$8,770

This randomized clinical trial of 120 patients compares the effects of spinal manipulation to cervical massage plus low level laser treatment in patients suffering from tension headache, by far the most prevalent form of headache observed. Following 8 treatments through a 4-week period preceded by 2 weeks of baseline monitoring, patients are to be monitored at weeks 7, 11, 15 and 19 with a followup at 30 weeks. Outcome variables include [i] the number of hours of headache per day; [ii] the headache intensity as measured by the Visual Analogue Scale; and [iii] the daily consumption rate of analgesics. Objective measures which will shed light upon the tenderness of pericranial muscles which characterizes tension headache include [i] changes in the pressure pain threshold and [ii] changes in pericranial tenderness in response to a standardized stimulus.

Inclusion criteria of subjects recruited through local newspaper advertising include [i] an age of 20-60 years, [ii] headache intensity of 25-85 on a 100-point VAS scale; [iii] fulfillment of the criteria of the International Headache Society, including a minimum of 5 episodes per month; and [iv] no contraindications to manipulation. To control for a placebo effect, the change in the participants' treatment outcomes will be monitored on a VAS toward the end of the baseline period.

To date, 56 subjects have completed the treatment phase of the study. Prelminary analyses of results suggest that the manipulation group continues to improve with time, as reported earlier in both the Meade and Boline studies.

$164,086

In order to evaluate the biomechanical factors that may sensitize paraspinal sensory endings to movement of a facet joint, the Principal Investigator seeks to evaluate the responses to mechanical stimuli delivered to the L₅-L₆ facet joint and surrounding tissues in cat models. A surgical procedure that the author has established isolates the dorsal roots while keeping intact a lumbar facet and the overlying musculature. During movement of the L₅-L₆ facet, the discharge of primary afferents can be recorded. Such afferents will be classified into group I, II, III or IV based upon their conduction velocity; their receptive fields are also to be measured.

The following hypotheses are to tested: [i] the discharge of group III and IV afferents in the lumbar spine is graded with the magnitude and direction of facet joint movement; [ii] the response of group III and IV afferents innervating muscles and deep tissues of the lumbar spin is diminished after removing a sustained static load applied to a lumbar facet. These data are to provide a bridge to future studies which will seek to evaluate how muscle fatigue-induced metabolites and inflammatory mediators influence the discharge of primary afferents at rest and during movement of the L₅-L₆ facet joint.

By determining the characteristics of spinal tissue afferents related to the mechanical insults which could lead to painful conditions, this study is distinguished in that it then sheds light upon procedures which could result in the decrease of back pain. By so doing, the proposed investigation provides a rational basis for explaining how chiropractic spinal manipulation helps patients in addition to adding to our understanding of the sensory mechanisms that cause back pain.

$27,397

The investigators propose a feasibility study of chiropractic care for the symptom of disequilibrum [vertigo, or dizziness]. Specific objectives include [i] obtaining information necessary to determine whether a controlled clinical trial is warranted; [ii] determine the sample size for such a trial; and [iii] attempt to identify any predictors of treatment outcome. This will be accomplished by means of a single-blinded, nonrandomized descriptive case series analysis.

Patients will be recruited from a hospital otolaryngology department where baseline data are to be assembled through standardized data collections. A 2-3 week trial of chiropractic care would be implemented based upon presentation to the chiropractor, with a followup reassessment to be taken by the individual taking baseline data at the clinic. The anticipated sample size is 200 patients, with an additional three-month followup scheduled for the first 100.

Four validated outcome measures are to be used to quantify symptoms associated with dizziness: [i] Dizziness Handicap Inventory, [ii] UCLA Dizziness Questionnaire, [iii] Visual Analog Scales for both symptom severity and neck discomfort, and [iv] electronystagmogram. If relevant, multivariate analysis will be undertaken to ascertain whether the results might be obscured through some confounding factors.

Top

$14,000

The Institute for Healthcare Improvement [IHI] was founded in 1991 as a non-profit organization whose intention is to bring together diverging forces in healthcare in order to create and implement systems that focus on improving healthcare quality while emphasizing collaboration over competition. Beginning in 1995, the IHI organized a series of collaboratives with the goal of achieving substantial improvement in ten key clinical and operational areas, one of which happens to be low back pain. Current participants include the Mayo Medical Center, Harvard Pilgrim Health Plan, Kaiser-Permanente, Blue Cross/Blue Shield California Workers Compensation Division, General Motors and GTE. No medical schools approached were willing to participate.

Until now the low back pain collaborative existed without a single chiropractic organization. That inequality has now been addressed with this grant to include two institutions which possess prominent yet contrasting advantages in providing chiropractic healthcare. Palmer University provides a dedicated, functional chiropractic clinic at the first chiropractic teaching institution in the world, while the Texas Back Institute has moved to position chiropractors in a gatekeeping role at a large multidisciplinary back care center.

Through February 1998, three representatives from each participating organization in the back pain collaborative will learn the most recent scientific information available on improving healthcare in this field as well as the most effective means to put this knowledge into practice, under the guidance of distinguished experts in subject matter and applications. These results are to be presented at a National Congress and documented and disseminated internationally in a Breakthrough Report.

Top

$36,000

This study continues the work of this laboratory in its evaluation of the neuroanatomical and neurophysiological relationship of abnormal spinal stimulation and visceral malfunction and associated symptomatology--a basic tenet of chiropractic theory. It does so by investigating spinovisceral reflexes in both the digestive system and urinary tract by using balloon catheters to measure changes in bladder and gastric motility in rats, following stimulation of spinal afferents from posterior spinal structures.

Because both the digestive and urinary systems have significant dual [sympathetic and parasympathetic] innervation, these studies will provide important data to compare and contrast with this research group's earlier and current studies of cardiovascular reflexes [which are sympathetic in nature]. The proposed research will use two types of stimulation parameters [graded electrical currents and microinjection of capsaicin] which excite larger afferent fibers, then at intensities which also excite small diameter afferents.

From this approach, it should be possible to make two important distinctions: [i] between reflex responses to the stimulation of nociceptive and non-nociceptive fibers; and [ii] between natural stimulations which are specific for a particular class of nociceptors [via capsaicin injections] and stimulations whose targets depend upon magnitude and which are not as tissue-specific [graded electrical currents].

The investigation will utilize previously published surgical, stimulatory, and outcome monitoring procedures already developed in the author's laboratory. All operations will be performed under urethane anesthesia with respiration, core temperature, blood pressure, and heart rate monitored and maintained using standard small animal surgical protocols. Miniature balloon catheter implantation will be either in the urinary bladder or the gastric pylorus for monitoring luminal pressure changes in the respective viscera.