Chiropractic Insights

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Chapter One

Healing From Within: The Power of You

A growing body of research suggests patient and practitioner attitude, intent and emotions can influence clinical outcomes.

A quiet revolution is gaining momentum in spine science: The biopsychosocial model is challenging the simplistic biomedical model.

Instead of limiting the perspective of the clinician to an identifiable pathology, the biopyschosocial model emphasizes that one should consider the patient's unique biologic, psychological, social, and economic milieu.¹

Recent publications are taking things to a higher level. An article titled The Power of Suggestion – A Wild Card Across Spine Care states, The power of suggestion – and corresponding patient/subject expectations regarding outcomes – can have major effects in spinal medicine and spinal research ... simply observing people, paying attention to them, or making them feel special can induce powerful effects.² A paper by Michael and Garry³ suggests that suggestion and expectation may affect other well-known findings.

Scientists are also studying the relationship between emotions, brain connectivity, and pain. A study reported that where pain persisted, brain gray matter density decreased. The authors also noted, Initially greater functional connectivity of nucleus accumbens with prefrontal cortex predicted pain persistence, implying that corticostriatal circuitry is causally involved in the transition from acute to chronic pain.⁴ And as reported in the U.K.'s The Telegraph, The more emotionally the brain reacted to the initial injury, the more likely it was that pain [would] persist after the injury [had] healed.⁵

A frequent question asked by patients and practitioners is, To what extent do intent, attitude and touch affect health outcomes? Although these issues may seem unrelated to the technical aspects of health care, a growing body of evidence suggests that such factors may significantly affect the healing process. Attitude matters. Laughter and humor have been shown to have beneficial health effects as well.

CBS News⁶ reported on a paper in Aging⁷ that examined personality traits in people 95 years of age and older. The researchers reported that most had positive personality traits; the majority were outgoing, optimistic and easygoing. As noted by CBS News, They considered laughter an important part of life and had a large social network. They expressed emotions openly rather than bottling them up. Other investigators have found that dispositional optimism protects older adults from strokes.⁸-⁹

Berk, et al.,¹⁰ investigated how humor-associated, mirthful laughter modulated certain neuroimmune parameters. Fifty-two healthy men participated in the study. Blood samples were taken 10 minutes before viewing an hour-long humor video. Additional blood samples were taken 30 minutes into the video, 30 minutes after the viewing was completed and 12 hours after the viewing. Increases were found in natural killer cell activity (immunoglobins G and M), with several immunoglobin effects lasting 12 hours after viewing the humor video.

Other effects lasting at least 12 hours were increases in leukocyte subsets and cytokine interferon gamma. The authors concluded, Modulation of neuroimmune parameters during and following the humor-associated eustress [pleasant or curative stress] of laughter may provide beneficial health effects for wellness.

Finally, in a study by Kimata,¹¹ allergy patients who watched a Charlie Chaplin comedy had their skin welts shrink, an effect not found in control subjects who watched weather reports.

Do these studies mean that practitioners should abandon our clinical procedures and become stand-up comics? Certainly not! However, realize that an upbeat, positive, empathic attitude will benefit your practice members more than a neutral or negative one. In a study by DiBlasi, et al.,¹² the authors stated, One relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance.

As chiropractors, we touch our patients and project an attitude that profoundly affects their well-being. We can do so by default or by design. My message to practitioners and patients alike is to focus on your intent to allow the body to express its potential. It may significantly affect clinical outcomes.

References

1. Weiner BK. Spine update: the biopsychosocial model and spine care. Spine, 2008;15;33(2):219.

2. The Power of Suggestion - A Wild Card Across Spine Care. The Back Letter, 2012;27(8);96.

3. Michael RB, Garry M. Suggestion, cognition, and behavior. Current Directions in Psychological Science, 2012;21(3):151.

4. Balioki MN, Petre B, Torbey S, et al. Corticostriatal functional connectivity predicts transition to chronic back pain. Nature Neuroscience, 2012;15:1117.

5. Chronic Pain Is Determined by Emotions, Scientists Believe. The Telegraph (UK), July 1, 2012.

6. Castillo M. Researchers Discover Optimism May Lead to Longevity. CBS News, May 30, 2012.

7. Kato K, Zweig R, Barzilai, Atzmon G. Positive attitude towards life and emotional expression as personality phenotypes for centenarians. Aging, 2012;4(5):359.

8. Smile a Lot; It Just Might Save Your Life. USA Today, Dec. 27, 2011.

9. Kim ES, Park N, Peterson C. Dispositional optimism protects older adults from stroke. AHA Stroke; published online before print July 21, 2011.

10. Berk LS, Felten DL, Tan SA, et al. Modulation of neuroimmune parameters during the eustress of humor-associated mirthful laughter. Alternative Therapies, 2001;7(2):62.

11. Kimata H. Effect of Humor on Allergen-Induced Wheal Reactions. (letter) Journal of the American Medical Association, 2001;285(6):738.

12. DiBlasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. The Lancet, 2001;357(9258):757.

Chapter Two

Body, Mind and Chiropractic

The scope of chiropractic is as broad as the scope of influence of the nervous system. Although many chiropractors tend to focus on disorders associated with the physical body, particularly musculoskeletal pain syndromes, abnormal nervous system function may also affect emotional and psychological health.

Research is providing chiropractors with information about how the stress response is mediated by the autonomic nervous system¹ and how afferent input from the spine affects brain function.²-³

Rome published a two-part series reviewing neurovertebral influence on visceral and autonomic function.⁴-⁵ This is the most comprehensive review I have seen on the topic, featuring more than 1,100 references. Rome notes: Attempts have been made to classify conditions addressed by spinal manipulation into Type M (musculoskeletal) and Type O (organic). However, it seems that this is the only area in the health sciences where such a classification has been suggested. If categorization is necessary at all, then virtually all conditions should be basically 'Type N' (neurological) as nominated by Leach, as essentially all conditions would have a neurological element ... the weakness of a Type M/Type O classification renders it superfluous, if not meaningless. A 'Type N' designation would highlight the importance of total body considerations in such an extensive and integrated model of health care, as well as the encompassing influence and the integrative action of the nervous system.

Among Rome's conclusions: It is the emphasis on a localized ANS connection with the spine which would differentiate the chiropractic health care profession from others in the manipulative and manual therapies field. It must be appreciated that this association implies more than a musculoskeletal connection, and thereby may have the potential to influence neurophysiology and consequently homeostasis, which could contribute to overall patient well-being.⁵

There is a small, but growing body of evidence concerning the relationship of the spine, vertebral subluxation, chiropractic care, and psychological and emotional health. The following sampling is not a comprehensive review; it is merely to whet your appetite on the subject. A systematic review examined psychological outcomes in randomized controlled trials of spinal manipulation. The study concluded: There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions ... The clinical implications are that physical treatments, such as spinal manipulation have psychological benefits.⁶

Genthner, et al.,⁷ reported on a series of 15 patients with a history of depression. The Beck Depression Inventory II was used to measure the baseline level of depression and any post-care changes following orthospinology care. A paired t-test demonstrated significant improvement in depression test scores.

Other articles addressing mental health issues and chiropractic care have been published, ranging from single case reports to randomized clinical trials. Favorable responses were reported in persons with conditions including addiction,⁸ depression,⁹ ADHD,¹⁰ autism,¹¹ dyslexia and learning disabilities.¹² Additionally, published papers report changes in general health measures in chiropractic patients using the RAND-36 and Global Well Being Scale (GWBS),¹³ changes in domains of health-related quality of life among public safety personnel undergoing chiropractic care,¹⁴ and chiropractic care for patients with cancer-related traumatic stress symptoms.¹⁵

More than 38 years ago, my first chiropractor explained that everything we experience is processed through our nervous system. When our perception of the world is distorted by nerve interference, it compromises our ability to respond appropriately. He noted that in addition to damaging our physical health, it could result in impaired psychological and emotional function as well. Finally, he opined that when this happened to a significant number of people in a society, a sick society would result.

The distinction between Type O (organic) and Type M (musculoskeletal) disorders is illusory. Chiropractic care is concerned with the totality of the human experience. By analyzing and correcting vertebral subluxations, a patient is placed on a more optimum physiological path. This brings the individual closer to the definition of health promulgated by the World Health Organization: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.¹⁶

References

1. Lee R. The New Pandemic: Superstress? Explore, 2010;6(1):7-10.

2. Carrick FR. Changes in brain function after manipulation of the cervical spine. J Manipulative Physiol Ther, 1997;20(8):529-45.

3. Kelly DD, Murphy BA, Backhouse DP. Use of a mental rotation reaction-time paradigm to measure the effects of upper cervical adjustments on cortical processing: a pilot study. J Manipulative Physiol Ther, 2000;23(4):246-51.

4. Rome PL. Neurovertebral influence upon the autonomic nervous system: some of the somato-autonomic evidence to date. Chiropr J Aust, 2009;39(1):2-17.

5. Rome PL. Neurovertebral influence on visceral and ANS function: some of the evidence to date, part II: somatovisceral. Chiropr J Aust, 2010;40(1):9-29.

6. Williams NH, Hendry M, Lewis R, et al. Psychological response in spinal manipulation (PRISM): a systematic review or psychological outcomes in randomized controlled trials. Complementary Therapies in Medicine, 2007;15:271-283.

7. Genthner GC, Friedman HL, Studley CF. Improvement in depression following reduction of upper cervical vertebral subluxation using orthospinology technique. Journal of Vertebral Subluxation Research, Nov. 7, 2005.

8. Holder JM, Duncan Robert C, Gissen M, Miller M, Blum K. Increasing retention rates among the chemically dependent in residential treatment: auriculotherapy and (in a separate study) subluxation-based chiropractic care. Journal of Molecular Psychiatry, March 2001;6(suppl 1).

9. Desaulniers AMJ. Effect of subluxation-based chiropractic care on quality of life in a patient with major depression. Journal of Vertebral Subluxation Research, April 23, 2008.

10. Lovett L, Blum CL. Behavioral and learning changes secondary to chiropractic care to reduce subluxations in a child with Attention Deficit Hyperactivity Disorder: a case study. Journal of Vertebral Subluxation Research, Oct. 4, 2006.

11. Khorshid KA, Sweat RW, Zemba DA, Zemba BN. Clinical efficacy of upper cervical versus full spine chiropractic care on children with autism: a randomized clinical trial. Journal of Vertebral Subluxation Research, March 9, 2006.

12. Pauli Y. The effects of chiropractic care on individuals suffering from learning disabilities and dyslexia: a review of the literature. Journal of Vertebral Subluxation Research, Jan. 15, 2007.

13. Blanks RHI, Dobson M. A study regarding measures of general health status in patients using the Bio Energetic Synchronization Technique: a follow up study. Journal of Vertebral Subluxation Research, 1999;3(2):1.

14. McAllister W, Boone WR. Changes in physical state and self-perceptions in domains of health related quality of life among public safety personnel undergoing chiropractic care. Journal of Vertebral Subluxation Research, Aug. 6, 2007.

15. Monti DA, Stoner ME, Zivin G, Schlesinger M. Short term correlates of the Neuro Emotional Technique for cancer-related traumatic stress symptoms: a pilot case series. J Cancer Surviv, 2007;1:161-166.

16. World Health Organization: definition of health. Online. www.who.int/about/definition/en/print.html

Chapter Three

Chiropractic: A Glorious Future

In an article in the Journal of the American Medical Association, Kilo and Larson¹ describe the real issues surrounding our current health care crisis. It is not purely an economic problem to be solved by altering the way health care goods and services are paid for.

It is acknowledging that applying the same clinical strategies that got us into this predicament, but tinkering with finance and distribution, will not solve the problem. According to the authors: On balance, the data remain imprecise, and the benefits that U.S. health care currently deliver[s] may not outweigh the aggregate health harm it imparts ... it is time to address possibility of net health harm by elucidating more fully aggregate health benefits and harms of current health care.

Not only have the authors acknowledged that the current system may be doing as much or more harm than good, they cite the observations of Schroeder² that Determinants of well-being transcend health care ... since health care contributes only about 10% toward reducing premature death, even a perfectly designed delivery system would prevent only a modest proportion of premature death. Lifestyle choices, not medical and surgical treatments, are the determinants of longevity over which we have control.

According to Uwe E. Reinhardt, the James Madison Professor of Political Economy at Princeton, government accounts for about two-thirds of health care spending.³ State Medicaid expenditures exceed those for education, while U.S. health care spending in 2008 totaled approximately $2.5 trillion; nearly 17 percent of the gross domestic profit. In a previous article, I discussed how the broad application of chiropractic care could result in spectacular cost savings.⁴ Now let's discuss the specifics of a strategy for the future of chiropractic that would operationalize that vision.

Our Identity

The chiropractic profession needs a solid identity that differentiates it from other health care professions. An amorphous identity, such as that proposed by the World Federation of Chiropractic (WFC), as The spinal health care experts in the health care system,⁵ places chiropractic in direct competition with physical therapy, manual medicine, orthopedics, physical medicine and rehabilitation, osteopathy, naprapathy, and others. Particularly disturbing is the absence of any explicit reference to the vertebral subluxation - arguably the one unique feature of chiropractic practice. Rosner has articulated some of the potentially devastating consequences of the WFC identity, and I encourage readers to carefully ponder his remarks.⁶

The WFC identity stands in sharp contrast to the findings of a survey of North American chiropractors completed by the Institute for Social Research at Ohio Northern University and published in 2003, in which the following was reported:

88.1 percent of chiropractors stated that the term vertebral subluxation complex should be retained.

89.8 percent stated the adjustment should not be limited to musculoskeletal conditions.

93.6 percent said