In Connecticut there is a debate over chiropractic and the topic of informed consent. (News Article) The debate is not over whether there should be informed consent. In fact, in the United States, informed consent is already mandatory for all health care providers. Informed consent is supported by chiropractors. It is in the best interest of our patients . No! This debate is over whether chiropractors should be forced to inform every patient of a risk of stroke.
There are many problems with this.
CAUTION: there are risks to drinking water!
The most obvious is that chiropractic is not known to cause stroke. The only evidence even remotely related does not show that it causes stroke, but that there is an association. The same association that exists with medical doctors (oh, and hair dressers). So if it’s not known to cause it why would you force chiropractors to inform people of the risk. I think I know the reason.
If it is required for chiropractors then it should also be required of all health care practitioners that have equivalent risks. Can you imagine walking into every doctor’s office and having to sign a paper that says that if you came to that office to see them for neck, head or upper back pain there is a possibility you could have a stroke after seeing this doctor. Either no one would go to doctors for those conditions or it would become so prevalent that the warning would become like the boy who cried wolf, useless.
Another problem is the actual risk level that we are talking about. The risk of having a stroke after seeing a chiropractor is somewhere in the region of 30-300 times less likely than you dying in a lightning strike. Should I have to also warn my patients that they may aspirate and die from that water I recommended they drink.
Defining what must be included in informed consent adds loopholes for dishonest people and destroys the purpose of informed consent, that of an honest and open conversation between a doctor and a patient. Please doctors share the likely and serious risks with your patients. Inform them, by all means. Don’t get ridiculous.
I have to pause my normal posting to announce that my wonderful wife has given birth to our 4th daughter. There were no complications and things went well. Both mom and baby are beautiful and healthy. Some of the training we receive in chiropractic college I never plan to use as a chiropractor. This is one of those things. I never plan to deliver a baby for anyone else, but I am happy to have been able to deliver all four of my little girls. If I didn’t feel outnumbered before this picture will show you how lopsided our family is now.
Because this is a professional health care site I would like to include a report on an experiment that we attempted during this labor. Many of you reading this will be familiar with E-stim or TENS. I posted about it a few posts back (link). I posted there that this modality was not used during pregnancy because there was no research to support or contraindicate it’s use. There are however studies indicating possible benefits to mothers in labor. The findings are interesting, and the application is safe and has been used successfully for over 30 years in Europe. I have asked my wife to write up her feelings on using the TENS unit during this labor. I’ll not bias you with my observations, but I will post her comments as soon as she gets the time to write them, though I must warn you she’s a much more engaging writer than I am. In the meantime here is a great though dry article on the use of this modality during labor.
In a review of research on the topic of evidence it was reported that about 75-85% of all medical treatments are evidence based. In this review, evidence based included non-experimental evidence most often reported to mean unanimity among physicians that there was convincing non-experimental evidence. Only about 30-40% of all treatments in these studies were based on Randomized Controlled Trials (RCTs). Here is another similar review with citations.
There are levels of quality in evidence. RCTs are currently held as the gold standard of evidence, but some treatments don’t lend themselves to testing in this manner or are common sense. Even in RCTs there are always outliers that don’t conform. If we could do an RCT for every treatment that would be great, but we can’t. Evidence based treatment relies on doctors to make the best decisions based on all the evidence available to them at the time. So I’d say that 85% of medical treatments are based on evidence and a judgment call. That, is good.
There does seem to be a double standard in this area of discussion. When it comes to traditional medicine the levels of accepted evidence are understood. When it comes to complimentary and alternative treatments (CAM) anything less than an RCT is refused as evidence. Because of this bias chiropractic has been forced to prove it’s self by performing RCTs. And research has now found about 68% of all chiropractic procedures are backed by RCTs. Compared to 30-40% of medical treatments. That is also good.
I appreciate having good research to support my profession. I’d really like to stop hearing that chiropractic is not founded in evidence, but that may not happen. On a slight tangent, and to give you a thought provoking sampling, here are a few common treatments that either have limited evidence or research that actually finds that they don’t help.
Low Level Laser Therapy (LLLT) is one of the many forms/names of this treatment. I’ve discussed this therapy before. The reality is that this modality uses light in a similar way that ultrasound uses sound. It also produces similar results though by different means. Some advantages of LLLT over ultrasound are that it can be used on open wounds, treatment time is reduced, it doesn’t require a conductive gel, and isn’t going to hurt with a broken bone.
LLLT is essentially just light at a particular wavelength directed into your body with a hand held “wand.” It’s usually done with lasers or LEDs, hence the name. You should feel nothing during treatment. Advertisers fight about lasers vs LEDs and what particular wavelength is best or how many Joules to use. Some day research will perfect it. Every modality goes through improvements, and I look forward to that day with this one. So far research has discovered it to be beneficial in chronic joint pain, soft tissue injuries (sprains/strains), reducing inflamation and wound healing.
There are many biochemical changes that go on with LLLT and the truth is that they are not all understood. It’s easy to see how light can effect change in cells. Photosynthesis happens around us everyday. LLLT does not cause photosynthesis in humans, but it is a good analogy. Our cells use the light energy of a particular wavelength to make changes that produce positive treatment results.
There are risks with LLLT just as there are with waking up in the morning. There have been no side effects found in the 30+ years existence of this therapy, but if you are using a high powered laser you should protect your eyes and don’t look into it. With our treatment we use LEDs so, we won’t shoot your eye out accidentally. LLLT has not been found to cause cancer. Because it improves growth however, if you use it on a cancer… well you get the idea. Don’t treat cancer with LLLT.
The video posted suggested that chiropractic may help people with ADD/ADHD, but it doesn’t say how. In fact it only mentions it in passing after explaining some of the dangers of the drugs used to treat such conditions. So here is a collection of some of the research. A single study by Mississippi State University found that specific chiropractic treatment improved results in the majority of ADD/ADHD sufferers. You can find that study here. Of course more research is needed, but so far medication has only been shown to keep ADHD controlled, not cure it. Chiropractic care has shown actual improvement without the risks of medication.
How does chiropractic treatment accomplish the improvement. Dr. Robert Melillo, a chiropractic neurologist said, “Motor activity—especially development of the postural muscles—is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that’s what’s happening in ADHD patients.” He also pointed out that “True ADHD patients have other signs — tics, tremors, balance or postural problems, or unusual sensitivity to touch, movement, sights, or sounds.”
Doctors of chiropractic and chiropractic neurologists don’t treat ADHD they treat dysfunction in the spine and body. The brain is stimulated by this stimulation of weakened function through adjustments. The body is aided in healing it’s self decreasing the imbalances. So instead of filling the gap with drugs the body may become dependent on, the brain is able to develop where it was otherwise weak through stimulation caused by chiropractic adjustments.
While chiropractic may provide a good treatment for many suffering from these conditions mechanical stimulation is not the only answer and dietary or life changes should also be included in treatment. Processed food containing food dyes, sugar, preservatives, additives, and pesticides or other chemicals should be avoided. Elimination diets can be used to determine if there is a particular food that provokes negative responses in that person. Food has a chemical effect on our bodies just like medication does. Other life changes such as exercise and identifying learning patterns will also be beneficial.
This video should not scare people out of using medication, as there are always risks with any treatment, and the risk that they are talking about is very low. (I know, that information doesn’t comfort a parent when their child is the 1 in a million.) I posted this video for an entirely different reason and that was in the last probably 30 seconds of the video when they mention specifically that chiropractic and dietary treatments have been found to be valid as treatment in place of or in addition to traditional medical treatment of ADHD.
I’ve seen some research, and I’ll try to find it to post it for you in the next few days.
Articles published at Consumer Reports this month rated Chiropractic as the number 1 provider/treatment for back pain. This was a satisfaction survey. That means that the people took into account the stressfulness of the treatment as well as how well it was implemented. Chiropractors have consistently been rated with a higher patient satisfaction than other health models for many years. Most of the respondents in this survey had tried many different methods of care.
The Consumer Reports Health Rating Center released the survey results of more than 14,000 Americans on April 6.
The survey rated doctors of chiropractic as the top practitioner, with survey respondents noting that they were more likely to be “highly satisfied” with the care received from their doctor of chiropractic (59 percent) than their primary care physician (34 percent).
That’s 59% highly satisfied, that’s just the highest rating, it doesn’t include those who were merely “satisfied.” This is great news for chiropractic especially because Consumer Reports put it out. In the past this publication has been oppositional to chiropractors, publishing negative reports from MDs without even interviewing a single chiropractor.
At the beginning of December we began a trial of Chiropractic care for a bed wetting (nocturnal enuresis) patient. We treated almost every night for 2 weeks and then reduced the frequency of treatments to 2-3 per week for 2 weeks. The Patient had 2 episodes of bed wetting during that time, when prior there had been 5-7 wet nights. The week between Christmas and New Years Day was crazy and treatment was not rendered. During that time and until Friday the 2nd of January there were no occurrences. Then from the 2nd to the 7th the bed was wet every night. Last night her chiropractor remembered the trial and adjusted listings found in the Lumbar spine. She woke this morning dry.
It looks like we may need to taper the treatment rather than stopping suddenly, through forgetfulness. I cannot say difinitively that this was not the natural history or that some other event did not cause this, however, it does appear, at least in this case study, that Lumbar Chiropractic Manipulative Therapy may have been effective in reducing incidence of nocturnal enuresis.
Prior to getting lumbar and SI adjustments before bed this patient was wetting the bed 6-7 nights a week despite her parents avoiding fluids before bed, and taking her to the bathroom 2-3 times per night. this meant that they would have to wake up in the night just to take her to the bathroom. This pattern had continued for a little less than a month of her parents trying to get the child free of night time training pants.
Nothing in the routine changed except adding an adjustment. After 2 weeks of treatment here are the results. In these last 2 weeks the child has had any chiropractic listings in the lumbar spine or pelvis adjusted 6 out of 7 nights of each week. Beginning with that first night the child ceased bed wetting except for one night when the child actually awoke on her own too late. The parents no longer have to get up during the night to take the child to the bathroom. They take her once before she goes to bed and then once before they go to bed themselves. She is able to control her bladder through the remainder of the night, and has on occasion woken up herself to go to the bathroom on her own. Treatment will continue, but reduce in frequency.
I will not be going into a possible mechanism of effect at this time (how the treatment may work). For understanding of why I am treating from the lumbar spine to the pelvis; Sympathetic nerves to the bladder come from the upper lumbar spine, and parasympathetic nerves come from the Sacral region.
People have been asking lately about laser therapy, so I thought I’d explain it a little and sneak in a quick condition at the same time.
De Quervain’s is the name for tenosynovitis of the thumb extender and abductor muscles. Which is to say the tendons that move your thumb hurt at the wrist because inflammation isn’t allowing them to move properly. It is more common in women, but anyone doing repetitive motions with their thumb such as typing, cashiering, mechanics, etc. is susceptible. If you have it you may notice a “squeaky thumb,” pain when moving your thumb and decreased grip strength. In my experience this condition doesn’t usually go away on it’s own. Similar to carpal tunnel syndrome it just keeps coming back unless you receive proper care.
Many things are done for treatment of this condition. Chiropractic manipulation and massage of the area are beneficial as well as reducing use. You’ll likely need to talk with your employer about decreasing or changing your duties for a time while you heal. There are also many electrical modalities that are beneficial for de Quervain’s.
That’s where the Cold Laser comes in. Cold Laser is called many names but it is all the same thing, particular light waves that have been found to increase cellular metabolism. In essence when exposed to these wavelengths of light your cells heal faster, and hurt less. That’s a good thing.
It’s an odd sort of treatment because you normally don’t feel anything at the time. Kind of like magic with good research behind it. We just put this wand with a laser or LEDs on the injured area and hold it there for a few moments with the light on. The reason I bring Low Level Laser Therapy (LLLT) up with this condition is the relief time. Generally speaking my patients are able to notice effects of LLLT within the first day, but I had a patient with de Quervain’s who claimed instantaneous relief with LLLT. It was amazing to me and worth reporting to you.
So, if you have pain at your wrist from thumb movement visit your chiropractor and ask them about Cold Laser Treatment.