Outcomes for chronic neck and low back pain patients after manipulation under anesthesia: a prospective cohort study

BACKGROUND: The purpose of this study was to investigate outcomes of chronic patients unresponsive to previous spinal manipulative therapy subsequently treated with manipulation under anesthesia (MUA). METHODS: A prospective outcome cohort study was performed on 30 patients who had not improved with previous treatment and who underwent a single MUA by a doctor of chiropractic. The numeric rating scale for pain (NRS) and Bournemouth Questionnaire (BQ) were collected at 2 weeks and 1 day before MUA. At 2 and 4 weeks after MUA, the Patient's Global Impression of Change, NRS, and BQ were collected. The intraclass correlation coefficient evaluated stability before treatment. Percentage of patients "improved" was calculated at 2 and 4 weeks. Wilcoxon test compared pretreatment NRS and BQ scores with posttreatment scores. Mann-Whitney U test compared individual questions on the BQ between improved and not improved patients. Logistic regression compared BQ questions to "improvement." RESULTS: Good stability of NRS and BQ scores before MUA (intraclass correlation coefficient=0.46-0.95) was found. At 2 weeks, 52% of the patients reported improvement with 45.5% improved at 4 weeks. Significant reductions in NRS scores at 4 weeks (P=.01) and BQ scores at 2 (P=.008) and 4 weeks (P=.001) were reported. Anxiety/stress levels were significantly different at 2 and 4 weeks between improved and not improved patients (P=.007). None of the BQ questions were predictive of improvement. CONCLUSION: Approximately half of patients previously unresponsive to conservative treatment reported clinically relevant improvement at 2 and 4 weeks post-MUA

Climate Warming and Past and Present Distribution of the Processionary Moths (Thaumetopoea spp.) in Europe, Asia Minor and North Africa

International audiencePine processionary moth, Thaumetopea pityocampa, is a model insect indicator of global warming, the northwards and upwards range expansion of this Mediterranean species being directly associated with the recent warming up. The knowledge about the drivers of moth expansion is synthesized. A first standardized mapping of the northern expansion edge, from Western Europe to Turkey, is presented, then detailed for 20 countries of Europe, Asia Minor and North Africa, including future trends. Additional data about the responses of the other Thaumetopoea species are given. Finally, the chapter points out the importance of the man-mediated introductions in the expansion process