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ObjectiveTo investigate the chronic low back pain and coronary heart disease relationship, after adjusting for relevant confounders, including genetics.MethodsIn a cross-sectional design, 2148 twins were recruited from the Murcia Twin Registry, Spain. The exposure was chronic LBP and the outcomes were myocardial infarction and other coronary heart diseases—lifetime and in the last 2 years–based on standardized health-related questionnaires. First, logistic regression analysis investigated associations of the total sample followed by a matched co-twin control analyses, with all complete twin pairs discordant for chronic LBP utilised, separated for zygosity—dizygotic (DZ) and monozygotic (MZ) pairs, which adjusted for shared familial factors, including genetics.ResultsChronic LBP pain is associated with lifetime myocardial infarction [odds ratio (OR) = 2.69, 95% confidence interval (CI) = 1.35–5.36], other coronary heart diseases over a lifetime (OR = 2.58, 95% CI: 1.69–3.93) and in the last two years (OR = 2.19, 95% CI: 1.33–3.60), while there was a borderline association with myocardial infarction in the last 2 years (OR = 2.64, 95% CI: 0.98–7.12). Although the magnitude of the association remained or increased in the co-twin control analyses, none reached statistical significance.ConclusionChronic LBP is associated with a higher prevalence of myocardial infarction and coronary heart disease. It is possible that this association remains even when controlling for genetics and early shared environment, although this should be investigated with larger samples of twins discordant for LBP.

Older people reporting spinal pain have 13% increased risk of mortality per year lived. However, this association is not likely to be causal, with the relevant confounders contributing to this relationship. Thus, pain in the spine may be part of a pattern of poor health, which increases mortality risk in the older population.

Background Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta‐analysis has investigated the effectiveness of SMT exclusively for CGHA. Objective To evaluate the effectiveness of SMT for CGHA. Databases and Data Treatment Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk‐of‐bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow‐up periods. GRADE described the quality of evidence. Results Seven trials were eligible. At short‐term follow‐up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] −10.88 [95% CI, −17.94, −3.82]) and small effects for pain frequency (standardized mean difference [SMD] −0.35 [95% CI, −0.66, −0.04]). There was no effect for pain duration (SMD − 0.08 [95% CI, −0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD − 13.31 [95% CI, −18.07, −8.56]). At intermediate follow‐up, there was no significant effects for pain intensity (MD − 9.77 [−24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD − 0.32 [−0.63 to − 0.00]). At long‐term follow‐up, there was no significant effects for pain intensity (MD − 0.76 [−5.89 to 4.37]) and for pain frequency (SMD − 0.37 [−0.84 to 0.10]). Conclusion For CGHA, SMT provides small, superior short‐term benefits for pain intensity, frequency and disability, but not pain duration, however, high‐quality evidence in this field is lacking. The long‐term impact is not significant. Significance CGHA are a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short‐term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.

Chiropractic students in Australia and New Zealand seem to hold both traditional and mainstream viewpoints toward chiropractic practice. However, students from different chiropractic institutions have divergent opinions about the identity, role, setting, and future of chiropractic practice, which is most strongly predicted by the institution. Chiropractic education may be a potential determinant of chiropractic professional identity, raising concerns about heterogeneity between chiropractic schools.