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Chiropractic Research Review

Management of Chest Pain: The Chiropractic Perspective

While the majority of chiropractic care focuses on the treatment of musculoskeletal disorders, doctors of chiropractic often serve as the primary point of contact for patients who present with conditions that may be nonmusculoskeletal in nature.

Among those conditions is chest pain, which may result from cardiopulmonary, gastrointestinal, and psychological factors, as well as musculoskeletal causes. Evidence suggests that musculoskeletal chest pain is prevalent in 20 percent to 50 percent of all medical settings. As such, the ability of all portal-of-entry providers to correctly diagnose chest pain is vital to delivering optimal patient care.

This study collected observational data from a multidisciplinary focus group consisting of chiropractors, medical doctors, and one dual-degreed chiropractic/medical physician. Among the goals of the focus group were to explore the attitudes and experiences of chiropractic and medical physicians regarding the treatment of chest pain, to identify important questions that could lead to the development of "best practices" for coordinating or managing care, and to discuss the feasibility of conducting or coordinating a multidisciplinary research program on the treatment of chest pain.

Several key themes emerged from the focus group's observations, including the following topics:

* Diagnosis. The group reported that a good patient history and physical exam are essential to good diagnosis. In addition, they observed that musculoskeletal chest pain is principally "a diagnosis by exclusion."

* Treatment and prognosis. Chiropractic participants provided anecdotal evidence of the effectiveness of manual/manipulative approaches to resolve chest pain of suspected musculoskeletal origin. Both chiropractic and medical participants noted a lack of formal clinical studies examining the effectiveness of manual/manipulative therapies in managing musculoskeletal chest pain, and a lack of evidence supporting medical drug interventions for musculoskeletal chest pain.

* Interprofessional coordination of care. Referrals should be based on evidence of efficacy for a given condition. In addition, the path of referral for chest pain will depend on the nature of the condition and the urgency of the situation, and the nature of the referral will depend on a variety of factors, including the nature of the condition, rationale for referral, provider preference, and relationships between providers.

* Best practices and standardization of care. Standardizing care within professions may facilitate opportunities for interprofessional referrals. Interactions between providers and professions may also be standardized.

The authors concluded: "Our research leads us to offer a number of recommendations for practice, research, education, and policy. Certainly, the investigators and members of the focus group feel that more education should be required in the diagnosis and management of chest pain. Research is also needed about the educational opportunities and challenges revolving around interdisciplinary care and practice."

Smith M, Lawrence DJ, Rowell RM. Management of chest pain: exploring the views and experiences of chiropractors and medical practitioners in a focus group interview. Chiropractic & Osteopathy Sep. 2, 2005;13(18).

Chiropractic Research Review

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