OBJECTIVE: This case report describes the evaluation and conservative management of mechanical low back pain secondary to multiple-level lumbar spondylolysis with spondylolisthesis in a United States Marine Corps veteran within a Veterans Affairs Medical Center chiropractic clinic. CLINICAL FEATURES: The 43-year-old patient had a 20-year history of mechanical back pain secondary to an injury sustained during active military duty. He had intermittent radiation of numbness and tingling involving the right lower extremity distal to the knee. Radiographs of the lumbosacral region demonstrated a grade I spondylolisthesis of L3 in relation to L4 and a grade II spondylolisthesis of L4 in relation to L5 secondary to bilateral pars interarticularis defects. There was marked narrowing of the L4-5 disk space with associated subchondral sclerosis. INTERVENTION AND OUTCOME: A course of conservative management consisting of 10 treatments including lumbar flexion/distraction and activity modification was provided over an 8-week period. Despite the long-standing nature of the complaint and underlying multiple-level lumbar spondylolysis with spondylolisthesis, there was a 25% reduction in low back pain severity on the numeric rating scale and a 22% reduction in perceived disability related to low back pain on the Revised Oswestry Disability Questionnaire. CONCLUSIONS: Conservative management is considered to be the standard of care for spondylolysis and should be explored in its various forms for symptomatic low back pain patients who present without neurologic deficits and with spondylolisthesis below grade III. The response to treatment for the veteran patient in this case suggests that lumbar flexion/distraction may serve as a safe and effective component of conservative management of mechanical low back pain for some patients with spondylolysis and spondylolisthesis.

J Chiropr Med. 2009 Sep;8(3):125-30. Dunn AS, Baylis S, Ryan D. Staff Chiropractor, VA of Western New York, Buffalo, NY 14215; Adjunct Assistant Professor, New York Chiropractic College, Buffalo, NY 14215.

Over the past 30 years, mental health practitioners, encouraged by rigorous empirical studies and literature and meta-analytic reviews, have increasingly appreciated the ability of hypnosis to modulate attention, imagination, and motivation in the service of therapeutic goals. This article describes how hypnosis can be used as an adjunctive procedure in the treatment of depression and rumination symptoms, in particular. The focus is on attention-based treatments that include rumination-focused cognitive behavioral therapy, cognitive control training, and mindfulness-based cognitive therapy. The authors provide numerous examples of techniques and approaches that can potentially enhance treatment gains, including a hypnotic induction to facilitate mindfulness and to motivate mindfulness practice. Although hypnosis appears to be a promising catalyst of attention and mindfulness, research is required to document the incremental value of adding hypnosis to the treatments reviewed.

Int J Clin Exp Hypn. 2010 Apr;58(2):202-21. Lynn SJ, Barnes S, Deming A, Accardi M. Psychology Department, Binghamton University, Binghamton, New York 13905, USA. slynn@binghamton.edu