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2018 World Spine Day stresses importance of self-help for back pain

October 15, 2018WSD18 web

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Media interviews:     Richard Brown

PRESS RELEASE

2018 World Spine Day stresses importance of self-help for back pain

Tuesday, October 16 marks the annual World Spine Day. Organised by the World Federation of Chiropractic on behalf of the Global Alliance for Musculoskeletal Health, World Spine Day highlights the global burden of spinal pain and disability. This year’s theme, Love Your Spine, emphasises the importance of self-help in the management of back pain.

Low back pain is the biggest single global cause of years lived with disability. At any time, it is estimated that over 1 billion people around the world are suffering with low back pain, with 4 out of 5 adults experiencing at least one disabling episode during their lives. It can profoundly affect work life, home life and social life, and low back pain can lead to other health issues.  People suffering with persistent back pain are three times as likely to suffer mental health issues such as depression.

This year’s World Spine Day focuses on how people can look after their spine and help prevent episodes of back pain. Under 1% of all back pain is caused by serious underlying problems, such as cancer and infection, yet people are often fearful of exercise and daily activities because they think it will make their condition worse. This is a myth, says World Spine Day Global Coordinator, Dr Robyn Brown.

“The old-fashioned advice to rest or lie on a board has never been supported by evidence, To the contrary, prolonged rest can often lead to muscle wasting and stiffness and make the problem worse. People with back pain need to know that in the vast majority of cases, getting out, moving and continuing to live a normal life is the best treatment.”

Evidence has shown that low back pain can affect people across the life course, from schoolchildren to the elderly. A long term study in Denmark involving 1400 schoolchildren showed that over a 3 year period 55% of schoolchildren aged 5-15 suffered at least one episode of spinal pain. Although this was usually short-lived and trivial, one in five children was found to be suffering with three or more episodes per year.  Seventeen (17%) percent of episodes lasted more than 4 weeks. Worryingly, child back pain sufferers are more likely to become adult back pain sufferers.

World Spine Day reaches around the globe and has attracted over 500 partner organizations globally, from hospitals and clinics to schools to government agencies, all committed to raising awareness and educating the public. On World Spine Day, activities will take place around the globe to engage people around the #LoveYourSpine theme.

Earlier this year, The Lancet published a series of papers on low back pain. The papers were picked up by media around the world, and resulted in an explosion of social media attention, with over 15 million tweets alone. The findings of the authors were stark -  disability due to low back pain has increased by over 50% since 1990, especially in low and middle-income countries – yet access to effective services remains poor and many myths and misconceptions remain.

Dr Brown adds: “We know that back pain is complex and that it’s not just made worse by physical factors. Attitudes and anxiety around back pain as well as social factors also play a part. We call this the biopsychosocial model of back pain. One of the biggest challenges we face is that other than in a small proportion of cases it’s not possible to identify exactly what’s causing the pain.”

So who is most vulnerable to back pain?

“We do know that certain groups are more likely to report low back pain than others,” continues Dr Brown. “People with physically demanding jobs, people who have other physical and mental health issues, smokers and obese people are at the greatest risk of reporting low back pain.”

How do we prevent back pain and best advise people how to #LoveYourSpine?
The latest and best evidence does not support the use of drugs and surgery. The Lancet papers Recommend not recommended. The Lancet papers recommend education and self management strategies. Advice to get back to normal activities as quickly as possible and to exercise was seen to be most effective with psychological programs added to those with persistent symptoms.

The guidelines recommend limited use of medication, surgery and imaging, such as x-ray and MRI. In particular, inappropriate use of opioids and spinal injections for back pain came in for strong criticism.

Dr Brown says: “The most effective strategies are those that get people back to work early and educate them about the reality of back pain, that movement is medicine and that effective collaborations between patients and their health care teams of spine care professionals work best. See someone who will help you to help yourself ”

Notes for Editors
1.    Dr Robyn Brown is a medical doctor, currently working in the trauma and orthopaedics department at Gloucestershire Royal Hospital in the United Kingdom. She has been the Global Coordinator for World Spine Day since 2016.
2.    The World Federation of Chiropractic (www.wfc.org) is a global, not-for-profit, non-governmental organisation headquartered in Toronto, Canada. It has over 90 country members in 7 world regions and is in official relations with the World Health Organization.
3.    The Global Alliance for Musculoskeletal Health (www.bjdonline.org)  is a non-governmental organisation focused on highlighting the burden of musculoskeletal disorders around the world.
4.    The Lancet series of low back pain papers can be accessed at https://www.thelancet.com/series/low-back-pain

Ends

 

Australian Professor Named as New WFC Research Committee Member

June 26, 2018

TORONTO, June 27, 2018. Australian chiropractor, Professor Simon French, has been named as the newest member of the World Federation of Chiropractic’s Research Committee.

simon frenchDr French’s appointment follows a global search that attracted high quality candidates from around the world.

A 1993 graduate of the Royal Melbourne Institute of Technology (RMIT), Dr French practised as a chiropractor for ten years, gaining a Masters in Public Health along the way, before pursuing a PhD at the School of Public Health and Preventative Medicine at Monash University, Victoria. His work involved developing and testing complex interventions for improving the use of evidence in clinical practice, specifically as it related to low back pain in general practice.

Dr French worked as a Senior Research Fellow with the prestigious Australasian Cochrane Centre as well as at the Primary Care Research Unit at the University of Melbourne.

In 2013, Dr French was named as the recipient of the Canadian Chiropractic Research Foundation Professorship in Rehabilitation Therapy at Queen’s University in Ontario, Canada. During his time in Canada, Dr French was also named as a member of the Low Back Pain Quality Standard Advisory Committee for Health Quality Canada.

Dr French returned to Australia in 2018 to commence a position at Macquarie University’s Department of Chiropractic. His appointment at Macquarie represents a very significant step forward for chiropractic in Australia and further develops the university's strong commitment to research and innovation.

As the Research Council’s newest member, Dr French brings an impressive track record of high value research grants, committee representation, and collaborations with world-renowned musculoskeletal researchers.

Speaking after his appointment, Dr French said, “I am grateful for the opportunity to work with the Research Committee and the confidence that the WFC has placed in me. I’m looking forward to getting down to work with this world-class group of research colleagues.”

Chair of the Research Committee, Professor Greg Kawchuk, commented: “"All of us on the Research Committee are excited to welcome Dr French to the team. Simon's experience as a scientist, journal editor and most recently, head of research of the Department of Chiropractic at Macquarie University, expands the breadth of our committee and allows us to advocate for the profession in exciting new ways."

The WFC Research Committee comprises researchers from many of its world regions. They work in a range of settings, including biomechanics, musculoskeletal pain, knowledge translation, quality, and basic science. Its Chair is Dr Greg Kawchuk, Professor of Rehabilitation at the University of Alberta, Canada.

   

WFC Among Founding Members of Global Rehabilitation Alliance

June 5, 2018

TORONTO, June 5, 2018: The World Federation of Chiropractic (WFC) is amongst 14 international organizations that have come together to found the new Global Rehabilitation Alliance (GRA), with chiropractor and epidemiologist Professor Pierre Côté being elected to the Board. .

The GRA is an initiative of the World Health Organization (WHO) and arose out of a high-level meeting, Rehabilitation 2030: A Call To Action that took place in February 2017. WFC Disability and Rehabilitation Committee Chair, Professor Pierre Côté and Secretary-General Dr Richard Brown were in attendance at this meeting and contributed in drafting a formal statement of support for the WHO on behalf of the global health professions.

Following a number of meetings and the drafting of a White Paper setting out the aims and objectives of the new alliance, the formal launch of the GRA took place at the International Committee of the Red Cross Headquarters in Geneva during the week of the World Health Assembly.

pierre coteAt its inaugural meeting, Professor Côté was elected to the Board. As well as holding the federally-funded Canada Research Chair in Disability Prevention and Rehabilitation, Professor Côté holds positions at the University of Ontario Institute of Technology (UOIT) and at the Canadian Memorial Chiropractic College (CMCC), where he heads the UOIT-CMCC Centre for Disability Prevention and Rehabilitation.

The aims of the GRA are to advocate for rehabilitation services around the world and to strengthen the role of rehabilitation in health and social systems around the world. The GRA will aim to further the efforts of existing rehabilitation organizations by building and strengthening networks and partnerships. It will work with WHO as a strategic partner to advocate for quality, co-ordinated and accessible rehabilitation services.

According to WHO, only 10 people per million population in the world currently has access to skilled rehabilitation services. It is also known that 74% of the total years lived with disability in the world are living with conditions for which rehabilitation is beneficial. With a 23% increase in prevalence of health conditions with severe disability, there is a large unmet need in low- and middle-income countries, the need for a dedicated focus on rehabilitation workers is critical.

Speaking on his appointment to the GRA, Professor Côté commented: “The founding of this important alliance comes at an important time. I am honoured and privileged to have been elected by the founder members of the GRA to sit on its Board and look forward to contributing to coordination of advocacy work in this area of global health. As an epidemiologist, I am all too aware of the catastrophic global impact of disability and the GRA’s advocacy efforts will make a key contribution towards supporting WHO’s commitment to the UN Sustainable Development Goals ”

WFC Secretary-General Dr Richard Brown said: “As primary contact health professionals, chiropractors can take a leading role in rehabilitation and disability prevention. With low back pain the leading global cause of years lived with disability, chiropractors have an opportunity to actively engage in rehabilitation. In addition, collaborating with other organizations and forming strategic partnerships will greatly increase the role our Constituent Member nationals associations can play.”

Inaugural Board of the Global Rehabilitation Alliance

President Thierry Regenass
Vice President Emma Stokes
Vice President Christoph Gutenbrunner
Treasurer Karsten Dreinhofer
Secretary Jan Monsbakken
Members at Large Stephanie Clarke
Pierre Côté
Isabelle Urseau

GRA BoardBoard members, Global Rehabilitation Alliance
Left to right: Pierre Côté, Jan Monsbakken, Karsten Dreinhofer, Emma Stokes, Thierry Regenass, Christoph Gutenbrunner, Isabelle Urseau, Stephanie Clarke.

Founder Members of the Global Rehabilitation Alliance

• American Speech-Language-Hearing Association (ASHA)
• Dementia Alliance International
• Global Alliance for Musculoskeletal Health (GMusc)
• Humanity & Inclusion (HI)
• International Council of Nurses (ICN)
• International Committee of the Red Cross (ICRC)
• ICRC MoveAbility Foundation
• International Society for Prosthetics and Orthotics (ISPO)
• International Society of Physical and Rehabilitation Medicine (ISPRM)
• International Spinal Cord Society (ISCoS)
• World Confederation for Physical Therapy (WCPT)
• World Federation for NeuroRehabilitation (WFNR)
• World Federation for Occupational Therapy (WFOT)
• World Federation of Chiropractic (WFC)

About the WFC

The World Federation of Chiropractic (WFC) is a worldwide, not-for-profit organization which serves as the global voice of the chiropractic profession. Its members are the national associations of chiropractors in over 90 countries worldwide. In addition, its non-voting association members include chiropractic educational institutions, corporate partners and individual supporters. Since 1997, the WFC has been an non-governmental organization in official relations with the World Health Organization (WHO). Its headquarters are in Toronto, Canada.   

   

Descarreaux Appointed To WFC Research Council

July 5, 2017

Professor Martin Descarreaux has been announced as the newest member of the WFC Research Council.

Dr. Descarreaux graduated from the UQTR’s first cohort of the chiropractic program in 1998, and completed a PhD in kinesiology at the Université Laval 6 years later.

Martin DescarreauxHe is now a full professor at UQTR in the Department of Human Kinetics and is a visiting professor at the Institut Franco-Européen de Chiropraxie (Paris and Toulouse) and at the Paris-Sud University’s Faculty of sports sciences.

His current research projects involve the characterization of the neurophysiological and biomechanical effects of spinal manipulation, the various effects of pain and pain-related psychological components on trunk neuromuscular strategies, as well as motor learning of spinal manipulation. In the past five years alone, Dr Descarreaux has been a primary or named author in over 60 published papers.

Over the years, he has developed several strategies to better integrate motor learning principles, which have been shared with students, professors and those responsible for clinical training within chiropractic teaching institutions not only in Canada, but also in Europe.

He is currently the Director of the Groupe de recherche sur les affections neuromusculosquelettiques (Research Group on neuromusculoskeletal disorders) at UQTR.

Chair of the WFC Research Council, Professor Greg Kawchuk commented: "On behalf of the Research
Council, I would like to welcome Dr. Descarreaux as our newest member. Martin's prior experience as a judge at many WFC events combined with his research record as a full professor at UQTR will assist the RC greatly in building toward the next WFC Congress in 2019 and beyond".

   

New Canadian Opioid Guidelines Recommend Chiropractic As Care Option

May 8, 2017

A new Canadian guideline published today (May 8, 2017) in the Canadia Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.

The guideline (http://www.cmaj.ca/content/189/18/E...) is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.

Jason BusseThe lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

The new guidelines significantly revise those published in 2010 with a clear message that opioids should not be the first-line therapy in CNCP and should only be used as a last, carefully dose-controlled resort after all other options have been exhausted.

Another key recommendation is that MDs do not simply keep raising the dose level of opioids if recommended levels are not providing effective relief, and to avoid opioids altogether where there is a history of substance abuse or mental health issues.

None of this is relevant to those already addicted to opioids. The guideline addresses this issue by advocating a tapering down of doses over time, utilizing multidisciplinary care options, such as chiropractic.

A keynote speaker at the joint WFC/ACC/ACA Conference, DC2017, Dr Brian Goldman, has spoken out strongly against MDs prescribing opioids, but says that the guideline must be supported by national programs to encourage compliance with the guideline’s recommendations (http://www.cbc.ca/radio/whitecoat/b...).

With many users of opioids doing so due to chronic back pain or other musculoskeletal disorders, the recommendation to primary care physicians to optimize their use of non-opioid medications and non-pharmacological therapy has the potential to increase utilization of chiropractic.

Secretary-General of the World Federation of Chiropractic, Richard Brown, commented: “The dangers of opioid therapy for chronic non-cancer pain are well documented, not just in Canada, but throughout the world. This new guideline sets out very clearly the recommendation to avoid prescribing opioids and to consider safer alternatives. The evidence for manual therapy in the treatment of back pain is strong and we are now seeing growing calls for its use as a first-line option.”

“Chiropractors as spine care experts are well-placed to deliver an effective and evidence-informed alternative as part of the solution to the opioid crisis. Chiropractors working in collaborative teams with other health professionals, such as in the US Veterans Administration, is resulting in very positive outcomes and we anticipate significant growth in the involvement of chiropractors in helping to tackle the opioid crisis. The WFC welcomes these recommendations and congratulates Dr Busse and his team on the publication of this important guideline.”

The WFC Public Health Committee has identified opioid overuse as one of its key priority areas. Its Chair, Dr Chris Cassirer D.Sc, MPH is clear on how chiropractors can make a difference. He remarked: “As nations continue to struggle with the growing epidemic of opioid addiction, it is imperative that we underscore the importance of this new Canadian guideline. Recommending chiropractic care as a primary intervention for patients suffering from neck and spine related conditions recognizes the growing body of scientific evidence that chiropractic is no longer an ‘alternative’, and instead it is a clinically effective first line of intervention for all doctors to recommend.”

Later this month, the WFC will be in Geneva at the World Health Assembly and will meet with representatives of the World Health Organization to discuss how chiropractic is contributing to global public health initiatives. As the only chiropractic non-governmental organization in official relations with WHO, the WFC is committed to supporting key strategies in a range of health areas, including the provision of non-pharmacologic health care around the world.

   

Evidence for spinal manipulation? Things are beginning to click.

May 5, 2017

Richard Deyo

By World Federation of Chiropractic

Richard Deyo is a bit of a big cheese in the back pain world. A medical practitioner, he’s a Professor of Evidence-Based Medicine in the Department of Family Medicine at Oregon Health and Sciences University. He’s the Deputy Editor of Spine. He’s also on the editorial board of the Back Review Group of the Cochrane Collaboration. So it’s fair to say that so far as back pain goes, when he speaks, we should listen.

In the April 11 issue of the Journal of the American Medical Association (JAMA), Deyo’s editorial (1) focuses on the role of spinal manipulation in the treatment of back pain. Like this week’s article by Dr Aaron Carroll published in the New York Times (For Back Backs It May Be Time To Rethink Prejudices About Chiropractors, May 1, 2017), Deyo stresses the need to balance popular criticism often leveled at those using spinal manipulation with a few home truths when it comes to so-called conventional approaches to acute and chronic back pain.

Deyo hints that although spinal manipulation’s profile is rising as an evidence-based treatment intervention, its link to chiropractic has stunted its growth. Why? Because, he says, outdated views about health promoted by some chiropractors, rejecting immunization and other scientific advances, have led to suspicion and a reluctance of medical doctors to refer to them.

Despite this, Deyo reflects on the popularity of chiropractic in the US, citing one study involving 4000 respondents that showed chiropractic had more ‘highly satisfied’ consumers than physical therapy and primary care physicians. While reflecting on a recent systematic review that showed spinal manipulation to lead to modest improvements in pain and dysfunction, Deyo highlights the challenges of finding studies comparable in subjects, study design and interventions; thus, he say, it’s difficult to really be certain about the real magnitude of benefit.

Deyo concedes that there remains much we don’t know about the precise mechanisms of back pain, or how spinal manipulation actually works. Importantly, however, he says that this is no reason not to use it as a first-line intervention. Addressing the “but it’ll get better on its own” brigade, Deyo is quick to point out, as do many chiropractors, that the body has a tremendous ability to heal itself, but stresses that this is no reason not to manage pain associated with back pain using spinal manipulation.

Deyo refers widely in his editorial to a new systematic review and meta-analysis published by Neil Paige and his colleagues in the same April 11 issue of JAMA (2). The multidisciplinary authorship of this paper, including chiropractors Paul Dougherty and Richard Branson, sets out the benefits of spinal manipulation as well as transient harms. As Deyo points out, not a single study examined in the systematic review suggested that spinal manipulation was less effective than conventional care.

Key to Deyo’s editorial is the admission that we don’t have all of the answers when it comes to back pain. What’s the precise cause? Why some people do better than others? How do we best predict responses? How exactly does manipulation work?

When it comes to the popularity of chiropractic, contextual factors are often cited in explaining successful outcomes, and Deyo touches on these in his editorial. The hands-on nature of care. The ongoing doctor-patient relationship, with continuity of care over successive visits. The expectation of positive change, often with practitioner encouragement, reassurance, and positivity. Patients who feel empowered by their experience. As Deyo suggests, is it really so important that we don’t quite know the precise mechanisms of action when care is considered in the round and patients are so satisfied with their treatment?

Deyo goes on to address those who claim that spinal manipulation is dangerous. Besides pointing out that none of the RCTs or large observational studies reviewed by Paige et al identified any serious complications, he highlights the prevalence of renal and gastrointestinal adverse events from non-steroidal anti-inflammatory drugs and the risk of addition to opioids, both of which, he says, should be factored into cost comparisons when studying the relative effectiveness of spinal manipulation and conventional pharmacological approaches.

In conclusion, Deyo cautions against chiropractors who make exaggerated claims over the likely benefits of their care, especially in relation to non-musculoskeletal diseases, but stresses that spinal manipulation is a legitimate treatment option for low back pain, which the evidence shows is at least as effective as conventional drug approaches. In an era of evidence-based care, he observes that this is one area where the informed views and preferences of patients should count as much as the preferences of clinicians.

What Richard Deyo’s excellent editorial makes clear is that with a growing body of evidence suggesting comparative effectiveness, cost-effectiveness and safety of spinal manipulation, chiropractors are faced with opportunities like never before to position themselves as spinal health care experts in the healthcare system. At the same time, issues that perpetuate suspicion and mistrust must be tackled forcefully. Our future is, quite literally, in our hands.

References:
Deyo R. The role of spinal manipulation in the treatment of low back pain. JAMA (2017) April 11; 317(14):1418-1419.
Paige NM, Miake-Lye IM, Booth MS, et. al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. JAMA (2017) April 11; 317(14):1451-1460

   

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