Chiropractic Management Research Articles

Atlas orthogonal chiropractic management of trigeminal neuralgia: A series of case reports

ContextTrigeminal neuralgia is a debilitating facial pain condition. Upper cervical chiropractic care has been mentioned as a possible solution ObjectiveTo determine the effects of Atlas Orthogonal upper cervical chiropractic technique adjustments on trigeminal neuralgia sufferers DesignCase series SettingA private chiropractic practice ParticipantsFive persons with chronic, severe, daily trigeminal neuralgia pain, radiological findings of significant head tilt, pain upon upper cervical palpation, and supine leg length inequality InterventionsUp to two consultations and/or Atlas Orthogonal adjustments a week for eight weeks Outcome measuresSelf-reported reduction in trigeminal neuralgia pain and changes in radiological findings, sensitivity to upper cervical palpation, and leg length inequality ResultsFour participants reported reduced trigeminal neuralgia pain, including two with complete cessation of pain. Three participants reduced medication dosages. One reported no change

Utilization of chiropractic services in patients with osteoarthritis and spine pain at a publicly funded healthcare facility in Canada: A retrospective study.

Osteoarthritis (OA) is one of the most prevalent and disabling musculoskeletal diseases worldwide. There is preliminary evidence from experimental studies and consensus documents that chiropractic management may alleviate spine and/or extremity OA related pain in the short term. This research explores the potential relationship of a pragmatic course of care, including soft tissue therapy, spinal manipulation, and other treatments commonly delivered by chiropractors, to spine and extremity pain in patients with OA. A retrospective analysis of prospectively collected data from the chiropractic program at a publicly funded healthcare facility was conducted. The primary outcome measures for patients diagnosed with spine and/or extremity OA (n= 76) were numeric pain scores of each spinal and extremity region at baseline and discharge, and a change score was determined. Statistically significant improvements that exceed a clinically meaningful difference in pain numeric rating scale scores were demonstrated by point change reductions from baseline to discharge visits. Change scores exceeding a minimally clinically important difference of "2-points" were present in the sacroiliac (-2.91), extremity (-2.84), cervical (-2.73), thoracic (-2.61), and lumbar (-2.59) regions. Patients diagnosed with OA in a socioeconomically disadvantaged community demonstrated reductions in mean pain scores in both a clinically meaningful and statistically significant manner concurrent with a course of chiropractic care.

Large abdominal aortic aneurysm presented with concomitant acute lumbar disc herniation – a case report

The purpose of this case report was to describe chiropractic management of acute lumbar disc herniation in a patient with a large abdominal aortic aneurysm. A 72-year-old male patient presented with low back pain and right lower leg numbness for 12 months. A review of full-spine X-ray and lumbar MRI revealed moderate spondylosis at L2-5, moderate lumbar scoliosis, and a 7.15 cm abdominal aortic aneurysm (AAA). Given the minimum 2-weeks of referral waiting time to receive treatment for AAA, the patient received chiropractic treatment with a hybrid rehabilitation to address the disc herniation causing severe physical disability. Through the treatments, the patient's pain was significantly alleviated with careful consideration of potential risk factors associated with AAA. In addition, the acute disc herniation was successfully managed by a series of chiropractic treatments before and after the operation for AAA. This case supports that low back pain in patients with AAA can be managed by manual therapy, in contrast to a widespread belief that manual therapy is contraindicated in AAA. More case reports of AAA patients with low back pain are warranted to assess the effectiveness and safety of manual therapy along with surgical treatment for AAA.

Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data

ObjectiveThe purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care. MethodsWe performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. We included those who received chiropractic management from January 1, 2010, to December 31, 2018. Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). The minimum clinically important difference (MCID) was set at 30% change from baseline. ResultsThere were 217 individuals who met the inclusion criteria. The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction (t = 13.5, P < .001). The mean score change for BBQ was 14.7 points, representing a 35.9% reduction (t = 16.7, P < .001). The percentage of participants reaching the MCID for the NRS was 57% (n = 124) and for the BBQ was 59% (n = 126), with 41% (n = 90) of the sample reaching the MCID for both the NRS and BBQ. ConclusionThis retrospective review revealed clinically and statistically significant improvement in NRS and BBQ scores for this sample of older male U.S. veterans treated with chiropractic management for chronic low back pain.

General practitioners' knowledge, perception and utilisation of services in the Chiropractic management of musculoskeletal disorders in Harare, Zimbabwe

The World Health Organization ranks musculoskeletal disorders (MSD) as the second largest cause of premature termination of one’s career. Consequently, the burden of MSD and limited primary health care in developing countries warrants the need for an integrative approach to health care. Although Chiropractic Therapy (CT) has emerged as a well-recognised form of Complementary and Alternative Medicine (CAM), particularly in MSD, there is a paucity of literature on knowledge and perceptions of General Practitioners (GPs) about CT in developing countries. Therefore, this study examined the knowledge, perceptions and utilisation of GPs towards CT. A questionnaire-based, cross-sectional study obtained data from 48 GPs in private practice in the Avenues suburb of Harare, Zimbabwe. Of the 48 respondents (55% response rate from 88 questionnaires distributed), approximately one-third (31.3%; n=15) never heard of CT. Of those who had heard of CT (n=33), almost two-thirds (66.7%; n=22) believed chiropractors to be competent in the treatment of musculoskeletal complaints and approximately one-third (35.4%; n=17) in the treatment of neurological ailments. There was a positive correlation between knowledge and perception (r=0.668) of CT. However, the association between knowledge and utilisation of CT services was not statistically significant (p=0.4), while the relationship between perception and CT utilisation was statistically significant (p=0.006). This finding suggests that the perception of CT influenced a GP’s referral of patients to a chiropractor. The study highlights the need for improving the knowledge and perceptions of CT among GPs as a basis for improving CT utilisation in developing countries, where an interdisciplinary approach to MSD may serve as an efficient alternative to conventional medical care.

Malpractice Litigation Involving Chiropractic Spinal Manipulation

To evaluate the relationship between chiropractic spinal manipulation and medical malpractice using a legal database. The legal database VerdictSearch was queried using the terms "chiropractor" OR "spinal manipulation" under the classification of "Medical Malpractice" between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of alleged injury. Forty-eight cases involving chiropractic management in the United States were reported. Of these, 93.8% (n= 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n= 34) of cases, with a plaintiff (patient) victory in 20.8% (n= 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n= 4) (mean payment $596,667 ± $402,534). Overaggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy. Litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

Association of Chiropractic Colleges Research Agenda Conference 2021 Abstracts of Proceedings.

An unusual postural headache: a case report

BackgroundThis paper presents a case of an evolving unusual thunderclap headache that presented to a chiropractor.Case presentationThe intense “migraine-like” headache was aggravated by standing up and relieved substantially when lying down. This low pressure, orthostatic headache was diagnosed as a spontaneous intracranial hypotension (SIH) secondary to a spontaneous tear of the dura. It was referred to the local hospital for management with autogolous blood injection to form an epidural blood patch of the defect. It resolved substantially within 3 days.ConclusionsThe significance of key features in the history and examination and how if not recognised and subsequently treated with manual therapy, the dural tear could be attributed to the treatment of the chiropractor, a treatment that would typically involve cervical manipulation. Discussion is provided of the implications of a missed diagnosis and possible subsequent chiropractic management with the evolving SIH being attributed to the chiropractic intervention rather than its true “spontaneous” nature.

Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline.

Objective: To develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain.Design: CPG based on evidence-based recommendations of a panel of experts in chronic MSK pain management.Methods: Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology.Results: The Delphi process was conducted January–February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions: low-back pain (LBP), neck pain, tension headache, osteoarthritis (knee and hip), and fibromyalgia. Recommendations were made for nonpharmacological treatments, including acupuncture, spinal manipulation/mobilization, and other manual therapy; modalities such as low-level laser and interferential current; exercise, including yoga; mind–body interventions, including mindfulness meditation and cognitive behavior therapy; and lifestyle modifications such as diet and tobacco cessation. Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized.Conclusions: These evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes.

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

ObjectiveThe purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. MethodsA consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. ResultsThirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. ConclusionThis study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.

Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain

ObjectiveThe purpose of this study was to develop best-practice recommendations for chiropractic management of adults with neck pain. MethodsA steering committee of experts in chiropractic practice, education, and research drafted a set of recommendations based on the most current relevant clinical practice guidelines. Additional supportive literature was identified through targeted searches conducted by a health sciences librarian. A national panel of chiropractors representing expertise in practice, research, and teaching rated the recommendations using a modified Delphi process. The consensus process was conducted from August to November 2018. Fifty-six panelists rated the 50 statements and concepts and reached consensus on all statements within 3 rounds. ResultsThe statements and concepts covered aspects of the clinical encounter, ranging from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral for patients presenting with neck pain. ConclusionsThese best-practice recommendations for chiropractic management of adults with neck pain are based on the best available scientific evidence. For uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended.

162. Opioid usage patterns, patient characteristics, and the role of chiropractic services in a publicly funded inner city health care facility

BACKGROUND CONTEXT Opioid prescription for spinal pain while common, is no longer recommended by recent clinical practice guidelines. Opioid prescription rates in the US and Canada are double those in most European countries. A recent study found chiropractic care provided in Veterans Health Administration facilities resulted in reduced opioid prescriptions. Further research on populations with access to chiropractic care and opioid medication is warranted. PURPOSE To determine if chiropractic management of financially disadvantaged individuals, using opioid medications and diagnosed with spine or extremity conditions, reduced pain, and impacted opioid prescription frequency, or dosage. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected quality assurance data. Data were collected in a publicly funded multidisciplinary health care facility (2011-2017) that includes primary care, a chiropractic program and an on-site pharmacy dispensary. The health care facility is exclusively utilized by a financially disadvantaged inner city population. PATIENT SAMPLE The typical opioid-using chiropractic program patient (N=64) had chronic lumbar region pain (>3 months) was female (59.4%) self-identified as Caucasian (50%), was 49.6 (SD = 13.6) years of age, and had an average BMI of 31.5 (SD 8.4) which is classified as obese. The majority were referred by their primary care physician who managed their prescriptions (66.7%). OUTCOME MEASURES Included: (1) numeric rating scale (NRS) for pain for each region (cervical, thoracic, lumbar, sacro-iliac and extremity); (2) number of chiropractic program patients prescribed opioids by the health care facility at baseline, visit 5 and discharge; and (3) dosage via the number of tablets per 24-hour period from T3 prescriptions filled at the health care facility. METHODS For each NRS region, percent change and a one-way analysis of variance (ANOVA) were calculated. The minimally clinically important difference (MCID) was defined as −20%. The ANOVA was a 1 Region x 3 Time Point (baseline, 5th visit, discharge) model. Posthoc paired Student's t-tests were applied to dissect significant main effects. Percent change scores were calculated for both the number of people prescribed opioids within the clinic (n=38), and dosage via number of tablets per 24-hours for T3 the most common opioid prescribed (n=21). RESULTS Percent change in pain by region after chiropractic management were as follows: cervical (−30.8%), thoracic (−37.2%), lumbar (−40.5%), sacral (−43.9%) and extremity pain (−43.0%). For each region, main effects were found for pain level between baseline measures, visit 5, and discharge (p CONCLUSIONS Financially disadvantaged patients with an opioid relationship who underwent chiropractic management for spine and extremity conditions in a publicly funded health care facility responded to treatment evidenced through reduction in pain beyond a MCID. Opioid usage decreased over a brief trial of care in both percentage of users and dosage. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Change in young people's spine pain following chiropractic care at a publicly funded healthcare facility in Canada

BackgroundThe presence of spinal pain in young people has been established as a risk factor for spinal pain later in life. Recent clinical practice guidelines recommend spinal manipulation (SM), soft tissue therapy, acupuncture, and other modalities that are common treatments provided by chiropractors, as interventions for spine pain. Less is known specifically on the response to chiropractic management in young people with spinal pain. The purpose of this manuscript was to describe the impact, through pain measures, of a pragmatic course of chiropractic management in young people's spinal pain at a publicly funded healthcare facility for a low-income population. MethodsThe study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic (MCC) chiropractic program database. Formal permission to conduct the analysis of the database was acquired from the officer of records at the MCC. The University of Manitoba's Health Research Ethics Board approved all procedures. ResultsYoung people (defined as 10–24 years of age) demonstrated statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management. ConclusionThe findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.

Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process

ObjectiveThe purpose of this study was to develop an integrated care pathway for doctors of chiropractic, primary care providers, and mental health professionals who manage veterans with low back pain, with or without mental health comorbidity, within Department of Veterans Affairs health care facilities. MethodsThe research method used was a consensus process. A multidisciplinary investigative team reviewed clinical guidelines and Veterans Affairs pain and mental health initiatives to develop seed statements and care algorithms to guide chiropractic management and collaborative care of veterans with low back pain. A 5-member advisory committee approved initial recommendations. Veterans Affairs-based panelists (n = 58) evaluated the pathway via e-mail using a modified RAND/UCLA methodology. Consensus was defined as agreement by 80% of panelists. ResultsThe modified Delphi process was conducted in July to December 2016. Most (93%) seed statements achieved consensus during the first round, with all statements reaching consensus after 2 rounds. The final care pathway addressed the topics of informed consent, clinical evaluation including history and examination, screening for red flags, documentation, diagnostic imaging, patient-reported outcomes, adverse event reporting, chiropractic treatment frequency and duration standards, tailored approaches to chiropractic care in veteran populations, and clinical presentation of common mental health conditions. Care algorithms outlined chiropractic case management and interprofessional collaboration and referrals between doctors of chiropractic and primary care and mental health providers. ConclusionThis study offers an integrative care pathway that includes chiropractic care for veterans with low back pain.

Changes in female veterans' neck pain following chiropractic care at a hospital for veterans

ObjectiveTo determine if U.S. female veterans had demonstrable improvements in neck pain after chiropractic management at a Veterans Affairs (VA) hospital. MethodsThis was a retrospective cross-sectional study of medical records from female veterans attending a VA chiropractic clinic for neck pain from 2009 to 2015. Paired t-tests were used to compare baseline and discharge numeric rating scale (NRS) and Neck Bournemouth Questionnaire (NBQ) scores with a minimum clinically important difference (MCID) set at a 30% change from baseline. ResultsThirty-four veterans met the inclusion criteria and received a mean of 8.8 chiropractic treatments. For NRS, the mean score improvement was 2.7 (95%CI, 1.9–3.5, p < .001). For the NBQ, the mean score improvement was 13.7 (95%CI, 9.9–17.5, p < .001). For the MCID, the average percent improvement was 45% for the NRS and 38% for the NBQ. ConclusionFemale veterans with neck pain experienced a statistically and clinically significant reduction in NRS and NBQ scores.

The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors

BackgroundWhile the clinical role of manual therapies in migraine management is unclear, the use of chiropractors for this condition is considerable. The aim of this study is to evaluate the prevalence and characteristics of chiropractors who frequently manage patients with migraine.MethodsA national cross-sectional survey of chiropractors collected information on practitioner characteristics, clinical management characteristics and practice settings. A secondary analysis was conducted on 1869 respondents who reported on their migraine caseload to determine the predictors associated with the frequent management of patients with migraine.ResultsA large proportion of chiropractors report having a high migraine caseload (HMC) (n = 990; 53.0%). The strongest factors predicting a chiropractor having a HMC include the frequent treatment of patients with axial neck pain (OR = 2.89; 95%CI: 1.18, 7.07), thoracic pain (referred/radicular) (OR = 2.52; 95%CI: 1.58, 3.21) and non-musculoskeletal disorders (OR = 3.06; 95%CI: 2.13, 4.39).ConclusionsSeveral practice-setting and clinical management characteristics are associated with chiropractors managing a HMC. These findings raise key questions about the therapeutic approach to chiropractic migraine management that deserves further examination. There is a need for more primary research to assess the approach to headache and migraine management provided by chiropractors and to understand the prevalence, burden and comorbidities associated with migraine found within chiropractic patient populations. This information is vital in helping to inform safe, effective and coordinated care for migraine sufferers within the wider health system.

Chiropractic Management for US Female Veterans With Low Back Pain: A Retrospective Study of Clinical Outcomes

ObjectiveThe purpose of this study was to determine if female US veterans had clinically significant improvement in low back pain after chiropractic management. MethodsThis is a retrospective chart review of 70 courses of care for female veterans with a chief complaint of low back pain who received chiropractic management through the VA Western New York Healthcare System in Buffalo, New York. A paired t test was used to compare baseline and discharge outcomes for the Back Bournemouth Questionnaire. The minimum clinically important difference was set as a 30% improvement in the outcome measure from baseline to discharge. ResultsThe average patient was 44.8 years old, overweight (body mass index 29.1 kg/m2), and white (86%). The mean number of chiropractic treatments was 7.9. Statistical significance was found for the Back Bournemouth Questionnaire outcomes. The mean raw score improvement was 12.4 points (P < .001), representing a 27.3% change from baseline with 47% of courses of care meeting or exceeding the minimum clinically important difference. ConclusionFor our sample of female veterans with low back pain, clinical outcomes from baseline to discharge improved under chiropractic care. Although further research is warranted, chiropractic care may be of value in contributing to the pain management needs of this unique patient population.

Chiropractic management of dominating one-sided pelvic girdle pain in pregnant women; a randomized controlled trial

BackgroundThe aim of this study was to investigate the outcome of chiropractic management for a subgroup of pregnant women with dominating one-sided pelvic girdle pain (PGP).MethodsThe study population was recruited from a prospective longitudinal cohort study of pregnant women. Women reporting pelvic pain (PP), and who were diagnosed with dominating one-sided PGP after a clinical examination, were invited to participate in the intervention study. Recruitment took place either at 18 weeks, or after an SMS-tracking up to week 29. The women were randomized into a treatment group or a control group. The treatment group received chiropractic treatment individualized to each woman with regards to treatment modality and number of treatments. The control group was asked to return to conventional primary health care. The primary outcome measure was new occurrence of full time and/or graded sick leave due to PP and/or low back pain. Secondary outcome measures were self-reported PP, physical disability and general health status. Proportion of women reporting new occurrence of sick leave were compared using Chi squared tests. Differences in secondary outcome measures were estimated using linear regression analyses.ResultsFifty-Six women were recruited, and 28 of them were randomized into the treatment group, and 28 into the control group. There was no statistically significant difference in sick leave, PP, disability or general health status between the two groups during pregnancy or after delivery.ConclusionThe study did not demonstrate superiority of chiropractic management over conventional care for dominating one-sided PGP during pregnancy. However, the analyses revealed wide confidence intervals containing both positive and negative clinically relevant effects.Trial registrationThe study was registered in ClinicalTrials.gov (NCT01098136; 22/03/2010).

Chiropractic management of post spinal cord stimulator spine pain: a case report

BackgroundA brief overview of failed back surgery syndrome, with emphasis on low back pain status post spinal cord stimulation, and post-surgical spinal manipulation is presented.Case PresentationFour cases of patients within the VA Connecticut Health Care System presenting between July 2014 and July 2015 reporting low back pain after surgical insertion of spinal cord stimulators are discussed. This study describes the outcomes experienced by four patients with low back pain status post implanted spinal cord stimulators receiving manual therapy in the form of lumbar spine manipulation or mobilization.ConclusionAll four patients denied adverse effects to spinal manipulation/mobilization and onset of new symptoms after treatment; two patients reported durable reduction in low back pain with increased tolerance to walking, standing, or lying down, one reported temporary relief of low back pain, and one reported no change in symptoms. Further investigation is needed to determine the benefit of spinal manipulation in patients with implanted spinal cord stimulators, but this study has shown the absence of adverse effects from manipulation or mobilization treatment, in regards to SCS.

Chiropractic Management of a Patient With Thoracic Pain and a Stable Thoracic Aortic Aneurysm: A Case Report

ObjectiveThe purpose of this case report was to describe chiropractic management of thoracic pain in a patient with a stable thoracic aortic aneurysm. Clinical FeaturesAn 89-year-old man presented with axial mid- and upper back pain localized predominantly at the T8 and T1 spinal segmental levels. A review of available imaging revealed a stable aneurysmal dilatation of the ascending aorta, which measured 4.3 cm. Intervention and OutcomeBecause the thoracic pain was musculoskeletal in nature and the thoracic aortic aneurysm was stable, mechanical manipulation was provided using the Impulse adjusting instrument. The patient’s pain was measured utilizing a numeric rating scale. The patient’s thoracic pain improved over the course of treatment. ConclusionThis patient was successfully treated for thoracic spine pain with a course of chiropractic care using a mechanical adjusting instrument.