Re: Evidence based is a club to beat you with

[Guest guest]

Maybe I missed it, but it doesn’t seem to mention the severity of the "flare up". Obviously that should be the indicator as to frequency and duration of care.

ph Medlin D.C.

From: Abrahamson

Sent: Tuesday, May 24, 2011 9:14 AM

Subject: "Evidence based" is a club to beat you with

Hey guys and gals!Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.Does it occur to anyone that this is nonsense?Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.I may choose to breach protocol and jump to “triple dog pejorative.”Her supporting references:The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website."CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004)"The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2ndEd. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)SCIF HC Utilization Review Assessment Version iv April 20ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly workThe new ACOEM "Lower Back Disorders" page 149 is clear regarding chiropractic and flare ups. "RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise."ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acuteor progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits."Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

[Guest guest]

Why not cite the AHCPR Guidelines for the Treatment of Acute Lower Back Pain which had a much more inclusive multi-disciplinary review panel and recommendations? Hers are more current though. From: [mailto: ] On Behalf Of AbrahamsonSent: Tuesday, May 24, 2011 9:15 AMSubject: " Evidence based " is a club to beat you with Hey guys and gals!Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.Does it occur to anyone that this is nonsense?Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.I may choose to breach protocol and jump to “triple dog pejorative.”Her supporting references:The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website. " CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004) " The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2ndEd. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)SCIF HC Utilization Review Assessment Version iv April 20ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly workThe new ACOEM " Lower Back Disorders " page 149 is clear regarding chiropractic and flare ups. " RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise. " ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acuteor progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits. " Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

[Guest guest]

Sounds like a DC who has ner put their hands on anyone!

meow.

sk

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com

From: drscott@...Date: Tue, 24 May 2011 09:14:57 -0700Subject: "Evidence based" is a club to beat you with

Hey guys and gals!Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.Does it occur to anyone that this is nonsense?Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.I may choose to breach protocol and jump to “triple dog pejorative.”Her supporting references:The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website."CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004)"The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2ndEd. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)SCIF HC Utilization Review Assessment Version iv April 20ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly workThe new ACOEM "Lower Back Disorders" page 149 is clear regarding chiropractic and flare ups. "RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise."ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acuteor progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits."Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

[Guest guest]

She said NO CARE is indicated but thanks for your incisive analysis.

Patient presented for this episode of low back pain with:

hypertonic lumbar paraspinal muscles, palpatory pain, some peripheral neuritis into his right leg, and spinal subluxations (you know, manipulable lesions, movement deficiency syndrome, non-allopathic lesions, bone out of place step on a nerve).

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: ph Medlin <spinetree@...>

Date: Tue, 24 May 2011 09:38:11 -0700

< >, Abrahamson <drscott@...>

Subject: Re: " Evidence based " is a club to beat you with

Maybe I missed it, but it doesn’t seem to mention the severity of the " flare up " . Obviously that should be the indicator as to frequency and duration of care.

ph Medlin D.C.

From: Abrahamson <mailto:drscott@...>

Sent: Tuesday, May 24, 2011 9:14 AM

<mailto: >

Subject: " Evidence based " is a club to beat you with

Hey guys and gals!

Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.

I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.

In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.

Does it occur to anyone that this is nonsense?

Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”

Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.

I may choose to breach protocol and jump to “triple dog pejorative.”

Her supporting references:

The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.

The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]

A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website.

" CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004) "

The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2nd

Ed. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)

SCIF HC Utilization Review Assessment Version iv April 20

ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.

Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly work

The new ACOEM " Lower Back Disorders " page 149 is clear regarding chiropractic and flare ups.

" RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise. "

ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acute

or progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits. "

Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

[Guest guest]

,

Being close to the California border, I use to see a few workers comp patients from California. But about 10 years ago these California ACOEM guidelines came into effect and after a few visits they started to deny treatment.

All the literature that I sent didn't matter because, I believe, the purpose of these "guidelines" was to eliminate patient treatment. I had one patient who summand a lawyer, won his case and was treated for some years thereafter. But the vast majority of these cases faded away.

So, that'd my experience with these "evidence-based" treatment guidelines.

Christian Mathisen, DC, CCWFN

3654 S Pacific Hwy

Medford, OR 97501

cmathdcjeffnet (DOT) org

"Evidence based" is a club to beat you with

Hey guys and gals!Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.Does it occur to anyone that this is nonsense?Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.I may choose to breach protocol and jump to “triple dog pejorative.”Her supporting references:The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website."CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004)"The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2ndEd. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)SCIF HC Utilization Review Assessment Version iv April 20ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly workThe new ACOEM "Lower Back Disorders" page 149 is clear regarding chiropractic and flare ups. "RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise."ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acuteor progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits."Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”. E. Abrahamson, D.C.Chiropractic physicianLake Oswego Chiropractic Clinic315 Second StreetLake Oswego, OR 97034503-635-6246Website: http://www.lakeoswegochiro.com

[Guest guest]

I thought you’d enjoy my rebuttal:

Health Consultant Utilization Review Assessment Appeal

I am in receipt of the opinion from Dr. with which I respectfully disagree.

Dr. ’s opinion begins with an error and goes downhill from there.

Prior to addressing the clinical need for care, Dr. describes the patient’s work and injury history in a manner which makes him appear to be a chronic absentee case if not a malingerer. I have not combed through the patient’s time loss history but he stated that he has worked far more than he has missed and his seeking care is necessary for him to avoid time loss.

She states that Mr. REDACTED “sought care on 5-3-11 for back tightness” implying that his need for care was minor and unnecessary.

My intentionally simple request for care outlines:

REDACTED was examined and found to have:

hypertonic lumbar paraspinal muscles,

palpatory pain,

some peripheral neuritis into his right leg, and

spinal subluxations.

I would ask Dr. if this were a presentation which she would see in her clinic, whether she would turn the patient away with instructions for home exercises and no care. I doubt it.

Dr. also helpfully cites various studies and opinions to support her existing belief that the patient will not benefit from care.

Her first study (American College of Occupational and Environmental Medicine) discusses chronic pain. This patient is demonstrating episodic acute pain. A patient reporting with several cases of strp throat does not have chronic strep. Throat infection (although they might be predisposed to repeat acute episodes.)

The citing goes on to say, “chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients.” If this patient is having an acute episode, then this study confirms that my treatment is “appropriate for acute pain patients.”

ACOEM November 2007, page 149:

" there are concerns about the use of manipulation in the presence of acute or progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits. " So Dr. suggests that the patient presented with “back tightness”, but cites the “concerns” that ACOEM has for treating “radicular pain syndromes, etc.”

Concerns aside, chiropractic care for low back pain (with radicular pain with the diagnostic support of an MRI, which Mr. REDACTED received), is well established as a choice for low back care.

I will cite studies of my own if asked. Rather than engage in dueling study citing, I will rely on my professional opinion of treating injured patients for 20 years. Mr. REDACTED has a work related injury, which is repeatedly acute, confirmed by MRI to not be a surgical case, which the worker’s compensation department has already accepted as a valid claim. The patient has not opted for a cash settlement, but rather prefers to work and receive care as needed to continue to work. He has demonstrated that he responds to chiropractic care coupled with therapy and active home stretching, ice application, and mobility exercise. Therefore, Mr. REDACTED should be granted continued care as needed to keep him working which is the best outcome for a disabling injury.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Christian Mathisen <cmathdc@...>

Date: Tue, 24 May 2011 11:15:58 -0700

< >, Abrahamson <drscott@...>

Subject: Re: " Evidence based " is a club to beat you with

,

Being close to the California border, I use to see a few workers comp patients from California. But about 10 years ago these California ACOEM guidelines came into effect and after a few visits they started to deny treatment.

All the literature that I sent didn't matter because, I believe, the purpose of these " guidelines " was to eliminate patient treatment. I had one patient who summand a lawyer, won his case and was treated for some years thereafter. But the vast majority of these cases faded away.

So, that'd my experience with these " evidence-based " treatment guidelines.

Christian Mathisen, DC, CCWFN

3654 S Pacific Hwy

Medford, OR 97501

cmathdcjeffnet (DOT) org <mailto:cmathdc@...>

" Evidence based " is a club to beat you with

Hey guys and gals!

Evidence based conclusions are here to help...paint you into a corner and destroy your expert status.

I received a denial of a work comp. aggravation from California written by a MS, DABCO, DC.

In citing a pile of research that takes longer to cite than to make the actual argument, one conclusion is in bold below that patients with “flare ups” need “1-2 manipulations every 3-6 months”.

Does it occur to anyone that this is nonsense?

Might as well say, “Children with dyslexia should have 6-8 tutoring sessions to overcome their learning deficit.”

Of course she did use the word, “promulgated” forcing me to counter with the word, “specious”.

I may choose to breach protocol and jump to “triple dog pejorative.”

Her supporting references:

The California Worker's Compensation Medical Treatment Guidelines, also known as the Medical Treatment Utilization Schedule (MTUS), has been updated and promulgated into law effective July 18, 2009.

The MTUS is the official set of evidence-based medical treatment guidelines adopted by the Administrative Director (AD). The MTUS indicates the frequency, duration, intensity and appropriateness of treatment for certain work-related injuries. [as opposed to all that nonsense that doctors learned in school and clinical practice sometimes called, “experience”.]

A copy of the final regulations adopted by the Administrative Director can be found at the DWC's website.

" CA Medical Treatment Utilization Schedule (7/18/09), ACOEM Practice Guidelines, 2nd Edition (2004) "

The available clinical information does not support medical necessity for future chiropractic treatment. ACOEM The American College of Occupational and Environmental Medicine; Occupational Medicine Practice Guidelines; Evaluation and Management of common Health Problems and functional Recovery in Workers, 2nd

Ed. 2004.chapter 6 Pain, Typically, the chronic pain patient cannot be treated by the interventions that are appropriate for acute pain patients. Further treatment should be appropriate for the diagnosed condition(s) and should not be performed simply because of continued reports of pain, (pages 106-112) In general, intervention for treating pain should be goal oriented and time limited, (page 113)

SCIF HC Utilization Review Assessment Version iv April 20

ACOEM also supports 1-2 ov's for education, home care instruction review, again, this based of increase in functional activities.

Many passive and palliative interventions can provide relief in the short term but may risk treatment dependence without meaningful long-term benefit. Such interventions should be utilized to the extent they are aimed at facilitating return to normal functional activities, particularly work

The new ACOEM " Lower Back Disorders " page 149 is clear regarding chiropractic and flare ups.

" RECOMMENDATION: MANIPULATION FOR FLARE UPS. In patients with good functional outcomes that include return to work, manipulation that is necessary in order to treat flare ups, and thus maintain at work status through 1-2 manipulations every 3-6 months, may be acceptable provided there is adherence to a conditioning program consisting of aerobic and strengthening exercise. "

ACOEM November 2007, page 149: " there are concerns about the use of manipulation in the presence of acute

or progressive neurological deficits. Manipulation is not recommended for the treatment of radicular pain syndromes with neurological deficits. "

Does anyone have some good research regarding the appropriateness of chiropractic care for treating “flare ups” which I call “acute episodes” or the correct term which is “aggravation”.

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com