worlds’ framework. The thematic analysis revealed that: 1. Beliefs and philosophical traditions play an active role in the practice and science of chiropractic. 2. The chiropractic investigative paradigm has started to mature. 3. The contextual role of research methods is being clarified. 4. Contemporary chiropractic practice is not as evidence-based as it should be. 5. The chiropractic model of practice is significantly different to the perceived standard medical model. 6. Chiropractic clinical practice has a fuzzy identity. 7. Chiropractic’s professional status is unclear. 8. The professional and disciplinary components of chiropractic are still institutionally immature. 9. Chiropractic’s legitimacy is questionable. Themes 1-3 indicated that beliefs and philosophical traditions affect the way in which chiropractors conduct themselves clinically, the way patients view the world of health care and the manner in which researchers study clinical phenomena. Themes 4-6 suggest that the state of the art of chiropractic clinical practice is different from medicine, however the exact nature of its model of practice seems quite fluid. Themes 7, 8 and 9 suggest that the degree of professional and institutional maturity provide chiropractic with only partial legitimization.With regards to the discipline it seems that science and education have an important buffering role to play between the patient and the practitioner, in order to curb metaphysically motivated practices. Furthermore, chiropractic’s investigative paradigm is progressing atypically and hence the view of it conforming to a standard view of science is questioned. With regards to professional matters, our study indicates that chiropractors function on a spectrum which runs between “technicians” and “physicians”. Whilst patients have holistic health care beliefs it seems they are pushed toward chiropractic, through negative allopathic health care experiences and are drawn to the profession by its integrated model of practice. However, the lack of mainstream healthcare integration counter balances this worth and reduces chiropractic’s professional legitimacy. Two cross over themes were revealed. Firstly, chiropractic’s investigative paradigm has started to narrow the gap between applied science and clinical practice and secondly chiropractic’s legitimacy cannot lie in the opinion of medicine. The ‘three worlds’ framework indicated that the first three themes are meta-scientific (W3) reflections on beliefs, philosophical traditions and research methodology. The fourth theme reflects the relationship of research and practice (W2 and W1), and the remaining five themes are reflections clinical practice (W1 activities). Our study contends that chiropractic has the potential to develop into a mainstream health care provider through the implementation of a multi-leveled development strategy.AFRIKAANSE OPSOMMING: Alhoewel chiropraktyk ’n geoorloofde verskaffer van manipulasieterapie is, funksioneer dit grootliks buite hoofstroomgesondheidsorg in Suid-Afrika. ’n Eng navorsingsfokus, swak institusionele verteenwoordiging en ontoereikende professionele integrasie het tot die onbepaalde rol van chiropraktyk in gesondheidsorg bygedra. Hierdie verkennende kwalitatiewe studie het gepoog om chiropraktiese praktyk ten opsigte van oortuiginge, filosofie, navorsingsmetodes en kliniese praktyke te ondersoek. Semi-gestruktureerde onderhoude is gebruik om response van tien chiropraktisyns, ses pasiënte en vier navorsers te verkry. Die uitslae is op drie vlakke geïnterpreteer: (i) tematies; (ii) met betrekking tot die chiropraktiese dissipline en beroep; en (iii) as ’n funksie van die “drie wêrelde”-raamwerk. Die tematiese analise het die volgende blootgelê: 1. Oortuiginge en filosofiese tradisies speel ’n aktiewe rol in die praktyk en wetenskap van chiropraktyk. 2. Die chiropraktiese ondersoekende paradigma is besig om verder te ontwikkel. 3. Die kontekstuele rol van navorsingsmetodes word duideliker gemaak. 4. Hedendaagse chiropraktiese praktyk is nie soveel op bewyse gegrond as wat dit behoort te wees nie. 5. Die chiropraktiese model van praktyk verskil aansienlik van die aanvaarde standaard- mediese model. 6. Die identiteit van chiropraktiese kliniese praktyk is vaag. 7. Chiropraktyk se professionele status is onduidelik. 8. Die professionele en dissiplinêre komponente van chiropraktyk is steeds institusioneel onderontwikkel. 9. Die legitimiteit van chiropraktyk is betwisbaar. Temas 1 tot 3 het daarop gedui dat oortuiginge en filosofiese tradisies die wyses beïnvloed waarop chiropraktisyns klinies handel, waarop pasiënte die wêreld van gesondheidsorg sien, en waarop navorsers kliniese verskynsels bestudeer. Uit temas 4 tot 6 kan afgelei word dat chiropraktiese kliniese praktyk van geneeskunde verskil; die presiese aard van die praktykmodel kom egter heel onbestendig voor. Uit temas 7, 8 en 9 kan afgelei word dat die graad van professionele en institusionele ontwikkeling chiropraktyk slegs gedeeltelik legitimeer

Botlhoko, botlhoko! How people talk about their musculoskeletal complaints in rural Botswana: a focused ethnography

Background: Conflicting interpretations about the structure and function of the body contribute to discordance in communication between healthcare professionals and lay people. Understanding musculoskeletal (MSK) complaints presents additional complexities when discussed in more than one language or in cross-cultural settings. In low- and middle-income countries (LMICs), few healthcare professionals have specialist MSK training and not all practitioners speak the primary language of patients. Objective: Our goal was to understand how people in rural Botswana perceive and express MSK complaints. Design: Ethnographic fieldwork for 8 months in the Botswana Central District included participant observations and interviews with 34 community members with MSK complaints. Audio-recorded interviews were typically conducted in Setswana with an interpreter, transcribed verbatim, and contextually translated into English. Abductive qualitative analysis was used as the interpretive methodology. Results: Whereas initial responses about MSK troubles yielded the exclamation botlhoko, botlhoko! combined with animated non-verbal gestures and facial expressions indicating widespread body pains, in-depth interviews revealed the complexities of pain expression among respondents. MSK pains were described as ‘bursting, exploding, aching, numbness, hot, pricking, stabbing, swollen, and pain in the heart’. Language subtleties manifested during interviews, where ‘meat’ or ‘flesh’ implied soft tissue pains; waist pains were voiced yet portrayed as low back or sacroiliac pain; and ‘veins’ variously referred to structural and functional types of pain. Psychological and social stressors accompanied many accounts of MSK troubles. Conclusions: Respondents offered diverse MSK symptom descriptions consistent with biopsychosocial illness models, yet few communicated complaints using the biomedical language of healthcare providers. Although research interview and transcription processes may not be practical for clinicians, working with interpreters who communicate detailed patient accounts for MSK troubles will complement patient–provider encounters. Community member perceptions of their MSK pain and associated conditions should be explored and incorporated into healthcare interventions and innovations for rural communities in LMICs

Health care encounters in Danish chiropractic practice from a consumer perspectives - a mixed methods investigation

Abstract Background Perceived value is the key ingredient to carving and maintaining a competitive business niche. The opportunities to interact with consumers to understand and enhance perceived value are termed ‘touch points’. Due to the out-of-pocket expense incurred by patients, Danish chiropractors are subject to consumer trends and behaviors. The purpose of this investigation was to explore and describe consumer touch points relevant to perceived value through healthcare journeys in chiropractic practices. Method We designed a convergent parallel, mixed methods study. Our purposive sampling framework identified 11 chiropractic clinics from which we collected observational field notes, video recordings and face-to-face interviews. Results Data was collected between April 14th and June 26th 2014. We described the exteriors and interiors of all participant clinics, interviewed 32 staff members, 12 new patients and 36 follow-up patients and finally video recorded 11 new and 24 follow-up consultations. Categorization and analysis led to the emergence six consumer touch point themes: ‘the internet’, ‘the physical environment’, ‘practice models’, ‘administrative staff’, ‘the consultation sequence and timing’ and ‘a consultation that adds value’. The Internet functions as a tool when choosing/confirming a clinic as appropriate, developing and initial image and managing appointments. The administrative hub appears integral to the shaping of positive consumer experiences outside of the consultation. Clinic location, practice model and interior design may contribute to context effects and thus may influence value perception during the clinical encounter. The duration of hands-on treatment received from the chiropractor is not an apparent consumer focus point. Rather, through a seven stage clinical procedure patients value consultations with clinicians who demonstrate professional competence by effective communication diagnosis/management and facilitating satisfactory treatment outcomes. Conclusion At least six consumer touch points add/detract from value-related experiences in chiropractic practices. The duration of hands-on treatment per se does not appear to be a particular focus point. More research is required to explore this issue