Faculty Bibliography

BACKGROUND: The safety of the manual treatment techniques such as spinal manipulation has been discussed and there is a need for more information about potential adverse events after manual therapy. The aim of this randomized controlled trial was to investigate differences in occurrence of adverse events between three different combinations of manual treatment techniques used by manual therapists (i.e. chiropractors, naprapaths, osteopaths, physicians and physiotherapists) for patients seeking care for back and/or neck pain. In addition women and men were compared regarding the occurrence of adverse events. METHODS: Participants were recruited among patients, ages 18-65, seeking care at the educational clinic of the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 767) were randomized to one of three treatment arms 1) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage) (n = 249), 2) manual therapy excluding spinal manipulation (n = 258) and 3) manual therapy excluding stretching (n = 260). Treatments were provided by students in the seventh semester of total eight. Adverse events were measured with a questionnaire after each return visit and categorized in to five levels; 1) short minor, 2) long minor, 3) short moderate, 4) long moderate and 5) serious adverse events, based on the duration and/or severity of the event. Generalized estimating equations were used to examine the association between adverse event and treatments arms. RESULTS: The most common adverse events were soreness in muscles, increased pain and stiffness. No differences were found between the treatment arms concerning the occurrence of adverse event. Fifty-one percent of patients, who received at least three treatments, experienced at least one adverse event after one or more visits. Women more often had short moderate adverse events (OR = 2.19 (95% CI: 1.52-3.15)), and long moderate adverse events (OR = 2.49 (95% CI: 1.77-3.52)) compared to men. CONCLUSION: Adverse events after manual therapy are common and transient. Excluding spinal manipulation or stretching do not affect the occurrence of adverse events. The most common adverse event is soreness in the muscles. Women reports more adverse events than men. TRIAL REGISTRATION: This trial was registered in a public registry (Current Controlled Trials) (ISRCTN92249294).

BACKGROUND: Detailed knowledge about the interrelationship between neck pain, back pain and psychological distress is important from a public health prospective, but missing due to lack of large population-based cohort studies. PURPOSE: The aims of the study were 1) to assess and compare the sex-specific recovery rate of spinal pain and psychological distress as single and comorbid conditions, and 2) to describe the interrelationships between these conditions at baseline (2002) and at follow-up five years later. In addition, 3) we explored the questions of spinal pain as a risk factor for onset of psychological distress and psychological distress as a risk factor for onset of spinal pain. STUDY DESIGN: A prospective cohort study. STUDY POPULATION: General population in Stockholm county aged 18-84, n=19,774 OUTCOME MEASURES: Spinal pain (modified Nordic Pain Questionnaire) and psychological distress (General Health Questionnaire, GHQ-12). METHODS: A random sample of the population in Stockholm was approached with postal questionnaires at baseline and at follow-up. Authors declare that they have no conflicts of interests related to this study. The financial support: The Swedish Council for Working Life and Social Research, The Swedish Naprapathic Association and the Scandinavian College of Naprapathic Manual Medicine. RESULTS: Comorbidity of spinal pain and distress was twice as common among women (11%) than among men (4%), (RR=2.4, 95% CI: 2.1-2.7). Women also more commonly had spinal pain without psychological distress (women 20%; men 14%) and psychological distress without spinal pain (15%;12%). Comorbidity makes recovery less probable (women 26%,;men 27%, than having single conditions of spinal pain(women 41%, men 44%), or psychological distress (women 49%, men 52%,) No statistical significant sex differences were seen. Twenty four percent of the women and 17% of the men with spinal pain without psychological distress at baseline had psychological distress at follow-up. Corresponding figures for spinal pain among participants with psychological distress without spinal pain at baseline were 24% and 20%. Spinal pain was a determinant of psychological distress (OR= 2.6, 95% CI: 2.3 - 2.9) and psychological distress was a determinant of spinal pain (OR= 2.0, 95% CI: 1.8 - 2.2). CONCLUSION: Spinal pain and psychological distress as comorbid and single conditions are common in the general population, especially among women. Comorbidity affects recovery negatively both in men and women. This study confirms the bi-directional association between spinal pain and psychological distress in the general population.