Wednesday, July 26, 2023

Reduced likelihood of gabapentin prescription in U.S. adults receiving chiropractic spinal manipulation for low back pain

UNIVERSITY HOSPITALS CLEVELAND MEDICAL CENTER

CLEVELAND - A new study conducted by researchers at University Hospitals (UH) Connor Whole Health sheds light on potential benefits of chiropractic care for adults with radicular low back pain (i.e., sciatica). The study, published in BMJ Open, entitled "Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using U.S. data," investigated the relationship between chiropractic spinal manipulative therapy (CSMT) and the prescription of gabapentin, an off-label treatment for radicular low back pain.

The researchers hypothesized that adults under 50 years of age receiving CSMT for newly diagnosed radicular low back pain would have reduced odds of being prescribed gabapentin over a one-year follow-up period. Using a retrospective cohort study design, the research team analyzed data from a large U.S. healthcare network comprising millions of patient records. The CSMT cohort had significantly lower odds of receiving a gabapentin prescription compared to the usual medical care cohort. The odds ratio was 0.53 (p<0.0001), indicating a meaningful reduction in gabapentin use among patients who received chiropractic care for radicular low back pain.

"We are excited by the implications of our findings, which suggest that chiropractic care could offer benefits to managing low back pain and lead to greater concordance with clinical practice guidelines with respect to medication prescribing," said lead author Robert J Trager, DC, from UH Connor Whole Health. "While chiropractic spinal manipulation is already recommended for low back pain, this study re-affirms its utility and sheds light on its other potential pain management benefits."

As the medical community continues to seek ways to improve patient care, studies like this one contribute valuable insights into the potential benefits of CSMT for low back pain. With this study, the authors build on their previous work, which showed that recipients of CSMT were less likely to be prescribed a benzodiazepine, and other studies, which showed a similar finding with opioids.

You can read “Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data” in BMJ Open by clicking here.

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About UH Connor Whole Health

UH Connor Whole Health is part of University Hospitals (UH), a comprehensive health system with annual revenues in excess of $5.0 billion, 23 hospitals (including 5 joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices located throughout 16 counties. UH’s goal is to be the most trusted health care partner in Northeast Ohio and UH Connor Whole Health furthers this objective by working to strengthen relationships between patients and providers to improve outcomes. The Whole Health approach prioritizes compassionate care centered on the patient’s entire well-being. The health care provider’s goal is to equip and empower each patient to take charge of their physical, mental, and spiritual health in order to live a full and meaningful life. Linking the patient’s larger purpose and life goals to their lifestyle allows clinical services, integrative medicine, and well-being programs to be delivered in a way that increases collaboration, motivation, and adherence to self-care and clinical needs. UH Connor Whole Health services include acupuncture, art therapy, chiropractic, expressive therapy (art, dance, and music), guided imagery, integrative medicine/lifestyle medicine consultations (adult and pediatric), massage therapy, meditation, mindfulness, osteopathic sports rehabilitation, stress management and resilience training workshops and yoga. For more information, visit UH Hospitals.org/ConnorWholeHealth. Follow UH Connor Whole Health on LinkedIn.

About University Hospitals / Cleveland, Ohio

Founded in 1866, University Hospitals serves the needs of patients through an integrated network of 21 hospitals (including five joint ventures), more than 50 health centers and outpatient facilities, and over 200 physician offices in 16 counties throughout northern Ohio. The system’s flagship quaternary care, academic medical center, University Hospitals Cleveland Medical Center, is affiliated with Case Western Reserve University School of Medicine, Northeast Ohio Medical University, Oxford University, the Technion Israel Institute of Technology and . National Taiwan University College of Medicine. The main campus also includes the UH Rainbow Babies & Children's Hospital, ranked among the top children’s hospitals in the nation; UH MacDonald Women's Hospital, Ohio's only hospital for women; and UH Seidman Cancer Center, part of the NCI-designated Case Comprehensive Cancer Center. UH is home to some of the most prestigious clinical and research programs in the nation, with more than 3,000 active clinical trials and research studies underway. UH Cleveland Medical Center is perennially among the highest performers in national ranking surveys, including “America’s Best Hospitals” from U.S. News & World Report. UH is also home to 19 Clinical Care Delivery and Research Institutes. UH is one of the largest employers in Northeast Ohio with more than 30,000 employees. Follow UH on LinkedIn, Facebook and Twitter. For more information, visit UHhospitals.org.

JOURNAL

BMJ Open

DOI

10.1136/bmjopen-2023-073258

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data

COI STATEMENT

RJT reports he has received royalties as the author of two texts on the topic of sciatica.

Spurge purge: Plant fossils reveal ancient South America-to-Asia ‘escape route’

Climatic and continental changes likely drove a well-known group of spurge plants out of southern South America to southeast Asia and beyond, as evidenced by newly identified fossils found in Argentina

Peer-Reviewed Publication

PENN STATE

Spurge fig 5 — IMAGE: A 52-MILLION-YEAR-OLD COMPOUND INFRUCTESCENCE FOSSIL SHOWING PRESERVED FRUITS AND SEEDS ATTACHED TO BRANCHES, COLLECTED BY THE LATE RODOLFO MAGÍN CASAMIQUELA FROM LAGUNA DEL HUNCO, CHUBUT PROVINCE, ARGENTINA. THE PLANT'S CHARACTERISTICS — SUCH AS THE TERMINAL FRUIT (TF), AXILE SEEDS (SD) AND PLUMOSE STIGMA (ST) — ARE ONLY FOUND TODAY IN THE MACARANGA-MALLOTUS CLADE OF THE SPURGE FAMILY. view more
CREDIT: COURTESY OF PETER WILF

UNIVERSITY PARK, Pa. — Anyone who has taken a long road trip or bike ride has used a product of the spurge plant family — rubber. The spurge family, or Euphorbiaceae, includes economically valuable plants like the rubber tree, castor oil plant, poinsettia and cassava. Newly identified fossils found in Argentina suggest that a group of spurges took a trip of their own tens of millions of years ago. Driven by climatic changes and land movements over millennia, a group of spurges relocated thousands of miles from ancient South America to Australia, Asia and parts of Africa, according to research led by Penn State.

Reported in the American Journal of Botany, the findings suggest that the spurge family’s Macaranga-Mallotus clade (MMC), encompassing a common ancestor and all its descendants and long considered to have Asian origins, may have first appeared in South America when it was still part of Gondwana — the supercontinent that encompassed South America, Antarctica and Australia — before spreading around the globe.

“Our study provides the first direct fossil evidence of spurges in Gondwanan South America,” said Peter Wilf, professor of geosciences at Penn State and lead author of the current study, noting that the finding contrasts with the prevailing idea that the MMC evolved in Asia. “But if they evolved in Asia, how in the world would they have gotten to where we found them, in Argentine rocks 50 million years old? Instead, we think these spurges tracked the moving continents from South America to Asia, to the other side of the world. You can’t go much farther than that without leaving the planet. We’ve seen this pattern in many other plant groups we’ve found as fossils in South America like kauris, Asian chinkapin and yellowwood trees. Altogether it is the most dramatic evolutionary biogeography story I’ve ever seen.”

According to Wilf, Euphorbiaceae have adapted well to evolutionary challenges in different environments.

“They’re common in tropical rainforests in Africa, South America and most notably in Asia, where if you count the number of trees in a plot, they’re usually the second most common type,” he said. “They make up much of the understory habitat that is structurally important to the rainforest and its animal life. The MMC is well known in the Asian tropics and is highly visible along roadsides and in burned areas. Its plants often have large, umbrella-like leaves that provide abundant shade, and they provide nutritious seeds for animal forage.”

The spurge family comprises more than 6,000 species, found mostly in the tropics but also in deserts and cold temperate zones, and there are about 400 species in the MMC alone. Given their prevalence in southeast Asia and 23-million-year-old fossils previously found in New Zealand, scientists have considered the MMC an “Old World” plant group likely with Asian origins. The current study, based on fossils more than twice as old as the New Zealand specimens, provides the first evidence of “New World” origins for MMC spurges and adds two new species to the plant family, according to the scientists.

Wilf and his colleagues at Argentina’s Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET) in Bariloche and the Museo Paleontológico Egidio Feruglio (MEF), and Cornell University examined 11 leaf fossils and two compound infructescence fossils, or fossils that show preserved fruits and seeds attached to branches. The fossils came from a site in Chubut, Argentina called Laguna del Hunco, where the researchers have collected fossils for decades. Dating of volcanic rocks at this site places the fossils at 52 million years old, a globally warm time immediately preceding the final separation of Gondwana.

The scientists studied the detailed characteristics of the leaves and fruits and compared them with living specimens. They also took CT scans of the infructescences at the Penn State Center for Quantitative Imaging. The scans picked up density changes in the rock and rendered them into three-dimensional images that the researchers used to study the fruits’ features, including tiny paired seeds inside the fruits that were barely visible at the surface.

The researchers found that the characteristics of the fossil fruits and leaves are only found today in MMC spurges, identifying them as two new species. They named the infructescences after the late Rodolfo Magín Casamiquela, an Argentine vertebrate paleontologist and anthropologist who collected one of the specimens, perhaps as early as the 1950s, and the leaf species after Kirk Johnson, paleobotanist and Sant Director of the Smithsonian National Museum of Natural History who had discovered the first of the leaf fossils in the 1990s.

“The MMC is widely distributed, but prior to this research they’ve never been found growing naturally in the Americas,” Wilf said. “This is the first time that the MMC has been reliably documented anywhere in the Western Hemisphere past or present.”

The fossils tell a story about environmental changes, plate tectonics and biogeography, or the distribution of plants and animals around the world, Wilf said. The plants likely originated and evolved in Gondwana and began retreating as the climate grew drier and colder over millions of years, suffering extinction in Antarctica and South America but apparently surviving in Australia, he said. At the same time, plate tectonics were pulling apart the Gondwanan supercontinent. Australia broke away from Antarctica more than 40 million years ago and collided with southeast Asia 25 million years ago, bringing the water-demanding plants to New Guinea and the southeast Asian rainforest, the researchers said.

“We’ve seen over and over again that we can trace a significant number of Australian and Asian rainforest plants all the way to Argentina and Western Gondwana,” Wilf said. “These fossils tell us how plants respond to environmental changes. If you give them time and an escape route, like Australia as it moved from the Antarctic latitudes to Asia, they can move around the world following their preferred environment and thrive. Deforestation and environmental changes today, including in southeast Asia where our Gondwanan survivor trees live, are occurring 100 to 1000 times faster than they did millions of years ago, and escape routes have been converted into cities and agriculture. These fossils serve as a warning from the deep past, that the natural world that we rely on is extremely resilient but cannot keep up with us. It is not too late to act and avoid the worst outcomes.”

Also contributing to the study were Ari Iglesias, CONICET, and María Gandolfo, Cornell University and the MEF.

The National Science Foundation and National Geographic Society supported this work.

Fossil leaves with characteristics identical to several Macaranga species.
A compound infructescence fossil showing preserved fruits and seeds attached to branches. The 52-million-year-old fossil fruits and leaves that the researchers identified as belonging the the Macaranga-Mallotus clade (MMC) of the spurge family suggest that the MMC, long considered to have Asian origins, may have first appeared in Gondwanan South America before spreading around the globe.

A CT scan of a fossil infructescence showing fruits and tiny paired seeds inside the fruits. The CT scan picked up density changes in the rock and rendered them into three-dimensional images.

CREDIT

Courtesy of Peter Wilf