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Low SYY, Ker JR, Ng LP, Seow WT, Low DCY. Thoracic epidural haematoma after spinal manipulation treatment. Childs Nerv Syst 2019; 35:735-737. [PMID: 30903282 DOI: 10.1007/s00381-019-04122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore.
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore.
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore.
| | - Justin R Ker
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
| | - Lee Ping Ng
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
- SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, 308433, Singapore, Singapore
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Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, Thacker H, Shankar A, Ramachandran L, Kalra S. Unproven Therapies for Diabetes and Their Implications. Adv Ther 2017; 34:60-77. [PMID: 27864668 PMCID: PMC5216071 DOI: 10.1007/s12325-016-0439-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.
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Affiliation(s)
| | - Banshi Saboo
- Dia Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Hemant Thacker
- Department of Endocrinology, Bhatia Hospital, Mumbai, India
| | - Arun Shankar
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, Haryana, India
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Day GS, Swartz RH, Chenkin J, Shamji AI, Frost DW. Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review. CAN J EMERG MED 2016; 16:164-70. [PMID: 24626124 DOI: 10.2310/8000.2013.131059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good.
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von Heymann W. Stufenschema der Diagnostik vor Stellung der Indikation einer Röntgendiagnostik. MANUELLE MEDIZIN 2015. [DOI: 10.1007/s00337-015-1237-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Creighton D, Gruca M, Marsh D, Murphy N. A comparison of two non-thrust mobilization techniques applied to the C7 segment in patients with restricted and painful cervical rotation. J Man Manip Ther 2014; 22:206-12. [PMID: 25395829 DOI: 10.1179/2042618614y.0000000077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Cervical mobilization and manipulation have been shown to improve cervical range of motion and pain. Rotatory thrust manipulation applied to the lower cervical segments is associated with controversy and the potential for eliciting adverse reactions (AR). The purpose of this clinical trial was to describe two translatory non-thrust mobilization techniques and evaluate their effect on cervical pain, motion restriction, and whether any adverse effects were reported when applied to the C7 segment. METHODS This trial included 30 participants with painful and restricted cervical rotation. Participants were randomly assigned to receive one of the two mobilization techniques. Active cervical rotation and pain intensity measurements were recorded pre- and post-intervention. Within group comparisons were determined using the Wilcoxon signed-rank test and between group comparisons were analyzed using the Mann-Whitney U test. Significance was set at P = 0.05. RESULTS Thirty participants were evaluated immediately after one of the two mobilization techniques was applied. There was a statistically significant difference (improvement) for active cervical rotation after application of the C7 facet distraction technique for both right (P = 0.022) and left (P = 0.022) rotation. Statistically significant improvement was also found for the C7 facet gliding technique for both right (P = 0.022) and left rotation (P = 0.020). Pain reduction was statistically significant for both right and left rotation after application of both techniques. Both mobilization techniques produced similar positive effects and one was not statistically superior to the other. DISCUSSION A single application of both C7 mobilization techniques improved active cervical rotation, reduced perceived pain, and did not produce any AR in 30 patients with neck pain and movement limitation. These two non-thrust techniques may offer clinicians an additional safe and effective manual intervention for patients with limited and painful cervical rotation. A more robust experimental design is recommended to further examine these and similar cervical translatory mobilization techniques.
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Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. ACTA ACUST UNITED AC 2014; 20:335-41. [PMID: 25454683 DOI: 10.1016/j.math.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022]
Abstract
Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making. This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP. AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. Standardized questions were asked at each treatment; participants were additionally encouraged to report AE as they occurred. Qualitative interviews documented participants' experiences with AE. Descriptive statistics and content analysis were used to categorize and report these data. Compliance was high among the 241 randomized participants. Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.
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von Heymann W, Terrier B. Leitlinien über die Grundlagen der Aus- und Weiterbildung und der Sicherheit in manueller/muskuloskeletaler Medizin. MANUELLE MEDIZIN 2014. [DOI: 10.1007/s00337-014-1105-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lidder S, Lang KJ, Masterson S, Blagg S. Acute spinal epidural haematoma causing cord compression after chiropractic neck manipulation: an under-recognised serious hazard? J ROY ARMY MED CORPS 2011; 156:255-7. [PMID: 21275361 DOI: 10.1136/jramc-156-04-11] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Spinal manipulative therapy performed by chiropractors is increasingly common in the United Kingdom. Spinal epidural haematoma is a rare complication of such physical therapy but when identified represents a neurological emergency. We describe the case of a 64 year-old man who presented with a dense hemiplegia due to a spinal epidural haematoma following cervical spine manipulation performed for acute neck pain. The clinical features and surgical management of the case are discussed and we stress the importance of recognition of chiropractic manipulation as a potential cause of neurological sequelae and discuss the potential pitfalls of such therapy as it becomes more widespread.
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Affiliation(s)
- S Lidder
- ST3 in Trauma and Orthopaedics, Royal London Hospital, Whitechapel Road, London, UK.
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Carlesso LC, Cairney J, Dolovich L, Hoogenes J. Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective. ACTA ACUST UNITED AC 2011; 16:440-6. [PMID: 21377403 DOI: 10.1016/j.math.2011.02.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 01/31/2011] [Accepted: 02/03/2011] [Indexed: 11/17/2022]
Abstract
Rare, serious, and common, benign adverse events (AE) are associated with MT techniques. A proposed standard for defining AE in manual therapy (MT) practise has been published but it did not include the patient perspective. Research comparing clinician and patient reporting of AE demonstrates that several differences exist; for example, the reporting of objective versus subjective events. The objective of this study was to describe how patients define AE associated with MT techniques. A descriptive qualitative design was employed. Semi-structured interviews were used with a purposive sample of patients (n = 13) receiving MT, from physiotherapy, chiropractic and osteopathic practises in Ontario, Canada. The interview guide was informed by existing evidence and consultation with content and methodological experts. Interviews were audiotaped and transcribed verbatim. Date were analysed by two independent team members using thematic content analysis. A key finding was that patients defined mild, moderate and major AE by pain/symptom severity, functional impact, duration and by ruling out of alternative causes. An overarching theme identified multiple factors that influence how the AE is perceived. These concepts differ from the previously proposed framework for defining AE that did not include the patient perspective. Future processes to create standard definitions or measures should include the patient viewpoint to provide a broader, client-centred foundation.
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Affiliation(s)
- Lisa C Carlesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
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Bilateral vertebral artery dissection after chiropractic maneuver. Clin Neuroradiol 2010; 20:255-9. [PMID: 20959946 DOI: 10.1007/s00062-010-0021-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/07/2010] [Indexed: 10/18/2022]
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Adverse events associated with the use of cervical manipulation and mobilization for the treatment of neck pain in adults: a systematic review. ACTA ACUST UNITED AC 2010; 15:434-44. [PMID: 20227325 DOI: 10.1016/j.math.2010.02.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 11/14/2009] [Accepted: 02/11/2010] [Indexed: 01/31/2023]
Abstract
Adverse events (AE) are a concern for practitioners utilizing cervical manipulation or mobilization. While efficacious, these techniques are associated with rare but serious adverse events. Five bibliographic databases (PubMed, CINAHL, PEDro, AMED, EMBASE) and the gray literature were searched from 1998 to 2009 for any AE associated with cervical manipulation or mobilization for neck pain. Randomized controlled trials (RCTs), prospective or cross-sectional observational studies were included. Two independent reviewers conducted study selection, method quality assessment and data abstraction. Pooled relative risks (RR) were calculated. Study quality was assessed using the Cochrane system, a modified Critical Appraisal Skills Program form and the McHarm scale to assess the reporting of harms. Seventeen of 76 identified citations resulted in no major AE. Two pooled estimates for minor AE found transient neurological symptoms [RR 1.96 (95% CI: 1.09-3.54) p < 0.05]; and increased neck pain [RR 1.23 (95% CI: 0.85-1.77) p > .05]. Forty-four studies (58%) were excluded for not reporting AE. No definitive conclusions can be made due to a small number of studies, weak association, moderate study quality, and notable ascertainment bias. Improved reporting of AE in manual therapy trials as recommended by the CONSORT statement extension on harms reporting is warranted.
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What is 'manipulation'? A reappraisal. ACTA ACUST UNITED AC 2010; 15:286-91. [PMID: 20080431 DOI: 10.1016/j.math.2009.12.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 11/03/2009] [Accepted: 12/21/2009] [Indexed: 11/19/2022]
Abstract
Due primarily to its colloquial function, 'manipulation' is a poor term for distinguishing one healthcare intervention from another. With reports continuing to associate serious adverse events with manipulation, particularly relating to its use in the cervical spine, it is essential that the term be used appropriately and in accordance with a valid definition. The purpose of this paper is to identify empirically-derived features that we propose to be necessary and collectively sufficient for the formation of a valid definition for manipulation. A final definition is not offered. However, arguments for and against the inclusion of features are presented. Importantly, these features are explicitly divided into two categories: the 'action' (that which the practitioner does to the recipient) and the 'mechanical response' (that which occurs within the recipient). The proposed features are: 1) A force is applied to the recipient; 2) The line of action of this force is perpendicular to the articular surface of the affected joint; 3) The applied force creates motion at a joint; 4) This joint motion includes articular surface separation; 5) Cavitation occurs within the affected joint.
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Profile of members of the Australian Osteopathic Association: Part 1 – The practitioners. INT J OSTEOPATH MED 2009. [DOI: 10.1016/j.ijosm.2008.04.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cervical arterial dysfunction and manual therapy: A critical literature review to inform professional practice. ACTA ACUST UNITED AC 2008; 13:278-88. [DOI: 10.1016/j.math.2007.10.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 10/29/2007] [Accepted: 10/30/2007] [Indexed: 11/23/2022]
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Cashley M, Cashley M, McWilliam R, Steen L. BISIMAN study: The background incidence of stroke in manipulation in the United Kingdom. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.clch.2008.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leon-Sanchez A, Cuetter A, Ferrer G. Cervical Spine Manipulation: An Alternative Medical Procedure with Potentially Fatal Complications. South Med J 2007; 100:201-3. [PMID: 17330693 DOI: 10.1097/smj.0b013e31802ed21f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are multiple reports in the literature of serious and at times fatal complications after cervical spine manipulation therapy (CSMT), even though CSMT is considered by some health providers to be an effective and safe therapeutic procedure for head and neck pain syndromes. We report a case of a young female with cervicalgia and headache with fatal posterior circulation cerebrovascular accident after CSMT. Serious complications are infrequent, with a reported incidence between one per 100,000 to one in 2 million manipulations. The most frequent injuries involve artery dissection or spasm. Stroke as a complication of cervical manipulation and dissection of the vertebral arteries (VAD) is a rare but well recognized problem. Neck pain, headache, vertigo, vomiting and ataxia are typical symptoms of VAD, but this vascular injury also can be asymptomatic. The most common risk factors are migraine, hypertension, oral contraceptive pills and smoking. Stroke following CSMT is more common than the literature reports. The best values derive from retrospective surveys. The lack of identifiable risk factors place those who undergo CSMT at risk of neurologic damage. Accurate patient information and early recognition of the symptoms are important to avoid catastrophic consequences.
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Affiliation(s)
- Andres Leon-Sanchez
- Department of Internal Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, TX, USA.
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Anger J, Loder E, Buse D, Golub J. Treatment options for migraine during pregnancy. FUTURE NEUROLOGY 2006. [DOI: 10.2217/14796708.1.3.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Migraine and pregnancy commonly co-exist and healthcare providers should be ready to give advice to women with migraine regarding treatment options that are compatible with pregnancy and lactation. A major goal of treatment is to avoid medications that may be harmful to the developing fetus or cause other pregnancy problems. Nonpharmacological behavioral methods of treatment are especially useful in pregnancy. Migraine increases the risk of pregnancy-related stroke and pre-eclampsia and women with migraine should be monitored for these problems.
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Affiliation(s)
- Jillian Anger
- Spaulding Rehabilitation Hospital, Research Assistant, Headache Program, Boston, MA, USA
| | - Elizabeth Loder
- Spaulding Rehabilitation Hospital, Director, Pain and Headache Management Programs, 125 Nashua Street, Boston, MA 02114, USA
| | - Dawn Buse
- Montefiore Medical Center, Director of Psychology, Montefiore Headache Unit, Bronx, NY, USA
| | - Joan Golub
- Brigham and Women’s Hospital, Attending Physician, Department of Obstetrics & Gynecology, Boston, MA, USA
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Lin YC, Lee ACC, Kemper KJ, Berde CB. Use of Complementary and Alternative Medicine in Pediatric Pain Management Service: A Survey: Table 1. PAIN MEDICINE 2005; 6:452-8. [PMID: 16336482 DOI: 10.1111/j.1526-4637.2005.00071.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To survey the use of complementary and alternative medical therapies by pediatric pain management services affiliated with major universities. DESIGN A telephone survey was conducted of pediatric anesthesia training programs accredited by the Accreditation Council for Graduate Medical Education in the United States. The survey instrument included questions on the provision of complementary and alternative medical therapies in their pediatric pain programs. RESULTS Forty-three pediatric anesthesia fellowship programs (100%) responded to the survey. Thirty-eight institutions (86%) offered one or more complementary and alternative medical therapies for their patients. Those therapies included biofeedback (65%), guided imagery (49%), relaxation therapy (33%), massage (35%), hypnosis (44%), acupuncture (33%), art therapy (21%), and meditation (21%). CONCLUSIONS This report documents trends in complementary and alternative medical therapies usage in the tertiary pediatric pain management service. There is a high prevalence in the integration of complementary and alternative medical therapies in pediatric pain management programs. Additional clinical research in the safety and efficacy in complementary and alternative medical therapies for pediatric pain management is urgently needed.
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Affiliation(s)
- Yuan-Chi Lin
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston; Harvard Medical School, Boston, Massachusetts 02115, USA.
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Abstract
The extracranial internal carotid artery (ICA) is susceptible to injury and dissection from external shear forces applied to the neck. Traumatic ICA dissection usually occurs in the setting of a sudden, high amplitude force causing significant distortion of surrounding soft tissues. Weaker, repetitive forces applied for longer intervals may also pose a risk for ICA dissection. A 38-year-old woman with no significant stroke risk factors had sudden onset of severe dysarthria and left hemiparesis several days after receiving an approximately 20-minute neck massage with a handheld electric massager. The moving elements consisted of two approximately 2-cm-diameter spheres that percuss the skin with low amplitude and high frequency. Magnetic resonance imaging and angiography demonstrated acute infarction in the right middle cerebral artery territory and dissection of the extracranial right ICA. Handheld electric massager units may cause ICA dissection and disabling stroke.
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Affiliation(s)
- Arthur C Grant
- Department of Neurology, University of California Irvine, Irvine, CA, USA.
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Rebain R, Baxter GD, McDonough S. The passive straight leg raising test in the diagnosis and treatment of lumbar disc herniation: a survey of United kingdom osteopathic opinion and clinical practice. Spine (Phila Pa 1976) 2003; 28:1717-24. [PMID: 12897499 DOI: 10.1097/01.brs.0000083164.41425.b1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Postal questionnaire survey. OBJECTIVES To carry out a confidential postal survey of United Kingdom osteopaths in order to record and assess their use of the passive straight leg raising test in the diagnosis of, and choice of, manipulation for lumbar disc herniation. The study also sought to determine whether an association existed between osteopaths' manipulation of suspected lumbar disc herniation and their use of the straight leg raising test, the length of their working hours, and their use of manipulation for the treatment of other lumbar conditions. SUMMARY OF BACKGROUND DATA The literature is not agreed on important aspects of the straight leg raising test, or on the use of spinal manipulation for suspected lumbar disc herniation. This is thought to be the first study to investigate opinion and practice in a large group of spinal manipulators, in this case United Kingdom osteopaths. METHODS A questionnaire was sent to all 1030 United Kingdom osteopaths registered with the General Osteopathic Council in January 2000. It comprised four sections: personal characteristics, professional characteristics, background to low back pain cases, details of straight leg raising test understanding and use within the diagnosis and treatment of lumbar disc herniation. RESULTS A response rate of 44% was achieved. United Kingdom osteopaths' opinions of low back pain and lumbar disc herniation clinical presentations, details of straight leg raising test mode of action, procedure, and interpretation were in keeping with the literature. Fifty-four percent of respondents sometimes employed manipulation in the treatment of lumbar disc herniation, but most of the others described the practice as "dangerous." The literature is similarly divided on the practice. Chi-square and Cramer V analysis implied that respondents were not influenced in choosing manipulation for lumbar disc herniation by their use of the straight leg raising test (chi2 = 4.002, df = 3, Cramer V = 0.0959, P = 0.261, alpha 0.05, n = 435). A moderate association implied that the frequency of use of such manipulation for all lumbar conditions influenced the choice of that treatment for lumbar disc herniation (chi2 = 81.808, df = 4, Cramer V = 0.4302, P < 0.001, alpha = 0.05, n = 442). There was also a weak association suggesting that hours worked per week influenced the choice of manipulation for lumbar disc herniation (chi2 = 9.840, df = 3, Cramer V = 0.1499, P = 0.020, alpha = 0.05, n = 438). CONCLUSIONS Respondents to this survey frequently treated low back pain and often employed the straight leg raising test in its diagnosis. Their recognition of the clinical presentation of lumbar disc herniation and their use and understanding of the straight leg raising test were in keeping with the literature. Respondents were divided nearly equally between those who would expect patient benefit from the use of manipulation for lumbar disc herniation and those who criticized the practice. There is a need for further research into the clinical reasoning employed for the manipulative treatment of lumbar disc herniation.
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Affiliation(s)
- Richard Rebain
- University of Ulster, Rehabilitation Sciences Research Group, County Atrim, Northern Ireland
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Abstract
Complementary and alternative medicine has become immensely popular. This review summarizes the recent literature on complementary and alternative medicine for rheumatic conditions. Research has emerged in the following areas: acupuncture, herbal remedies, homeopathy, magnetic fields, massage therapy, spiritual healing, and supplements. Positive evidence was found in relation to glucosamine, chondroitin, some herbal remedies, and acupuncture. Generally speaking, complementary and alternative medicine is grossly underresearched. Because of the popularity of complementary and alternative medicine, adequately defining risk-benefit relationships is an urgent matter.
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Affiliation(s)
- E Ernst
- Department of Complementary Medicine, School of Sport and Health Sciences, University of Exeter, Exeter, United Kingdom.
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Medeiros JM. Cervical Spine Manipulation—Is it Safe? J Man Manip Ther 2001. [DOI: 10.1179/106698101790819716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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