January 2019 - chiropracticforward January 2019 - chiropracticforward

Month: January 2019

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

Today we’re going to talk about What Is Contributing To Low Back Pain And More Opioid Bashing from us. We hate them and they don’t do any good anyway so why did 72,000 people have to die at their hands last year in America?

But first, here’s that bumper music.

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have fumbled your way into Episode #57

Junk I Say

Let’s first talk a bit about junk I say. I drive myself crazy and here’s why; I get flustered sometimes. I don’t know why. Honestly, I’d like to eventually go on the speaking circuit but I think I’ll be terrible at it. Lol. I get flustered. 

I always listen to the episodes after they post. For a couple of reasons but it’s kind of like why a football team will watch game tape the day and week after a game. I do the same thing. I want to identify where I can improve and how I can make myself and the show better from week to week. 

Well, I invariably catch myself saying stuff that makes no sense. Like in the recent episode where I discussed the lack of research for lumbar fusion, I referred to an orthopedic surgeon as an osteopath. What? Trust me…..I know the damn difference so things like that make me want to punch myself in the nose a little. 

Another is that, without thinking, I’ve been calling it the diplomate of American chiropractic orthopedists. Yeah….that’s not what it is and I know that. Lol. It’s the Diplomate of the Academy of Chiropractic Orthopedists and those folks can be a member of the American Chiropractic Orthopedists. You see the confusion, right?

Anyway….I’m not a dummy people. Well, most days anyway. I still have my brain farts but I’m usually fairly put together. Or at least I like to think I am. Reminds me of a comedian I heard when I was a kid. He said, “I may look dumb, but that doesn’t mean I’m not!” Yeah….so you just think about that for a bit. 

The DACO

Speaking of the DACO program, “What’s the latest?”, you may ask. To that I would answer that a lot is going on actually. I slowed down for a bit but picked it back up during the holidays with the spare time I had. 

More communication drills including ideas and instruction on how to tactfully disagree with our medical counterparts. For instance, if they diagnose a patient with a disc and we are CERTAIN it’s an SI, how are you going to let them down softly and keep them from going away mad ala Motley Crue…girl….don’t go away mad. Just go away. 

You know we all have egos and you know damn well that “king ego” exists in the medical world. How do you tell those people they’re at odds with the research? I’m afraid there are some of them that would rather be wrong than be corrected. 

How do you tell them that they diagnosed a tension-type headache when, in reality, the symptoms are more in line with a cervicogenic headache? And then, how do you tell a GP that probably doesn’t like cervical manipulation that you recommend just that?

Things that make you go “Hmmmm….”

At the end of each of the Communication Drills, they give you a script to help you in the future should the need pop up for you to artfully and tactfully slap around Mr. King Ego without them really knowing you payahed them across the face with a glove. 

Short Show 

Alright, it’s a crazy week. I’m trying to close out 2018 as far as stats go and all that good stuff so this episode ain’t gonna be a big one. 

Before we get to it though, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We’ll send you one once a week when a new episode pops up and, if we have something cool to tell you about, I’ll include it in that email. No extra emails. Don’t be so stingy with that damn email address. 

Don’t be like a college kid with the last piece of pizza. Don’t be that kid. 

Onto the Research

Let’s get to the goodies, folks. Let’s start with this one from BMC Musculoskeletal Disorders by Shanthi Ramanathan, Peter Hibbert, Louise Wiles, Christopher Maher, and William Runicman called “What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study[1].”

 

First thing here is that Chris Maher is a busy guy, y’all. Seriously. He is a Physical Therapist and I believe lives in Australia if I remember correctly. He was on a paper we discussed recently having to do with lumbar fusion as well as being on The Lancet series of papers for low back pain. He’s a mover and shaker

Why They Did It

Knowing that low back pain is non-specific in 90% of cases, low back pain is treated as an independent entity even though we know other conditions exist with it or contribute to it. What comorbidities? Things like obesity, diabetes, heart disease, high blood pressure, arthritis, etc…

What They Found

One hundred and sixty-four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions.

Wrap Up

This study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research.

Paper #2

Onward we march…. This one is called “Chiropractors’ views on the use of patient-reported outcome measures in clinical practice; a qualitative study.” It was written with Michelle Holmes as the lead author followed by Felicity Bishop, David Newell, Jonathan Field, and George Lewith and it was published in Chiropractic and Manual Therapies in December of 2018[2]. 

I know you people like the new stuff. 

Why They Did It

Patient-reported outcome measures (also known as OATS in my office and probably your office as well. OATS meaning Outcome Assessments)

Anyway, OATS are widely available for use in musculoskeletal care there’s not much research exploring the implementation of OATS in clinical practice. They wanted to see what chiropractors’ views were on OATS to identify any barriers and facilitators to implementing OATS in chiropractic care.

What They Found

“Chiropractors are increasingly using OATS in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using OATS. Exploring chiropractors’ experience of using OATS, this study identified how clinician knowledge and engagement and organizational barriers and facilitators affect implementing OATS in chiropractic care, such as choosing the appropriate OATS and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding OATS, with training including the process and benefits of using OATS in clinical practice.”

Opioids

Now, in our “beating a dead horse” segment, let’s bash the hell out of opioids, shall we? Well, don’t mind if I do!

This one is by Jason Busse, a Chiropractor by the way, and associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada……. Canada has it going on, folks. Seriously.

Here’s a chiropractor in the department of anesthesia at a school of medicine. We need to get that guy on our podcast don’t you think?

The paper was also written by Li Wang, Ph.D., and Mostafa Kamaleldin. Easy for you to say. 

It’s called “Opioids for Chronic Noncancer Pain; A systematic review and meta-analysis[3]” and appeared in JAMA in December of 2018. 

Why They Did It

They wanted to find out if the use of opioids to treat chronic noncancer pain was associated with greater benefits or harms compared with placebo and alternative analgesics.

Wrap It Up

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

CNN’s Spin 

CNN actually did an article by Michael Nedelman[4], on this paper where they get a little deeper saying the following, “For adults with chronic pain, opioids offer narrow improvements over placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit.”

Subgroups of the studies included in the analysis suggest that non-opioid alternatives — such as NSAIDs, certain antidepressants and medical cannabis — may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said.

Question

Here’s my question for Dr. Busse, “Considering the fact that the American College of Physicians and The Lancet promote spinal manipulative therapy for acute and chronic low back pain as an alternative to opioids, and considering you are a chiropractor, why did your research not include spinal manipulative therapy as one of the alternative treatments?”

My guess is that maybe there were not enough randomized controlled trials comparing spinal manipulative therapy directly to opioids? I’m not sure why, to be honest. 

What We Know

But, we do know from JAMA that a current review found that spinal manipulation therapy is associated with moderate improvements in pain and function in patients with acute low back pain[5].

We know from Keeney et al that there “Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor[6].”

From Haas et. al[7]., we know “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

There are so many others that I just don’t have the time to get into right now but, I’m certainly interested in papers comparing the two directly to each other. I bet I already know the answer and I bet you do too. 

Integrating Chiropractors

The Message

Here’s why you know the answer already……it’s because we know that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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TuneIn

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

1. Ramanthan S, H.P., Wiles L, Maher C, Runicman W,, What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study. BMC Musculoskelet Disord, 2018. 19(391).

2. Holmes M, B.F., Newell D, Field J, Lewith G,, Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap, 2018. 26(50).

3. Busse J, W.L., Kamaleldin M,, Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 2018. 320(23): p. 2448-2460.

4. Nedelman, M., Opioids offer little chronic pain benefit and wane over time, study says, in CNN. 2018: CNN Online.

5. Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.

6. Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.

7. Haas M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther, 2004. Mar-Apr;27(3): p. 160-9.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

 

 

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration  

Today we’re going to talk to one of the giants in our profession, Dr. James Lehman. We will be talking to Dr. James Lehman all about all sorts of things but mostly about the future of chiropractic. What is it looking like for those of us in the profession over the course of the next 15-30 years?

Dr. James Lehman, FACO - University of Bridgeport Connecticut

But first, here’s that delicious bumper music

Integrating Chiropractors

 

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We will get to Dr. James Lehman soon. 

Introduction

You have fluttered into Episode #55 kind of like the feather on Forrest Gump. Come on, you know the feather from literally one of the best movies of all time. Yes, that feather. 

Diplomate of the Academy of Chiropractic Orthopedists

This is normally the point in the program where I mention the DACO program and how I am progressing through it but, for reasons that will become obvious fairly quickly, we are going to save that talk for just a little later in our program. 

However, I will tell you I have 80 online hours at this point and some of my more recent classes have been Why does my shoulder keep hurting and how to diagnose a tension-type headache. If you recall from a week or so ago, two classes on migraines were among the classes so, after this last week, I’m getting a handle on the headache mystery. 

I have just about completed all of the Diagnostic Drills. There are 40 of them and I’ve finished 39 of them. The last one is on ankle sprain and what we really need to know about them. Then, we move on to Communication Drills that reinforce these Diagnostic Drills and help you write to your colleagues in an effective and professional way to describe your findings. I’m looking forward to those!

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Questions for Dr. Lehman

How did the job at UofB become a reality for you? How did you make that happen or even make it a possibility?

Can you tell me about your position at UofB? 

What are your responsibilities? 

What does a regular day for you look like? 

Dr. Lehman and I became acquainted with each other through the DACO program. In case you have been hiding under a rock, zoning off during our podcasts, or maybe this is the very first podcast you’ve listened to of ours, DACO stands for Diplomate of American Chiropractic Orthopedists. 

What got you so interested in the Orthopedic side of our profession? 

What was it that made you want to specialize originally?

Can you tell us a little about your experience with chiropractic integration over the years? 

Have you had some battles to fight internally against medical practitioners?

What are some of the pitfalls and what are some of the rewards beyond seeing the patients recover?

Can you tell us about FQHCs? I had no idea they existed, especially in my city, until you showed me. Integrating into an FQHC was something that was never on my radar until we talked in Dallas.

At this point in our discussion, I need to tell you, the audience, that Dr. Lehman has played a vital role in furthering the DACO program. Through his position at the University of Bridgeport Connecticut, and through a partnership of sorts with online education through Chiropractic Development International out of Australia, obtaining the DACO has become very do-able and very attainable for all that may be so inclined. 

Dr. Lehman, can you tell us a little about how you and the University of Bridgeport got involved in the DACO and how it’s going so far? How did you identify the need and then go about filling that need?

Can you tell us why you feel like specialization like the DACO is so important to doctors of chiropractic these days? 

Why has this become your mission?

Through email, you suggested to me that, for the chiropractic profession to gain the respect of the healthcare system, a reasonable definition of chiropractic would be a good starting point. You offered a definition that doesn’t restrict providers nor does it highlight ‘subluxation.’ That definition is as follows:

“The evidence-based practice of differential diagnosis, patient-centered treatment, and prevention of pain and human disease as taught by CCE-approved chiropractic colleges, institutions, or schools.”

Tell me how you came up with this definition. 

Just to tell a quick personal experience, I have been introduced before by one neurosurgeon to another neurosurgeon using a disclaimer. He said, “He’s not one of THOSE chiropractors. He’s one of the good guys.” Which, I have to say that I appreciated the vote of confidence but at the same time it made me think, “With such a prevailing sentiment toward our profession, how will we ever integrate successfully or is it even possible?”

Do you think that even those of us that are specializing are going to be forever introduced with a disclaimer? I personally don’t see how a profession as split as ours progresses and integrates successfully. Is there a solution to this or are we just stuck with the split and the internal fighting?

With the knowledge that PTs are now utilizing spinal manipulative therapy, what do you feel is going to happen with our profession in the next 15-30 years?

In the two classes I’ve sat through with you as a speaker, you were adamant about Informed Consent. I read your paper on that topic after I got back from Dallas and thought it was pretty interesting. Informed Consent doesn’t sound like a particularly interesting or sexy topic to the general population so, would you mind telling us about that and what interested you enough in a topic like Informed Consent to actually publish a paper on it?

We covered the vast divide in our profession, what are some other big obstacles you see on the horizon for our profession right now?

In our private Chiropractic Forward Group, when we discussed you episode coming on the show, Dr. Brandon Steele said I need to ask you this question, “What can students do right now to prepare for current trends in Healthcare? Are there residencies, certifications, internships or other equivalents they should be considering going through to prepare for their future after graduation?”

Also in the private group, Dr. William Lawson, who has been a guest with us before, told me to ask you about rural healthcare centers and how a chiropractor can work in or own a rural healthcare center. 

 being with us and taking time out of your day. I really appreciate you and what you are doing for our profession. I don’t know where we would be without folks like you and others just like you. 

Integrating Chiropractors

 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

CF 039: Communicating Chiropractic

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future