BMC Musculoskeletal Disorders

Background: Chronic pain is a common reason for consultation in general practice. Current research distinguishes between chronic localized pain (CLP) and chronic widespread pain (CWP). The aim of this study was to identify differences between CWP and chronic low back pain (CLBP), a common type of CLP, in primary care settings.

Methods: Fifty-eight German general practitioners (GPs) consecutively recruited all eligible patients who consulted for chronic low back pain during a 5-month period. All patients received a questionnaire on sociodemographic data, pain characteristics, comorbidities, psychosomatic symptoms, and previous therapies.

Results: GPs recruited 647 eligible patients where of a quarter (n = 163, 25.2%) met the CWP criteria according to the American College of Rheumatology. CWP patients had significantly more comorbidities and psychosomatic symptoms, showed longer pain duration, and suffered predominantly from permanent pain instead of
distinguishable pain attacks. CWP patients were more often females, are less working and reported a current pension application or a state-approved grade of disability more frequently. We found no other differences in demographic parameters such as age, nationality, marital status, number of persons in household, education, health insurance status, or in health care utilization data.

Conclusions: This project is the largest study performed to date which analyzes differences between CLBP and CWP in primary care settings. Our results showed that CWP is a frequent and particularly severe pain syndrome.

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Journal of Manipulative and Physiological Therapeutics

Objective

The objective of the study was to investigate the cerebrovascular hemodynamic response of cervical spine positions including rotation and cervical spine manipulation in vivo using magnetic resonance imaging technology on the vertebral artery (VA).

Methods

This pilot study was conducted as a blinded examiner cohort with 4 randomized clinical tasks. Ten healthy male participants aged 24 to 30 years (mean, 26.8 years) volunteered to participate in the study. None of the participants had a history of disabling neck, arm, or headache pain within the last 6 months. They did not have any current or history of neurologic symptoms. In a neutral head position, physiologic measures of VA blood flow and velocity at the C1-2 spinal level were obtained using phase-contrast magnetic resonance imaging after 3 different head positions and a chiropractic upper cervical spinal manipulation. A total of 30 flow-encoded phase-contrast images were collected over the cardiac cycle, in each of the 4 conditions, and were used to provide a blood flow profile for one complete cardiac cycle. Differences between flow (in milliliters per second) and velocity (in centimeters per second) variables were evaluated using repeated-measures analysis of variance.

Results

The side-to-side difference between ipsilateral and contralateral VA velocities was not significant for either velocities (P = .14) or flows (P = .19) throughout the conditions. There were no other interactions or trends toward a difference for any of the other blood flow or velocity variables.

Conclusions

There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations.

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Complementary Therapies in Medicine

Objectives: The physiological changes that occur during pregnancy, including increased bloodvolume and cardiac output, can affect hemodynamic control, most profoundly with positionalchanges that affect venous return to the heart. By using Osteopathic Manipulative Treatment(OMT), a body-based modality theorized to affect somatic structures related to nervous andcirculatory systems, we hypothesized that OMT acutely improves both autonomic and hemody-namic control during head-up tilt and heel raise in women at 30 weeks gestation.

Design: One hundred subjects were recruited at 30 weeks gestation.

Setting: The obstetric clinics of UNTHealth in Fort Worth, TX.

Intervention: Subjects were randomized into one of three treatment groups: OMT, placeboultrasound, or time control. Ninety subjects had complete data (N = 25, 31 and 34 in each grouprespectively).

Main outcome measures: Blood pressure and heart rate were recorded during 5 min of head-uptilt followed by 4 min of intermittent heel raising.

Results: No significant differences in blood pressure, heart rate or heart rate variability wereobserved between groups with tilt before or after treatment (p > 0.36), and heart rate variabil-ity was not different between treatment groups (p > 0.55). However, blood pressure increased significantly (p = 0.02) and heart rate decreased (p < 0.01) during heel raise after OMT comparedto placebo or time control.

Conclusions: These data suggest that OMT can acutely improve hemodynamic control during engagement of the skeletal muscle pump and this was most likely due to improvement ofstructural restrictions to venous return.

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Presentation available here.

International Journal of Osteopathic Medicine

Background

Osteopathy is now taught across the world, but each school has different teaching and learning strategies that may influence the preparedness of students for practice in different ways.

Objective

To investigate levels of the satisfaction with the learning environment and the preparedness to practise from the perspective of osteopathic students. The study compares full-time schools in three different countries to analyse relationships between learning environment and preparedness.

Method

A web-based questionnaire using a five-point Likert scale (strongly agree, agree, uncertain, disagree, strongly disagree) was sent by e-mail to all final year students of the British School of Osteopathy (BSO-UK), Accademia Italiana Osteopatia Tradizionale (AIOT-Italy) and Centre Européen d'Enseignement Supérieur de l'Ostéopathie (CEESO-France).

Results

The response rate was 58% for the BSO (n = 51), 100% for the AIOT (n = 12) and 80% for the CEESO (n = 63). The AIOT students perceived a better learning environment than CEESO and BSO students, while CEESO students felt more prepared than AIOT and BSO students. Statistically significant associations were found between learning environment and preparedness.

Conclusion

Small classes may be partly responsible for the perception of a better learning environment. This study also highlighted that the learning environment may be partly responsible for the perceived differences in preparedness.

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