Is the diagnosis of osteoarthritis subluxations at the T5 and T7 vertebrae comprehensive, given the exacerbation of upper back pain by cold and/or humid weather, stress, and limited relief from yoga, physiotherapy, massage, and stress relief exercises such as guided relaxation?

From the Guidelines

Your chiropractor may not be missing anything, as osteoarthritis can indeed worsen with weather changes and stress, but it is essential to consider a comprehensive approach to manage your condition effectively. To supplement your current management, consider adding evidence-based non-pharmacologic therapies.

Non-Pharmacologic Therapies

• Yoga, as supported by a systematic review for an American College of Physicians clinical practice guideline 1, can be beneficial for managing pain and improving function. Iyengar yoga, in particular, has been associated with lower pain scores and better function at 24 weeks.
• Mindfulness-Based Stress Reduction (MBSR), as evaluated in several trials 1, can lead to greater improvement in short-term back pain and function compared to usual care. MBSR programs typically involve 8 weekly group sessions and can be an effective adjunct to your current stress relief exercises.

Additional Recommendations

• For stress-related pain, mindfulness meditation apps or progressive muscle relaxation techniques practiced for 10-15 minutes daily may help, as they can reduce muscle tension and inflammatory responses.
• Maintaining good posture and ergonomics is essential, especially when sitting for long periods, to minimize mechanical stress on your joints.
• Heat therapy (heating pads for 15-20 minutes) can help during cold weather, while gentle stretching focused on thoracic mobility might improve function.
• If pain persists despite these measures, consult with a rheumatologist or pain specialist who might recommend additional treatments like corticosteroid injections or prescription medications, as suggested by the 2019 American College of Rheumatology/Athritis Foundation guideline for the management of osteoarthritis 1.

Lifestyle Modifications

• Weight loss, if applicable, can be beneficial for osteoarthritis symptom management, especially when combined with an exercise program 1.
• Self-efficacy and self-management programs are strongly recommended for patients with osteoarthritis, as they can provide consistent benefits across studies with minimal risks 1.
• Tai chi is strongly recommended for patients with knee and/or hip osteoarthritis, as it can have a holistic impact on strength, balance, and fall prevention, as well as on depression and self-efficacy 1.

From the Research

Potential Factors Exacerbating Pain

• Cold and humid weather, as well as stress, may be exacerbating factors for chronic pain, as seen in studies on spinal cord injury and chronic pain management 2.
• The biopsychosocial model of pain suggests that physical symptoms, including pain, are the result of a dynamic interaction between biological, psychological, and social factors 3.
• Factors such as negative mood, prolonged afferent activity, and transient somatic afferent activity may also contribute to pain exacerbation 2.

Additional Treatment Options

• A personalized, multimodal, and interdisciplinary treatment approach may be effective in managing chronic pain, including pharmacotherapy, psychotherapy, integrative treatments, and invasive procedures 3.
• Management of chronic pain may involve addressing underlying conditions, such as myofascial pain syndrome, fibromyalgia, or complex regional pain syndrome, and utilizing current treatment options 4.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be effective in treating rheumatoid arthritis and other inflammatory conditions, but their use should be carefully considered and monitored 5.

Considerations for Chiropractic Care

• It is possible that the chiropractor may not be addressing all underlying factors contributing to the pain, and a comprehensive evaluation of the patient's condition may be necessary to develop an effective treatment plan.
• The patient's experience of worsening pain during cold and humid weather, as well as under stress, suggests that a multifaceted approach to pain management may be necessary, incorporating strategies to address these exacerbating factors.