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hey guys, I just checked out the website that has an Ad onthe top of this page.

Is this laser stuff efficacious?

I looked at all the MD's profiles. They seem to be well trained and at great places.

I've never been exposed to Laser use for chronic pain in my residency. I'm not certain if I will during fellowship. What are everyone's thoughts?
 

lobelsteve

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If it sounds too good to be true.......

quote from their website:

AccuraScope™ Discectomy and Neural Decompression (D.N.D.)

AccuraScope™ D.N.D. at North American Spine is a Minimally Invasive, Natural Opening procedure used to both diagnose and treat inter-vertebral discs, spinal stenosis and many other causes of back pain.

Using live x-ray for guidance and a tiny incision, our physicians insert an endoscopic fiber-optic scope, like a small tube, through a small incision in the skin and into a natural opening at the base of the spine.

Our physicians examine the inside of the spinal canal and the discs of the lower back, from both sides of the spinal canal, to identify any tears, ruptures, herniations, bulges, scar tissues or other abnormalities.

Our physicians find inflammation and actually diagnose the source of pain!

Our physicians then use a number of instruments to shrink the damaged disc(s) or scar tissue, or treat the spinal stenosis, and relieve pressure on the spinal nerve(s).

The procedure is usually completed in 30 to 40 minutes. Most patients experience immediate relief.

Patients are returned to the recovery area and are usually discharged approximately one hour after surgery. Patients can walk the same day as their procedure, and can start gentle physical therapy exercises the next day!

Many patients can resume normal activities the following day, and most can return to work in under a week.

North American Spine's approach to AccuraScope™ D.N.D. was pioneered by Lawrence B. Rothstein, M.D. and is currently performed in only two medical facilities in the U.S.
 

hyperalgesia

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I saw this at a booth at a conference last year. They were telling me that mostly they were trying to market to neurosurgeons even though Rothstein is an anesthesiologist. They were vague and non-commital when I asked them if the laser actually ablates disc tissue or bone. When I asked for any peer-reviewed papers to support their product, they were completely unprepared. From my point of view, that's a non-starter :thumbdown:
 
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exactly...they are to spine surgeons what chiropractic "pain doctors" are to us
 
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SleepIsGood

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I saw this at a booth at a conference last year. They were telling me that mostly they were trying to market to neurosurgeons even though Rothstein is an anesthesiologist. They were vague and non-commital when I asked them if the laser actually ablates disc tissue or bone. When I asked for any peer-reviewed papers to support their product, they were completely unprepared. From my point of view, that's a non-starter :thumbdown:
I hear you.

I mean I think for peer reviewed articles since its so new how would they be able to produce it.

But people are right..sounds tooo good.
 
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The second link you sent was for a CESI. That kind of complication could have occurred to anyone that does CESI.

What about "Laser" tx for LBP, herniated discs,etc.

Does it work? Any of you all doing it? I'm sure there are skeptics just like there is for PRF and RF.

Clearly, from these links it seems like Rothstein may have some personal issues. But the others at North American Spine look well credentialed. The guy's personal business is his personal business as far as I am concerned. What he does professionally, is another ball game.
 

algosdoc

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Litigation is a part of our society, and many pain physicians will be sued by a public with unrealistic expectations of perfection. Physicians that have acquired several lawsuits for permanent injuries over a few years time should raise some eyebrows. Physicians that have lost their license to practice for being arrested for using cocaine in public and beating up a prostitute in his car, then are bounced out of the state only to return several years later should raise more eyebrows. (arrest record also available on the internet) Be that as it may, the procedure as has been described by the patients that have had it involve suspension in a harness from the ceiling of the OR and the use of a caudal epiduroscope through which a holmium yag laser is advanced to the level of the disc, then the herniated fragment is vaporized from the back of the disc. It appears the inpissated fragment within the annulus fibrosis is not removed. Does it work? No data at all from anyone. It is cowboy medicine that belongs in the realm of the controlled experimental protocol with data collection.
 

facetguy

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exactly...they are to spine surgeons what chiropractic "pain doctors" are to us
Chiropractors provide safe, effective conservative pain relief for many patients. Not every patient is a candidate, nor is it effective 100%. But what is? Patients who are not responding are referred out to, among others, pain manangement physicians. There's no need to be condescending.
 

Jcm800

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The second link you sent was for a CESI. That kind of complication could have occurred to anyone that does CESI.

What about "Laser" tx for LBP, herniated discs,etc.

Does it work? Any of you all doing it? I'm sure there are skeptics just like there is for PRF and RF.

Clearly, from these links it seems like Rothstein may have some personal issues. But the others at North American Spine look well credentialed. The guy's personal business is his personal business as far as I am concerned. What he does professionally, is another ball game.
i want to comment on a little inside info i have, but i wont...unless it gets moved to the private forum. i keep typing and erasing hahah
 

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Interestingly, I had a older golf buddy get the caudal epiduroscope with laser procedure done by NA Spine approx 2mos ago. He said it was great and feels much better but I see him walking with a limp/giddy-up that wasn't present before. We had talked about doing an LESI before but he decided he didn't want one as one of his family members told him "that stuff doesn't work and caused a family friend's nephew's brother-in-law to become paralyzed". Thus, I haven't asked him about it in any detail
 

algosdoc

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Some of the elderly (and some younger patients) are fools when it comes to health care, jumping on unproven extremist therapies that use slick advertising schemes in an attempt to legitimize their work. If a therapy is legit, it will have human study results to back it up, and these studies will be published in peer reviewed journals. It is unfortunate medicine lacks the ability to police itself and bring punitive measures against those that prey upon the weak minded. On the other hand, perhaps when complications ensure, the patient-fools that knowingly pay out of pocket for unproven therapies get what they deserve....
 

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ampaphb

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Chiropractors provide safe, effective conservative pain relief for many patients. Not every patient is a candidate, nor is it effective 100%. But what is? Patients who are not responding are referred out to, among others, pain manangement physicians. There's no need to be condescending.
Could you possibly provide us with peer reviewed literature that documents that chiropractic pain relief is more efficacious than placebo?
 

ampaphb

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The second link you sent was for a CESI. That kind of complication could have occurred to anyone that does CESI.
Actually, the article doesn't describe the complication, so I have no idea what the complication was that lead to the law suit. What I do know is that most of us would not be either as arrogant or as stupid as Dr. Rothstein was to incur $500,000 in punitive damages for altering/falsifying medical records.
 

Jcm800

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Actually, the article doesn't describe the complication, so I have no idea what the complication was that lead to the law suit. What I do know is that most of us would not be either as arrogant or as stupid as Dr. Rothstein was to incur $500,000 in punitive damages for altering/falsifying medical records.
thats for sure...

it would appear that there is a kinda guy that would get a complication (as we all eventually will if we havent already) and then falsify the medical records to "protect" themselves. its usually is a person with a laser...
 

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Could you possibly provide us with peer reviewed literature that documents that chiropractic pain relief is more efficacious than placebo?
LBP: http://www.ncbi.nlm.nih.gov/pubmed/19028250 (there are dozens of RCTs for spinal manipulation and LBP)

Acute and Chronic LBP: http://www.ncbi.nlm.nih.gov/pubmed/17909210 (note that spinal manipulation is the only treatment in the review recommended for both acute and chronic LBP)

Neck and LBP: http://www.ncbi.nlm.nih.gov/pubmed/15125860

Neck Pain Task Force:
http://www.ncbi.nlm.nih.gov/pubmed/18204393 (spinal mobilization/ manipulation recommended for what they call Grade I and II injuries)

Neck Pain Task Force:
http://www.ncbi.nlm.nih.gov/pubmed/18204386 "Manual therapy and exercise...are more effective than no treatment, sham or alternative interventions"

Chronic Neck Pain: http://www.ncbi.nlm.nih.gov/pubmed/17416276
 

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LBP: http://www.ncbi.nlm.nih.gov/pubmed/19028250 (there are dozens of RCTs for spinal manipulation and LBP)

Acute and Chronic LBP: http://www.ncbi.nlm.nih.gov/pubmed/17909210 (note that spinal manipulation is the only treatment in the review recommended for both acute and chronic LBP)

Neck and LBP: http://www.ncbi.nlm.nih.gov/pubmed/15125860

Neck Pain Task Force:
http://www.ncbi.nlm.nih.gov/pubmed/18204393 (spinal mobilization/ manipulation recommended for what they call Grade I and II injuries)

Neck Pain Task Force:
http://www.ncbi.nlm.nih.gov/pubmed/18204386 "Manual therapy and exercise...are more effective than no treatment, sham or alternative interventions"

Chronic Neck Pain: http://www.ncbi.nlm.nih.gov/pubmed/17416276
facetguy definitely took the bait.
 

SSdoc33

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chiropractic is one thing. chiropractic "pain physician" is another. i think that was the distinction.
 

facetguy

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chiropractic is one thing. chiropractic "pain physician" is another. i think that was the distinction.
There's no such thing as a "chiropractic pain physician". Dealing with pain patients is inherent to chiropractic practice.
 

facetguy

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All of those articles and more are well refuted by Mark Crislip, MD.
www.quackcast.com

Podcast # 10, 11, 27, 33, 40
Ampaphb asked for peer-reviewed literature, so that's what I provided. Anyone is free to critique the literature. But to say there is no such literature would be inaccurate.

Now, if one were to argue that spinal manipulation (alone) is not much better than any other treatments typically used for neck and back pain, perhaps a case could be made. But I think that simply speaks to the fact that no form of treatment has a perfect track record in terms of outcomes for neck and back pain, as we all know.
 

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Ampaphb asked for peer-reviewed literature, so that's what I provided. Anyone is free to critique the literature. But to say there is no such literature would be inaccurate.

Now, if one were to argue that spinal manipulation (alone) is not much better than any other treatments typically used for neck and back pain, perhaps a case could be made. But I think that simply speaks to the fact that no form of treatment has a perfect track record in terms of outcomes for neck and back pain, as we all know.
That part sounds good, but when the science meets the road....

1. There is no such thing as the chiropractic subluxation based on anatomic-pathological correlates.
 

facetguy

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That part sounds good, but when the science meets the road....

1. There is no such thing as the chiropractic subluxation based on anatomic-pathological correlates.
How about if we instead call it a functional spinal lesion, or a somatic lesion, or joint dysfunction, or a manipulable lesion? I agree that 'subluxation' was not the best choice of terms. And it also doesn't help that many folks (including some chiropractors, unfortunately) still envision the old model of subluxation, i.e., a bone out of place choking off a nerve.
 

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How about if we instead call it a functional spinal lesion, or a somatic lesion, or joint dysfunction, or a manipulable lesion? I agree that 'subluxation' was not the best choice of terms. And it also doesn't help that many folks (including some chiropractors, unfortunately) still envision the old model of subluxation, i.e., a bone out of place choking off a nerve.
No fair, you are making this as a reasonable argument. I'm in ATL. If our local DC's can't strip the PIP and kick them to the curb, they get them in their VAX-D units.

You must have trained somewhere respectable (anywhere but LIFE).

Look guys, no dark orchid!!!
 

facetguy

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No fair, you are making this as a reasonable argument. I'm in ATL. If our local DC's can't strip the PIP and kick them to the curb, they get them in their VAX-D units.

You must have trained somewhere respectable (anywhere but LIFE).

Look guys, no dark orchid!!!
Ha! New York grad here. (Can you give me a heads-up on the 'dark orchid' thing?)
 
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Great..now there are quacks, i mean chiropractors on here?

Seriously?

Chiropractors are not "physicians'. They are chiropractors..PERIOD.
 

Jcm800

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Great..now there are quacks, i mean chiropractors on here?

Seriously?

Chiropractors are not "physicians'. They are chiropractors..PERIOD.

im gonna have to agree with you on that one...
which is why most of what i post is on the private forum...
 

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look at their demo video on their website ---- it is hysterical...
 

facetguy

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Great..now there are quacks, i mean chiropractors on here?

Seriously?

Chiropractors are not "physicians'. They are chiropractors..PERIOD.
im gonna have to agree with you on that one...
which is why most of what i post is on the private forum...
You guys sound like a couple of babies. I routinely get referrals from, and refer patients to, pain management. So if I see something in this forum that I think may benefit me and my patients, I'm going to read it. 99.9% of the time I don't post any comments. But early in the thread someone made an uncalled for derogatory comment about chiropractors, so I simply responded. Big deal.

As to posting in the private forum, please do and spare the rest of us from your whining.
 

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I actually do work with a few select chiropractors in the community. When I get patients who ask for a referral or can't tolerate physical therapy in any form, I will refer to them. I have actually gone to their offices, met with them, and picked their minds about their treatment philosophy to make sure they are "conservative"(no latest and greatest gadgets to sell) and know their limits and when to stop. They also don't claim to cure diabetes or cancer :laugh:

There are many quacks in chiropractic as well as in medicine. Vulnerable patients in pain get taken advantage of by many practitioners including chiros, doctors, naturopaths, snake oil salesmen, etc. When patients tell me they were in the "one year chiropractic program" or they paid "$2000 for the 'spinal decompression' treatment", I get upset. I have also seen complications of chiropractic treatment (stroke, compression fracture, etc.). But I also get upset when they tell me they went through a series of 3 epidurals, facet blocks, RFA, stimulator trial, back to back while only seeing a NP or a PA in clinic. (doctor sits in procedure suite all day every day) Obviously, none of the above worked because they are in my office to see me for their pain. The number of times I have diagnosed SI joint pain in someone who has gone through the series of 3 and blocks/RFA is astounding.

I teach my patients the difference between "passive" and "active" treatment. most passive treatments give temporary relief including traction, TENS unit, massage, chiro, and even injections. When patients take a more active role in healing themselves by going to PT, losing weight, getting more active, they tend to do better.
 

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With trepidation jumping into the chiro hijack discussion (almost as much fun as a MD vs. DO thread on the student forums!:rolleyes:)

I think the crux of the problem is not spinal manipulation or chiropractic as a modality. The problem, as likely the cause of pain physcian anger here, is the way some individual chiropractic practices market and execute their training.

I have several family members who are chiros, some I would send pts to and some I wouldn't. I think a better practice is where the chiro works hand in hand with other medical professionals as a specialist who treats and communcates the results with the PCP who should be the captain of the ship so to speak. Where I think folks who are MDs/DOs get pissed is when a D.C. goes cowboy, telling the pt. western medicine will kill them, and signs them up for 2 treatments a week from here until hell freezes over and doesn't know the limits of their training.

I'm not sure pain medicine (or other specialities for that matter) should get into a pissing contest over evidence. As a D.O. who uses manual med, I fell very confident in the evidence that says it is a reasonable and useful treatment. Like anything we offer chronic pain pts, we can trial it, if it works I'll repeat as needed, but not more than q2-4 wks in an acute case and less in chronic and they should see PT as well. If it doesn't work don't keep beating the horse just for $$$.

If you think chiro is quackery then I assume you never use PT? --b/c there is a lot of crossover.

Direct your anger at individuals and not a profession. Find a chiro in your area who is a consumate professional and let them lead by example. Or find a D.O. who can offer these services if you can't yourself.

facetguy sounds like a reasonable person until proven otherwise. Let us show the professionism we demand of them.
 

facetguy

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I actually do work with a few select chiropractors in the community. When I get patients who ask for a referral or can't tolerate physical therapy in any form, I will refer to them. I have actually gone to their offices, met with them, and picked their minds about their treatment philosophy to make sure they are "conservative"(no latest and greatest gadgets to sell) and know their limits and when to stop. They also don't claim to cure diabetes or cancer :laugh:

There are many quacks in chiropractic as well as in medicine. Vulnerable patients in pain get taken advantage of by many practitioners including chiros, doctors, naturopaths, snake oil salesmen, etc. When patients tell me they were in the "one year chiropractic program" or they paid "$2000 for the 'spinal decompression' treatment", I get upset. I have also seen complications of chiropractic treatment (stroke, compression fracture, etc.). But I also get upset when they tell me they went through a series of 3 epidurals, facet blocks, RFA, stimulator trial, back to back while only seeing a NP or a PA in clinic. (doctor sits in procedure suite all day every day) Obviously, none of the above worked because they are in my office to see me for their pain. The number of times I have diagnosed SI joint pain in someone who has gone through the series of 3 and blocks/RFA is astounding.

I teach my patients the difference between "passive" and "active" treatment. most passive treatments give temporary relief including traction, TENS unit, massage, chiro, and even injections. When patients take a more active role in healing themselves by going to PT, losing weight, getting more active, they tend to do better.
Good post. You should be commended for taking such an active interest in your patients. There are good and bad in medicine, chiro, PT, etc. Chiros tend to be the boogeymen in these forums, but like you, I've seen plenty of overtreatment done at the hands of pain mgmt docs, with the obvious difference being way higher costs and risks to the patient. And I agree that it is clear that there needs to be an active component to treatment, particularly for chronic pain patients (and most chiros practice this way today).
 

facetguy

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With trepidation jumping into the chiro hijack discussion (almost as much fun as a MD vs. DO thread on the student forums!:rolleyes:)

I think the crux of the problem is not spinal manipulation or chiropractic as a modality. The problem, as likely the cause of pain physcian anger here, is the way some individual chiropractic practices market and execute their training.

I have several family members who are chiros, some I would send pts to and some I wouldn't. I think a better practice is where the chiro works hand in hand with other medical professionals as a specialist who treats and communcates the results with the PCP who should be the captain of the ship so to speak. Where I think folks who are MDs/DOs get pissed is when a D.C. goes cowboy, telling the pt. western medicine will kill them, and signs them up for 2 treatments a week from here until hell freezes over and doesn't know the limits of their training.

I'm not sure pain medicine (or other specialities for that matter) should get into a pissing contest over evidence. As a D.O. who uses manual med, I fell very confident in the evidence that says it is a reasonable and useful treatment. Like anything we offer chronic pain pts, we can trial it, if it works I'll repeat as needed, but not more than q2-4 wks in an acute case and less in chronic and they should see PT as well. If it doesn't work don't keep beating the horse just for $$$.

If you think chiro is quackery then I assume you never use PT? --b/c there is a lot of crossover.

Direct your anger at individuals and not a profession. Find a chiro in your area who is a consumate professional and let them lead by example. Or find a D.O. who can offer these services if you can't yourself.

facetguy sounds like a reasonable person until proven otherwise. Let us show the professionism we demand of them.
I'm beginning to like this thread.

As stated above, find a chiro in your area that you can trust. You only need one. He or she can be a real asset to you and your patients. Who cares if there are a bunch of other wacky chiros in the neighborhood (let the chiro profession worry about that).
 

ampaphb

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Your attempt at providing literature, while laudable, belies the standard chiropractic misunderstanding and lack of sophistication that all neck and back pain can be addressed by a one size fits all approach. Note that every one of the studies you cited address neck and back pain as if the symptom defined the disease. Your "wacky" colleagues will perform all manner of radiographic studies, but will ultimately perform the exact same treatment algorithm, no matter what lines they draw on the films.

Medical professionals first try to isolate the pain generator, and then tailor or treatment to the underlying pathology. Therein lies the bright line difference between D.Os and chiros. D.O.s incorporate manual medicine as a component of a comprehensive treatment plan, based on the patient's presentation, and diagnostic studies, and tailor and fine tune them based on patient response.

You recommend the use of terms like functional spinal lesion, or a somatic lesion, or joint dysfunction, or a manipulable lesion. These are nonsense terms, and basically all mean we can perform manipulation on them, and there are no objective findings we need before we start treating the patient, nor is there any measurable endpoint beyond which we should stop treatment.

Based on your preferred terms, we can assume subluxations is not the underlying pathology. So what is? Your terms provide no insight to the pathophysiology of the "lesions" you claim to be treating. Why are you doing what you are doing? If you have no idea what you are doing, this question would be moot.

This then undermines the concept of a "good" chiropractor. Not claiming to cure cancer, provide prophylactic good health, cure asthma, or auto-immune diseases, or treat children means you are not a charlatan. I suppose limiting yourself to "treating" generalized neck and back pain might make you less reprehensible than those who claim to do more.

The "well there are good and bad in any profession," argument doesn't wash bewcuase there is no such thing as a "good" chiro, IMHO. My experience is, docs work with chiros for referrals. We have no idea what you do, and the "less bad" of you steal less of the patient's money, and run them through less of a mill, than your reprehensible brethren. The ones who treat kids and claim to increase immunity, as well as those who demand cash from even the poorest of their patients for phony technologies like the DRX-9000 and its progeny have a special place in hell waiting for them (right next to the guys from LSI and MicroSpine). Unless you can show me that chiropractic has some actual impact on the specific disease process (whatever, in fact, it is you claim to be treating, other than generalized neck and back pain) I will be hard pressed to know how to determine who, exactly, is a "good" chiropractor.

Until you can tell me what you are doing, and why it works, I think your laying on of hands and talking to patients is the most effective element of your care. For my patients, those are awfully expensive sugar pills.
 
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facetguy

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Your attempt at providing literature, while laudable, belies the standard chiropractic misunderstanding and lack of sophistication that all neck and back pain can be addressed by a one size fits all approach. Note that every one of the studies you cited address neck and back pain as if the symptom defined the disease. Your "wacky" colleagues will perform all manner of radiographic studies, but will ultimately perform the exact same treatment algorithm, no matter what lines they draw on the films.
Let's not confuse the various types of literature available. You asked me for "peer reviewed literature that documents that chiropractic pain relief is more efficacious than placebo". As such, those are the studies I provided. It's a function of how these studies are done, not a limitation of a chiropractor's understanding of spinal pain and function, that these studies look at "neck pain" or "low back pain". Clearly, the symptom doesn't define the disease, yet that's how this research is done. By the way, at least some of this research isn't even done by chiros, so it's not some chiro thing.

Medical professionals first try to isolate the pain generator, and then tailor or treatment to the underlying pathology.
And chiropractors don't?? Believe me, friend, I am quite interested in whether a patient's pain is being generated by a fracture or tumor, or a facet joint or a disc. Why would you think otherwise? If anything, chiros are among those who are more interested in pain generators, and therefore tailor their examinations along those lines, than most others treating spine pain, with obvious exceptions.

Therein lies the bright line difference between D.Os and chiros. D.O.s incorporate manual medicine as a component of a comprehensive treatment plan, based on the patient's presentation, and diagnostic studies, and tailor and fine tune them based on patient response.
Chiropractors do the same thing. DCs practice this way if for no other reason (and there are of course other reasons) than to avoid getting sued. The lame notion of all DCs simply lying patients down and banging on their spines is completely ridiculous and suggests a degree of ignorance on your part.

You recommend the use of terms like functional spinal lesion, or a somatic lesion, or joint dysfunction, or a manipulable lesion. These are nonsense terms, and basically all mean we can perform manipulation on them, and there are no objective findings we need before we start treating the patient, nor is there any measurable endpoint beyond which we should stop treatment.
I suggested these terms mostly in jest to concede that the term 'subluxation' is not a very good one. But these terms have been used by non-DCs to describe the same things. I don't think they are any more nonsense terms than 'non-specific neck pain' or 'non-specific back pain', which shows up all the time in medical circles.
 

ampaphb

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Let's not confuse the various types of literature available. You asked me for "peer reviewed literature that documents that chiropractic pain relief is more efficacious than placebo".
Quite right. But what you provided me was GIGO research. If you address all chest pain with cardiac meds, do you really think the results would be valid if you include those who had heartburrn or costochondritis?

Chiros are among those who are more interested in pain generators, and therefore tailor their examinations along those lines.
So by all means enlighten us - we poor medical dolts don't have physical examination techniques that can definitively determine pain generators. We are not so arrogant as to believe that MRIs provide all the answers, nor document anything specific about pain. So if chiropractors do, by all means, please educate us.

do the same thing. DCs practice this way if for no other reason (and there are of course other reasons) than to avoid getting sued. The lame notion of all DCs simply lying patients down and banging on their spines is completely ridiculous and suggests a degree of ignorance on your part.
Then please teach me - how do you distinguish facet pain from discogenic symptoms. What techniques do you use in each instance? How many sessions do you advise before reconsidering your diagnosis? When is the use of "decompression" acceptable? What presentation suggests it is time to send the patient on to another type of specialist. And even if your responses are reasonable, , in my experience, that would set you, at minimum, 2SDs beyond the mean of your colleagues, who do, in fact, by and large employ the one size fits all approach.

I don't think they are any more nonsense terms than 'non-specific neck pain' or 'non-specific back pain', which shows up all the time in medical circles.
Those are terms of exclusion, used typically by generalists (FPs and internists). Chiropractors present themselves as specialists in neck and back pain. As such, they are help to the standard of other specialists, where the use of "non-specific" or "generalized" pain typically generates a referral to either the psychiatrist or rheumatolgist, not a year of three times a week shake and bake.
 
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facetguy

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Based on your preferred terms, we can assume subluxations is not the underlying pathology. So what is? Your terms provide no insight to the pathophysiology of the "lesions" you claim to be treating. Why are you doing what you are doing? If you have no idea what you are doing, this question would be moot.
First, let's establish that chiropractic care (at least in the traditional sense) best addresses functional musculoskeletal problems, particularly involving the spine. That's where the most research is, and that's what chiropractors as a group do best.

So why do we do what we do? Chiropractic care, or at least the spinal mobilization/manipulation component thereof, seeks to normalize motion of the spinal motion segments. Doing so restores normal afferentation, particularly mechanoreceptive information. Restoring normal mechanoreception, as you know, helps reduce pain. It also improves motor control, firing patterns and coordination, motion, stabilization, et cetera. It's not about 'cracking backs' but improving the neuromechanics, if you will, to dysfunctional motion segments.

I think it would have been much more accurate for you to have said that YOU have no idea what chiropractors do or why they do it. But we do, and I think that's more important, no?

This then undermines the concept of a "good" chiropractor. Not claiming to cure cancer, provide prophylactic good health, cure asthma, or auto-immune diseases, or treat children means you are not a charlatan. I suppose limiting yourself to "treating" generalized neck and back pain might make you less reprehensible than those who claim to do more.
I don't consider myself reprehensible at all.

The "well there are good and bad in any profession," argument doesn't wash becuase good and bad in both professions.
Uh, ok. Let's agree that there are good and bad in both professions.

My experience is, docs work with chiros for referrals. We have no idea what you do, and the "less bad" of you steal less of the patient's money, and run them through less of a mill, than your reprehensible brethren.
You are painting with a rather broad brush. Everyone reading along here knows at least one pain mgmt doc who will stick a patient with as many needles as the insurance will pay for. Let's not pretend otherwise.

The ones who treat kids and claim to increase immunity, as well as those who demand cash from even the poorest of their patients for phony technologies like the DRX-9000 and its progeny have a special place in hell waiting for them (right next to the guys from LSI and MicroSpine). Unless you can show me that chiropractic has some actual impact on the specific disease process (whatever, in fact, it is you claim to be treating, other than generalized neck and back pain) I will be hard pressed to know how to determine who, exactly, is a "good" chiropractor.
You are referring here to the basic science literature. We've long known that spinal manipulation has all kinds of neurophysiologic and biomechanical effects. The question has always been "but what does all that mean to treating patients with neck and back pain?". Enter the literature I provided for you earlier in the thread. Like it or not, that's where the rubber meets the road.


Until you can tell me what you are doing,
Done.

and why it works,
Done

I think your laying on of hands and talking to patients is the most effective element of your care. For my patients, those are awfully expensive sugar pills.
You are of course entitled to your opinion, even if it's based on faulty, or a frank lack of, information.
 

ampaphb

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So why do we do what we do? Chiropractic care, or at least the spinal mobilization/manipulation component thereof, seeks to normalize motion of the spinal motion segments.
Please show me literature that shows that, in fact, chiropractic care normalize motion of the spinal motion segments.

Doing so restores normal afferentation, particularly mechanoreceptive information.
Show me literature that shows that chiropractic care restores normal afferentation, particularly mechanoreceptive information.

It's not about 'cracking backs' but improving the neuromechanics, if you will, to dysfunctional motion segments.
Show me literature that shows that chiropractic care improves the neuromechanics, to dysfunctional motion segments.

Unless you have basic science to back up the axiomatic tenets of your field, and science can actually document that chiropractic care can do what it claims it can do, all you have is a bunch of well-packaged pseudoscientifc jargon.
 
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facetguy

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Quite right. But what you provided me was GIGO research. If you address all chest pain with cardiac meds, do you really think the results would be valid if you include those who had heartburrn or costochondritis?

So by all means enlighten us - we poor medical dolts don't have physical examination techniques that can definitively determine pain generators. We are not so arrogant as to believe that MRIs provide all the answers, nor document anything specific about pain. So if chiropractors do, by all means, please enlighten the rest of us.
You are misrepresenting my position. You conveniently edited out where I stated "with obvious exception". I happen to feel that pain management docs are very helpful to me and my patients, arguably more helpful than any other specialty, and I have much respect for what you do. But truth is, primary care docs don't typically concern themselves with the nitty gritty of spinal pain. Orthopedic docs typically don't add much useful spinal diagnostic information for me either, at least in a functional capacity; it's my experience that they live in a more structual framework. Physiatrists and pain docs help me the most.

Then please educate me - how do you distinguish facet pain from discogenic symptoms.
As you are well aware, using invasive measures for diagnostic purposes usually yields the most specific information. But do all patients need to undergo such invasive procedures? Or can we use our best clinical judgement and proceed with conservative measures first and see how it goes?

What techniques do you use in each instance? How many sessions do you advise before reconsidering your diagnosis? When is the use of "decompression" acceptable? What presentation suggests it is time to send the patient on to another type of specialist. And even if your responses are reasonable, , in my experience, that would set you, at minimum, 2SDs beyond the mean of your colleagues, who do, in fact, by and large employ the one size fits all approach.
I'm not sure I can provide any answer that would satisfy you, given your entrenched bias.

Those are terms of exclusion, used typically by generalists (FPs and internists). Chiropractors present themselves as specialists in neck and back pain. As such, they are help to the standard of other specialists, where the use of "non-specific" or "generalized" pain typically generates a referral to either the psychiatrist or rheumatolgist, not a year of three times a week shake and bake.
Shake and bake. I like that. I'll try it out on my next patient.
 
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Hey chiropractor

why dont you go hijack another thread? Better yet why dnt you go to one of the chiropractory forums? dont you guys have one of those?
 

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i think it's a dying field and rightfully so. too many chiro mills around taking advantage of hopeful, but misguided patients. yea, plenty of pain people doing that too, but they are just greedy. if one wanted to be a great pain physician (term reserved for MD and DO) one could - based on a culture of real scientific principles. one could continue real research to advance both basic science and clinical practice. this is impossible in chiropractics, as the profession is based on pseudoscientific nonsense. so even if you are an honest practitioner, you are still at the level of a shaman. chiropractics is science like christian science is science...
 

facetguy

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Hey chiropractor

why dont you go hijack another thread? Better yet why dnt you go to one of the chiropractory forums? dont you guys have one of those?
You say hijack, I say answering questions being posed to me.
 

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i think it's a dying field and rightfully so. too many chiro mills around taking advantage of hopeful, but misguided patients. yea, plenty of pain people doing that too, but they are just greedy. if one wanted to be a great pain physician (term reserved for MD and DO) one could - based on a culture of real scientific principles. one could continue real research to advance both basic science and clinical practice. this is impossible in chiropractics, as the profession is based on pseudoscientific nonsense. so even if you are an honest practitioner, you are still at the level of a shaman. chiropractics is science like christian science is science...
Hey Jeff, be honest. How much have you really examined chiropractic? My guess is you haven't done any due diligence prior to forming your opinion. Just a hunch.
 

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here are some citations that I have used in my manual med lectures:


Increased joint ROM has been shown by MRI (Cramer, JMPT 2000)

Decreased L-spine SSEPs post manipulation (Zhu, Spine 1993)


More than 50 RCTs of SMT for LBP
Many meta-analyses and reviews
• “We found no evidence that spinal manipulative therapy was superior to other advocated therapies…Therefore, we conclude that spinal manipulative therapy is one of several options of only modest effectiveness for patients with low-back pain.”

Assendelft WJJ et al. Spinal manipulative therapy for low-back pain. Cochrane Back Group, Cochrane Database of Systematic Reviews. 4, 2006.



“None of the clinical trials of lumbar manipulation reported any complications”
Swenson, JAAOS 2003




There is no unified theory for the effects of spinal manipulation. But then again nor for SCS or PNS or ONS.

However flawed you feel the man med literature is how many RCTs do we have for most pain procedures?




•
This discussion has degraded rather quickly and I really doubt either side will agree.

This facetguy has not been a jerk so why treat him that way?
 
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Firstly no one cares what's written in a "chiro" magazine, I mean their version of a 'journal'.

Secondly, if you went to medical school you would realize that a meta analysis is worth basically NOTHING. So referring to those types of studies doesnt save your cause.

Stuff published in random journals and in chiro journals have just as much utility as stuff that goes into 'nursing journals'. Most medical journals have physicians that peer review topics.

Again, using the term "pain physician" should be solely dedicated to people that went to MEDICAL SCHOOL. The term 'physician' is dedicated to someone that went to medical school. Any joe blow can do chiro school and do a few manipulations. When you call yourself a 'physician' you are essentially committing fraud as it misrepresents your degree to your patient.

Cant wait for that bill to pass that makes sure everyone's occupation is properly identified.