Objective: The purpose of this article is to describe the management of chronic spine pain in 3 United States military veterans who participated in extended courses of chiropractic care that focused on active care strategies in a group setting.
Clinical Features: A 68-year old male veteran (case 1) with a 90% service-connected disability rating presented with chronic neck and lower back pain. An 82-year old male veteran (case 2) with a 20% service-connected disability rating presented with chronic neck and upper back pain. A 66-year old male veteran (case 3) presented with a 10% service-connected disability with chronic episodic back and neck pain. Each veteran described a desire to maintain ongoing chiropractic treatments after completion of a course of chiropractic care in which maximal therapeutic gain had been determined. Patient-Reported Outcomes Measurement Information System (PROMIS) Patient Interference Short Form 6b (PPI), PROMIS Physical Function Short Form 10b (PPF), and Pain, Enjoyment, and General Activity (PEG) outcome measurement tools were used to track response to care.
Interventions and Outcome: Each veteran participated in an extended course of chiropractic visits consisting of group pain education, group cognitive behavioral strategies, group exercise, group mind-body self-regulation therapy, and optional individual manual therapy. Case 1 completed 8 extended chiropractic visits in 12 months and reported no change in PPI scores, improvement in PPF scores, and worsening PEG scores. Cases 2 and 3 completed 6 extended chiropractic visits each over a 12-month period and reported improvements in PPI, PPF, and PEG scores.
Conclusion: This article describes the responses of 3 veterans with chronic spine pain participating in long-term care using chiropractic visits in a group setting that focused on active care strategies. Our group-based, active care approach differs from those described in literature, which commonly focus on visits with a strong emphasis on manual therapy in 1-on-1 patient encounters.
Author keywords: Chiropractic; Low Back Pain; Neck Pain; Chronic Pain; Rehabilitation; Long-Term Care
Author affiliations: JAG: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States; NJC, ASM: Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, United States; CJD: VA Puget Sound Health Care System, Tacoma, Washington, United States; ASM: Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, United States
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