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A better way to measure and interpret pain severity?

Have you ever been challenged with interpreting pain that a patient rates with a number from 0-10? To my knowledge, there is no formula to conveniently and accurately convert a sensation to a number. For example, how do we really know what the number 6 means? I for one, have great difficulty interpreting a...
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More satisfied patient when I sit or stand?

Several years ago, a patient thanked me for making them feel like the only person in my office, no matter how busy the practice seemed. To me, the comment was both rewarding and troubling. Though I had been in practice for several years, it was the first time I recalled a patient making that...
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Pain education, how can it benefit patients?

A recent article published in the journal Spine describes a 30 minute educational program for patients undergoing surgery for lumbar radiculopathy.1 The education focused on giving patients a basic understanding of the physiology of pain. Of the 67 patients in the study, ½ received the educational session. One year post surgery, both patient groups...
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Efficacy evidence for manual therapies

The Journal of Manual and Manipulative Therapy recently published a systematic review of evidence for the efficacy of spinal manipulation, mobilization and soft tissue techniques, exercise, and usual medical care for patients with acute and chronic low back pain (1). The authors found moderate – strong evidence for spinal manipulation for acute and chronic...
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Guidelines for treating adults with neck pain

Clinical guidelines are, in short, recommendations for evidence-based care constructed from a synthesis of clinical trials and systematic reviews. Recently, guidelines for chiropractic treatment of adults with acute and chronic neck pain were published in the Journal of Manipulative and Physiological Therapeutics.(1) The guidelines focus on several types of care provided by doctors of...
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The complex diagnostic process

The diagnostic investigation at its core seeks to discover key information necessary to better understand the patient, the condition, and to better inform care tailored to the patient’s needs and desires. If this statement can be accepted at face value, then I submit that the information seeking at the heart of the diagnostic process...
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A clinical prediction rule

In a previous post, I introduced the evidence-based diagnostic classification system for low back pain (LBP) developed at the Palmer Center for Chiropractic Research (1). We developed the system to facilitate our clinical trial research and to provide a resource for others who wish to use it, especially those in practice settings. The system...
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An evidence-based diagnostic aid

Clinical trials focused on treatment for patients with low back pain (LBP) typically classify patients into few diagnostic categories. Often, after LBP from pathological conditions is ruled out, patients are labeled only with “non-specific LBP.” The generic diagnosis is a repetition of the symptom, and makes it difficult to understand how patients in clinical...
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Chronic Pain: another component

There is growing evidence showing that brain structure can predispose a person to chronic back pain following an injury. In a series of studies, researchers in Chicago IL identified differences in structural connectivity between different areas of the brain. Differences were measurable in a manner that allowed the prediction of patients likely to develop...
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Caregiving 101

I recently read an article highlighting the role nurses can play to reduce the suffering of patients with chronic pain(1). The article cites studies showing how motivation, listening, encouragement, and camaraderie provided by nurses and others can greatly relieve psychological distress and influence how patients with chronic pain deal with and adapt to their...
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