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CF 030: Integrating Chiropractors – What’s It Going To Take?

Episode #30

Integrating Chiropractors – What’s It Going To TakeIntegrating Chiropractors

Today we’re going to talk about what the medical field may be looking for when integrating chiropractors into their referral network. We’ll also talk about a recent article discussing The Lancet papers and whether or not the Chiropractic profession needs to take more care…..or care at all for that matter. 

But first, here’s that bumper music

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

Before we get started, it was brought to my attention by Dr. Ryan Doss out in Lubbock, TX that our Chiropractic Froward episodes in iTunes only go back to Episode 18 or 19 right now. This is a new development that I’m not sure exactly how to fix or what to do about it at this time but, I am trying to figure it out. For now, though, you can go to our website at www.chiropracticforward.com and have access to all of the directly right there. All of them in one place.  

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you and helps me notify when a new episode is up and ready for you. 

I’m always offering myself up for speaking opportunities or to be a guest on YOUR podcast or at your seminar.  Just send me an email at dr.williams@chiropracticforward.com and we will connect.

I have to tell you that I have recently joined the Facebook group called Forward Thinking Chiropractic Alliance led by Dr. Bobby Maybee who also hosts the Forward Thinking Chiropractic Podcast and I have been a member of the Evidence-Based Chiropractic group over there on Facebook for a while now. That one is led by Dr. Marc Broussard and has several highly respected admins. 

First, I host the Chiropractic Forward podcast and Bobby Maybee hosts the Forward Thinking Chiropractic podcast. Those sound similar right? And….to be fair…in regards to focusing on researched information and draggin’ chiropractic further into the evidence-based realm, we are very similar. OF course, we have different deliveries and Forward Thinking Chiropractic Alliance has been around longer than we have. Integrating chiropractors is a common topic. 

When I was trying to figure out what to name my podcast, I somehow came up with Chiropractic Forward. I Googled it and nothing showed up for Chiropractic Forward and I was so excited and ran with it. It wasn’t until a few months later that I stumbled on Forward Thinking Chiropractic and thought, well hell…. But, though there are similarities in the names, I do my thing and Bobby and his crew do theirs and they are very successful and good at what they are doing. In the end, I hope we are both extremely healthy for chiropractors everywhere a podcast can be heard. 

There is also Dr. Jeff Langmaid known as the Evidence-Based Chiropractor. Jeff has built an amazing brand talking about many of the things we talk about here and he does a great job with it. He’s a great speaker. Clear, concise, and easy to understand. 

So, outside of myself and the Chiropractic Forward Podcast, I hope you will give Dr. Bobby Maybee and the Forward Thinking Chiropractic Podcast a listen as well as Dr. Jeff Langmaid and the Evidence-based Chiropractor Podcast. They are excellent resources for further learning and understanding on all of this stuff. Again, integrating chiropractors is a common topic and you know I love that topic!

The Facebook groups I mentioned are simply priceless when it comes to being an evidence-based chiropractor.

I’ve found myself from time to time feeling a little uncomfortable and surrounded by ideas and philosophies within our profession that I just never got behind or could support. I’ve had to sit through countless speeches that made my eyes roll with disbelief. The Evidence-Based Chiropractic group and the Forward Thinking Chiropractic Alliance groups on Facebook are groups that fit me like a glove. As I said, integrating chiropractors is a topic I’m on board with. I’m not super active in there but really do enjoy reading the threads, opinions, and yes….even some light arguing here and there. But, these groups are very educational and an absolute must if you are evidence-based. 

We have a Chiropractic Forward group as well on Facebook but it’s new and just now getting going. I’d love to invite you all over there to join up with us as well as like our Facebook page itself and maybe even check us out on Twitter at chiro_forward. 

Hey, I’m doing my part to get the word out. You can rest assured on that. 

Enough social media talk, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have collapsed into Episode #30. I can’t believe I started this journey 30 weeks ago. It’s crazy to think. I really can’t tell you how much I have enjoyed it so far. I suppose it takes some amount of hubris to think anyone would care about what you have to say but, in the end, don’t you just have to go where you’re led? That’s what I’m doing and I’m glad you’re coming along with me each week.

We have talked a lot in previous episodes about integrating chiropractors. Whether that means integrating chiropractors into a hospital setting, bringing medical services into your clinic, or some sort of co-treatment/referral sort of set up between the chiropractor and other medical professionals. Regardless, integrating chiropractors is the next step for our profession. 

On that note, let’s start with the article about The Lancet papers on low back pain. This was in Chiropractic & Manual Therapies and Published June 25, 2018. Brand new stuff here folks. This was written by Simon French, et. al. and titled “Low back pain: a major global problem for which the chiropractic profession needs to take more care(French S 2018).” 

The abstract on this article introduces the series of papers published in The Lancet back in March of 2018 which provided the global community with a comprehensive description of low back pain, treatment recommendations based on research, and low back pain going forward from where we are currently. 

They go on to mention what we have been saying over and over here on the podcast. And that is that chiropractic is poised to step in and run the show for non-complicated low back pain. But, according to the authors and according to the Chiropractic Forward podcast, many chiropractors make statements and do things that aren’t supported by robust, contemporary evidence. 

We went through the Lancet papers here on the podcast and you can listen to them by going back to episodes 16, 17, and 18. I encourage you to do so. There really is some excellent information from a multidisciplinary panel of low back pain experts around the world. 

The authors of the Lancet papers, if you follow them on Twitter, have said repeatedly that they don’t want this paper to be profession specific. Meaning, they don’t want to come right out and say, “Hey folks, chiropractors should be the first referral or, we recommend PTs take any and all low back pain patients first and then deal them out where needed for more treatment.” 

I think that’s probably smart on their part but, as a chiropractic advocate, I have no problem throwing our hat in the ring and saying that research has proven several times over that spinal manipulation is superior to the mobilization that PTs perform AND less expensive. If chiropractors are less expensive and more effective, then why in the Hell WOULDN’T we be the first referral for these low back pain patients? Integrating chiropractors makes more sense now than ever before.

This paper goes on to mention that there has been a shift in thinking on low back pain in recent years from the traditional medical approach to a more patient-centered, evidence-based, non-pharma approach putting chiropractors right where they always should have been. 

They also talk about how The Lancet papers say that imaging needs to be reduced significantly. Wouldn’t you agree that may be a challenge for the way many chiropractors practice? You know who you are out there! They also discuss how evidence doesn’t support ongoing passive chiropractic care. This will also be an obstacle for many in my profession. In addition, they state that many chiropractors implement therapy modalities that simply have little to zero good evidence supporting them. 

French says chiropractors are in the right placed but not enough of us are actively involved in research and our research output is small when compared to other healthcare professions. Integrating chiropractors into the medical field will require more research production from our profession that we currently see. 

He also says that the chiropractic profession needs to be more integrated to be a major player if we are to be able to fulfill the role The Lancet papers put us in. And I agree wholeheartedly. If you check out episode #20 called Chiropractic Evolution or Extinction, you’ll hear a robust discussion on this. 

CF 020: Chiropractic Evolution or Extinction?

 

French’s conclusion highlights the reason the Chiropractic Forward podcast exists. It puts a spotlight right on the purpose if you listen close enough. 

He wraps up the article by saying the following: “Our low back pain “call to action” for the chiropractic profession is to get our house in order. In our opinion, nothing is more relevant to chiropractors than people with low back pain, and the evidence clearly shows that we can do a better job for the millions of people who experience this potentially debilitating condition every year. Chiropractors in clinical practice need to provide higher quality care in line with recommendations from evidence-based clinical practice guidelines.

The chiropractic profession is perfectly placed to be a major player in providing a part of the solution to the global challenge of low back pain. But the profession has been shut out of this role in most countries around the world due to, amongst many other things, internal political conflict, a lack of political will, and a minority of chiropractors who provide non-evidence-based approaches. The profession needs to invest heavily to support chiropractors who wish to undertake high-quality research directed at solving this major global problem.”

Amen amen amen. I’ve always wished I knew more about running my own research projects. It’s just not something we were taught. I’m looking at maybe searching out a mentor to help me get my own projects going…..maybe just case reports but something…. and get them published. Although the idea of generating my own research projects makes me want to punch myself in the nose, I know it’s important towards integrating chiropractors.

OK, let’s shift gears a bit. If we are poised and ready for integrating chiropractors and we start following evidence-based protocols, that’s all fine and dandy and moving in the right direction. However, what if there are already perceptions out there in the medical field we’ll be needing to change? I said what it? I meant, of course, there are negative perceptions of us that will have to be battled. It’s a fact. 

Here is a paper from June 22, 2018, by Stacie Salsbury, et. al. called “Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team(Salsbury S).” It would have been more fun if Salsbury would have just titled it “Stop, collaborate and listen if you want to be a good chiropractic physician….. but……she didn’t. We’re obviously not dealing with a Vanilla Ice fan here. It’s probably a good thing that, so far, I’m not responsible for naming research papers. 

Anyway, this paper wanted to explore the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting. 

How They Did It

  • It was a qualitative analysis of a multi-phase, organizational case study
  • It was designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team
  • It was a 62-bed rehabilitation specialty hospital
  • Participants were patients, families, community members, and professional staff of administrative, medical, nursing, and therapy departments. 
  • Data collection was from audiotaped, individual interviews and profession-specific focus groups 
  • 60 participants were interviewed in June 2015
  • 48 were staff members, 6 were patients, 4 were family members, and 2 were community members. 
  • The analysis process helped them produce a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings. 

What They Found

  • The central domain was Patient-Centeredness, meaning the practitioner would be respectful, responsive, and inclusive of the patient’s values, preferences, and needs. This was mentioned in all interviews and linked to all other themes. Of course, I may interject my own opinion here if you don’t mind. Isn’t the lack of patient-centered care the MAIN gripe when it comes to medical doctors too?!? That’s not just a chiropractic issue. 
  • The Professional qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Again, something desired of all practitioners regardless of discipline I would think. 
  • Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence
  • Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting.
  • Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

Wrap It Up

Salsbury ended the article with this conclusion, “Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.”

Now when you go a little deeper than the abstract you’ll see statements that hint at the fact that, when it comes to chiropractors there is fragmentation, disconnection, boundary skirmishes, and a general failure to communicate. 

In addition, the primary care providers and medical specialists have recognized the ability of some chiropractors to treat some musculoskeletal stuff in some patients but that’s about it right now. Couple that with the fact that most in the medical kingdom report just not knowing much about chiropractic or its treatments. 

Some medical providers express concern about the safety of spinal manipulation and have voiced skepticism over the efficacy of our protocols. Let’s be fair, I have my own concerns and am skeptical of some of their protocols as well so that swings both ways friends. But for evidence-based chiropractors, integrating chiropractors into the field makes perfect sense.

When talking to orthopedic surgeons that had particularly negative attitudes toward chiropractors, they typically cited something a patient told them or would cite aspects of the fringe element of the chiropractic community that allowed the surgeons to question the ethics of some chiropractors, to comment on the inadequacy of educational training, and comment on the sparse scientific basis of chiropractic treatments. 

To all of this, I say…..what the hell rock have these people been living under? Sure question the ethics of some. I question the ethics of A LOT of chiropractors if I’m being honest. I could be a wealthy man right now myself but I wouldn’t be able to sleep knowing I’m taking advantage of people. But, what about laminectomies? What about the fact that outcomes have never improved for lumbar fusion but they incidence of performing fusions has gone sky high. Where are the ethics on that? The epidural shots have shot through the roof without any improved outcomes and proof of zero long-term benefits. Where are the ethics?

If you question our education, know what you’re talking about first. That’s all I’m saying. The admission scale is low admittedly. There are philosophy courses I could do without. There are a few technique classes I think are worthless but, overall, the education of chiropractors is outstanding. Are physical therapists getting the same basic science courses the medical doctors are getting? Is that happening? From a quick search of the Physical Therapist curriculum, it appears that it is not so what on Earth are these people even talking about?

The other comment was the sparse body of research. Let’s just say that I’ve been blogging on chiropractic research since 2009 every single week without repeating research papers. The body of research is absolutely there. They’re just ignorant of it. It’s that simple. And where is the research for some of the garbage they utilize? 

I’m in no way saying chiropractors don’t need to step up. They most certainly do in a big way if integrating chiropractors si to become a reality. I hope the evidence-based guys and gals are starting to find more places they feel comfortable out there in social media and starting to find more of a voice within the profession. I truly believe there are many many more evidence-based chiros than there are others. Let’s be honest here. If you want to fit into healthcare, you damn well better do it based on solid research and evidence backing your profession and protocols. 

If I went through this paper from top to bottom, we’d be here for hours, I would have a red face from defending chiropractic, my blood pressure would be sky high, and my vernacular would probably devolve into meaningless gibberish at some point. So I’m going to leave it there. I gave you some highlights, I have it cited in the show notes. Go and read it and email me your thoughts. I’d love to hear them. 

This week, I want you to go forward with some things a poster in the Evidence-based chiropractic group on facebook the other day that I thought had value when it comes to what we’re talking about. She said:

Chiropractic is not a religion. 

A medical doctor should be able to understand the language coming out of your mouth, if they do not, they need to be able to find it cited in a medical textbook. 

I think chiropractic has a long way to go. It does indeed. But, not as far as we had to go 5 years ago. We still have too many people out there on the fringe. We still have far too many practices that are about numbers instead of being patient-centered. Don’t you think that when your business is patient-centered, your patients know that and the money takes care of itself? 

On the other hand, if you are trying to get 50 visits out of a patient, some will go for it, but many more will be turned off by it and will not return. Not only that but for many patients, you will have ruined the entire profession in their eyes based on your act of hitting numbers rather than making sure you’re doing what is best for the patient. That’s just being as honest as I know how to be. I know some won’t like that much but it’s a fact. 

I can’t tell you how many patients I have gotten from a guy that made patients sign contracts for treatment and when treatment didn’t work, he wouldn’t allow them out of the contract. How in the hell does that fit into healthcare folks? It certainly not patient-centered in any shape form or fashion and you’re fooling yourself if you think otherwise. You will never see us integrating chiropractors into the medical profession with junk like that. 

I told you that I can’t tell you how many patients we got from this guy’s poor ethics but, the bigger question is, “How many patents did he ruin on the idea of chiropractic so now they’re out there thinking they have to suffer in pain when all they had to do was visit a chiropractor better equipped with a high standard of ethics?”

THAT is the real question. 

We have to improve, yes. But, for us to integrate properly, the medical kingdom has to improve as well in regards to musculoskeletal complaints, proper recommendations and treatments, and in their perception and understanding of chiropractic and what we can do for these patients. It’s not all one-sided in my mind. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments. Integrating chiropractors makes perfect sense here.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you heard on integrating chiropractors, be sure to check out www.chiropracticforward.com. We want to ask you to share us with your network and help us build this podcast into the #1 Chiropractic podcast in the world. More people need to hear about integrating chiropractors!

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

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

 

 

 

French S (2018). “Low back pain: a major global problem for which the chiropractic profession needs to take more care.” Chiropr Man Therap 26(28).

Salsbury S “Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspecrtives on adding a chiropractor to the multidisciplinary rehabilitation team.” Chiropr Man Therap 26(29).

Today’s topic was integrating chiropractors, integrating chiropractors, and integrating chiropractors. : )

CF 028: Will Chiropractic First Finally Take Its Place?

 Will Chiropractic First Finally Take Its Place?

Chiropractic First is on the table today.

As they say in Texas, Howdy y’all. You could also say, Hola Amigo in Texas as well, and as I learned last week, it’s How you doin? in New York. Today we’re going to be talking about whether or not Chiropractic should or could be poised to step up and take it rightful spot in healthcare globally. Buckle up, bucko.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and today it’s about chiropractic first.  So, glad you’re here with me. In case you are a youngster, the term “bucko” came from a young tike himself named Ritchie Cunningham on Happy Days played by Ron Howard. Yep, that Ron Howard, the famous director and was once a tiny tot named Opie on the Andy Griffith show. No, I’m not THAT old but….I know a little TV trivia here and there. And now it appears that you do too. 

Ritchie, every now and then, would get all worked up into a fuss and call Fonzie or Potsy or whoever a “bucko.” Man…..you wanna talk about fighting words. Fonzie about ended him a time or two but, in the end, Fonzie was way too cool to beat up on Ritchie. OK, enough of that…

I want to ask you to go to http://www.chiropracticforward.com and sign up for our newsletter. We won’t be filling up your inbox and it’s easy to fill you in on all the new stuff. And, in the end, it’s nice of you and it will help keep the wrord circulating if you would like to help us. Likes, shares, and retweets also keep the world turning around and around and that’s really important stuff…..Keeping the world spinning and all….. if we can talk you into it. 

Have you noticed we aren’t selling you anything? That doesn’t mean that we won’t if the right opportunity arises down the road but, I want you to know that I’m doing this podcast for the right reasons. I make furniture, I am a musician, I am a sculptor…..and, Just like anything else I do, I make the things that interest me and that come from my heart. If someone ends up buying what I’ve made down the road, then heck yeah!! Good for me. But, in the meantime, I do what I do because I love it and I guess I have enough ego that I think others may love it as well. I hope you guys and gals love it and find the value like I find in it. 

As with every episode, we are honored to have you with us. We truly are. Now, here we go with some vital information that we think can build confidence and improve your practice which we think will improve your life overall. That’s a tall order but everyone needs goals.

You have Firecircled your way into Episode #28 ala Dr. Strange. My family is full of action movie junkies so just deal with the reference. 

I think a great place to start is by saying that I stumbled upon a heck of a deal this last weekend when I attended the Texas Chiropractic Association’s ChiroTexpo down in Dallas at the Hyatt Regency. I realize the Hyatt Regency holds no meaning to those outside of Dallas but, it’s the hotel with the really cool lit up ball in downtown Dallas. Ah….yes, if you’ve seen the amazing Dallas Cowboys perform inside your TV box, you’ve probably seen the down town rotating restaurant ball on your screen. 

Part of the program had to do with the Lumbar Management portion of the Diplomate of American Chiropractic Orthopedists program. I’m still getting the nuts and bolts of this dude figured out but, basically, it consists of five 10-hour live face-face seminars, 50 hours in total there. Then, 250 of online courses through the University of Bridgeport. After that, you sit for the DACO exam and, assuming you pass it, you now have the honor of being called a DACO and you have the knowledge to back it up. This class was one of the 10-hour sessions.

Now, I have to say, I literally thought I would sit in the class for a couple of hours, my eyes would glaze over, and my butt would start to hurt, and I’d get up and wonder around asking where the nearest trouble could be had because I’m onery on the weekends. I mean really, who the heck wants to sit in a classroom from 1-7pm on a Saturday night and 8-1 on a Sunday morning? Not this guy. Not all in one stretch like that.  

But I did. I sat through all 10 of them. Yep, even surprised myself. Dr. Tim Bertlesman from Illinois was the instructor of the class and he kept it moving, he kept it extremely relevant, and he even kept it pretty funny. Basically, he kept my interest and you know what? I may…..just may…..do the whole program. 

It’s evidence-based for sure and about Chiropractic First

It’s patient-centered without a doubt. And it’s current with the research. If you’ve been paying attention, that’s right in my wheelhouse. If you’d like more information on this program, send me an email at dr.williams@chiropracticforward.com and we’ll connect. As I learn more and more about it all, I’ll be glad to share if you think you’d be interested as well. 

He started off the class with some slides referencing a few studies that I haven’t seen just yet and I a lot of what he was saying is what I’ve been telling all of you for 28 episodes now. All of them. Every single episode. 

The overwhelming sentiment here is that the door is open thanks to opioids. The door to chiropractic first, that is. The chance we have waited for is here. Right now. We may not get it again. People are hungry for what we do and we now have all of the research we need to back ourselves and our profession up, to show complete validation, and thrust us into the mainstream of healthcare for non-complicated musculoskeletal issues. That’s here. 

Let’s look at a little bit of it and see if you agree. 

This is from April 2016 and was published in JAMA. It was authored by Dr. Deborah Dowell, MD, et. al. and was called “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016(Dowell D 2016).”

Why They Did It

Realizing that opioids are a problem, that there are a limited number of long-term opioid research papers, and that primary care physicians need better, safer ways of managing chronic pain, the authors hoped to make recommendations for when to prescribe opioids outside of cancer treatment, etc….and when to not prescribe them. 

How They Did It

  • The Centers for Disease Control and Prevention (CDC) used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol in order to assess the evidence type and make recommendations from there. 
  • Evidence was made up of observational studies or randomized clinical trials with notable limitations. 
  • No study evaluated long-term (over 1 year) benefit for opioids in chronic pain. 

What They Found

  • There are 12 recommendations
  • Of the most importance was the recommendation that non-opioids is preferred for treatment of chronic pain. That’s where WE fit in folks.
  • Opioids should only be used when benefits for pain and function outweigh risks but risks are use disorder, overdose, and death so….. Pretty much never.
  • Before starting any opioid therapy, practitioners need to set goals and settle on how they will be discontinued if benefits do not outweigh risks.
  • Blah….blah blah….a bunch of other language that does not pertain to us chiropractors. 

Wrap Up

Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred. Chiropractic first

I think that, before the American College of Physicians finally came right out and said to go see someone that performs spinal manipulation to treat acute and chronic low back pain, this was JAMA’s way of saying, “Hey guys and gals, ummm….we’ve created a bit of a mess and we had better start cleaning it up (cough chiropractic cough) and maybe we should look outside of usual medical care like pills (cough chiropractic cough) and drugs that people get hooked and drugs that kill people (cough Chiropractic).

JAMA has come along slowly but they’ve made great progress. Even since this paper originally came out. 

For the next article, let’s look at this one called “Attorney General Janet Mills Joins 37 States, Territories in Fight Against Opioid Incentives,” released by the Office of the Attorney General on September 18, 2017(Roth-Wells A 2017). 

The Attorney General in Maine, Janet Mills, joined 37 other states in the fight against opioids according to this article. The AG was quoted in the article as saying, “Last year Maine enacted a law limiting opioid prescriptions and that law is beginning to have a positive impact. Now health insurers need to reduce any financial incentives to prescribing these addicting narcotics and offer greater coverage for alternative therapies. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction.”

The attorneys general contend that incentives that promote use of non-opioid therapies will encourage medical providers to consider physical therapy, acupuncture, massage, chiropractic care, and non-opioid medications, instead of narcotic drugs.

The article went on to list all 37 states that were signed on to this initiative but, sadly, my state of Texas was not on the list. That pesky Texas Medical Association really tends to get in the way. I see the other biggest states on the list in regards to the number of chiropractors practicing. Those states are California, New York, and Florida but, no, not Texas.

The next article is called “FDA Education Bluepring for Health Care Providers Involved in the Management or Support of Patients with Pain” and was published in May 2017(FDA 2017). 

On page three, section two, the paper dicusses nonpharmacologic therapies. It states, “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly msculoskeletal pain and chronic pain.” 

It then goes on to mention categories. The categories they mention are Psychological approaches, and, while I think our patients look at us as chiropractors, financial advisors, psychologists, and a whole host of other professionals, this paper is speaking to cognitive behavioral therapy and, if I’m honest, I’m simply unfamiliar with that as a treatment regimen. I certainly have more to learn on that topic. They also mention physical therapy, of course. They mention surgical intervention and then they mention complementary therapy underwhich is mentioned acupuncture and chirlpracty. 

I’ve not ever in my life heard the term “chiropracty” but at least we’re in the game, I suppose. 

Then the paper closes the section by saying, “Health care providers should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”

Isn’t that interesting? How many practitioners do you think came across this paper and this section of this paper? How many do you suppose have decided to take it upon themselves to get extra information and education in this particular topic? 

Maybe some but, mostly, I would say that it is up to us chiropractors to do our part to educate our medical communities on this sort of information. It’s the FDA for goodness sake. It’s on a government website. It cannot be hard to point them in the right direction and for the medical practitioners to be able to trust the information if it’s coming from this sort of a platform or footing. But, they have to be shown the way. Most of them aren’t simply going to stumble on to it and say, “Oh hey, looky here. Looks like I’ve been wrong my whole life about chiropractic.” 

They need some help and some guidance to find it and then hopefully to receive the information on their own. Regardless of where you start, using sources like the FDA, the Journal of American Medical Association, The Lancet, and the American College of Physicians is always a good idea. They are reputable and they are forms of information that the medical kingdom place a lot of stock and value in. It turns out that they’re on our side on this matter. 

Next, let’s talk about The Joint Commission. “What is The Joint Commission?” you may ask yourself. You may ask yourself that question because that’s the question I asked myself when I first saw the paper so I did some homework for you. 

A quick visit to their website tells us the following:

“An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

 

Our Mission:  To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

 

Vision Statement:  All people always experience the safest, highest quality, best-value health care across all settings.”

If you really read and understand what is said in that description, you’ll see the terms “improve health care for the public” and “providing safe and effective care of the highest quality and value” and safest, highest quality, best-value health care across all setting.” The vast majority of paper we have covered in the previous 27 episodes argue that chiropractic fits the bill in a lot of different ways.

This article comes from The Joint Commission Online and was published on November 12, 2014 talking about revisions to pain management standards that were to be updated just a couple of months later, January 1, 2015(The Joint Commission Online 2014). I want to give this group credit. They seem to have started to catch on to the need for nonpharma protocols about a year to a year and a half prior to the rest of the medical profession. Kudos to them. 

In the blue box is the Standard PC.01.02.07 which is the code for assessing and managing patients’ pain. The revision states that both nonpharma and pharma play a part in pain management, the non-pharma strategies may include the following: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy. 

That stuff sounds fairly familiar for the most part doesn’t it? We’ve been talking about it for months by now so it should indeed be familiar. Except for the cognitive behavioral therapy bit. I kid. Cognitive behavioral therapy is geared toward treating depression, anxiety disorders, phobias, and other forms of mental disorders. Certainly the disorders that may exacerbate chronic pain or, at minimum, prevent the patient from moving beyond the pain in any meaningful way.

Continuing on, here’s a paper from the prestigious Spine Journal by Jon Adams, PhD et. al. called, “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults(Adams J 2017).” 

Why They Did It

Just as the title of the paper indicates, the goal of the authors was to learn more about the prevalence, patterns, and use of chiropractic care in the US. 

How They Did It

  • They took a cross-sectional data from the 2012 National Health Interview Survey. The National Health Interview Survey (NHIS) is the principal and reliable source of comprehensive health care information in the United States, utilizing a nationally rep- resentative sample of the civilian noninstitutionalized popu- lation of the United States
  • They used that information to analyze the lifetime and 12-month prevalence and utilization patterns of chiropractic use. 
  • They determined the profile of chiropractic users. 
  • They determined the predictors of chiropractic consultations.

What They Found

  • Lifetime prevalence of chiropractic use was 24%
  • 12-month prevalence of chiropractic use was 8.4%
  • The use of chiropractic care has grown from 2002 to when the data stopped in 2012
  • Back pain caused people to seek chiropractic care to the tune of 63%
  • Neck pain caused them to go about 30% of the time. 
  • The majority of chiropractic users reported that it helped a great deal with their health problem and improved overal health or well-being. 

Wrap It Up

The authors concluded by saying, “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems.”

When we dive a little further past the abstract and get down into this paper, it goes into the specific percentages for different questions:

Chiropractic led to:

  • Better Sleep 42%
  • Reduced Stress 40%
  • Felt better overall and improved health 39%
  • Was seen as very important to the user 48%
  • Helped for a specific health problem 65%
  • Didn’t help at all 4% 
  • 62% went to a chiropractor to treat the cause, not the symptom!

I want to finish up this week’s papers by citing one that came right out of the White House not long ago.

If you go to The President’s Commission On Combating Drug Addiction and The Opioid Crisis report and make your way down to page 57, you will see where the authors say the following, ““A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” That is from the White House. 

If you continue to the very bottom of the page, you’ll see this quote, ““The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

In Episode #11, when I brought this up to my long-time buddy and past TCA President Dr. Tyce Hergert, he said, “You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.” I couldn’t have said it any better. 

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians, The Lancet, the FDA,  and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

Key Takeaways:

  1. The general population is starving for what we chiropractors do and for what we can offer them. 
  2. All of the important entities in the medical kingdom now recommend what we do but primary practitioners and specialists haven’t caught on just yet.
  3. There are barriers set up within Medicare and insurance in general keeping people from seeking the safest, most cost-effective, non-pharma means to treat themselves.
  4. It’s up to US and nobody else to get the word out in our medical communities. Nobody is going to do it for us and that’s a guarantee. 

I want you to go forward this week with confidence and validation but with the understanding that it is up to every single one of you to figure out how to educate your medical community in an evidence-based, patient-centered way an the first one that does it correctly and effectively may just win a pot of gold and become THE spinal authority in your community. 

I would say that you also need to do your friend Dr. Williams, and all other chiropractors in the world, a big favor. That favor would be to help us get the word out about this podcast. If you find value in it, don’t you think others would too? I’m not sponsored here. I’m doing it because I love it. I don’t have $10,000 to promote the podcast on Facebook or Twitter so I have to keep asking our listeners to please do us a favor and go like our page on Facebook, Like and Share our content EVERY WEEK, FOLLOW us on Twitter, and RETWEET our content on Twitter. 

These are incredibly easy things to do and I truly need your help with them if you would please be kind enough. 

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Social Media Links

iTunes

Bibliography

Adams J (2017). “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults.” Spine 42(23): 1810-1816.

Dowell D (2016). “CDC Guideline for Prescribing Opioids for Chronic Pain – United States.” MMWR Recomm Rep 65: 1-49.

FDA (2017). “FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.”

Roth-Wells A (2017). “Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives.” Office Of The Maine Attorney General.

The Joint Commission Online (2014). “Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web.” Joint Commission Online.

 

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

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

Today we’re going to talk about our vets with low back pain. We have already shown how chiropractic is backed completely by research for low back pain. For us, that’s not even in question. But, this week, there’s brand new research out in JAMA, yes, THAT JAMA, talking about vets with low back pain and chiropractic.

But first, make way for that bumper music

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

I want to  humbly, with my hat in my hand and puppy dog eyes ask you to go to chiropracticforward.com and sign up for our newsletter. Make it easy on us to update you when a new episode come out. It’s just the nice thing to do folks. 

On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Do you need a guest for YOUR podcast?

Look no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. Heck, we’re trying to get the word out about what we’re doing here don’t ya know?

We are honored to have you listening today. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have grooved nice and easy……. 70’s style right into Episode #25

As you may have heard me say several times before, I’m in practice. Day to day, week to week, month to month. In fact, I’ve been in active daily practice for over 20 years. I’ve answered the phones, booked the appointments, been an associate that basically answered to a receptionist. I’ve also been a busy chiropractor having a hard time keeping up with my own head. 

I tell you this because I think it’s important to know that the information you get from me is not only from research journals but is also from daily experience. Twenty years of it at this point! 

When we start discussing active military and veterans, if you’ve been in practice very long at all, you know these men and women are hurting and, many times, are not getting the help they desperately need. I see them every week. I’m actually in the process of signing up for the Choice Program as we speak so I can see more and more of them. Vets with low back painare a priority.

As a side note, you’d think that veterans are among the most honorable of all American citizens wouldn’t you? And wouldn’t you expect that the most honorable of all Americans would be worthy of healthcare that adequately addresses their needs based on current research and knowledge? 

One would think but, as we see over and over, that just isn’t the case, unfortunately. 

Here’s one example, a friend of mine….her father is in the VA hospital right now with several issues. She went to visit and was looking for his room. When she asked a staffer for directions, they directed her through this plywood board attached to a door that kind of opened up all together and allowed passage into the hallway that led to his room. Can you imagine our veterans being in a place that has plywood boarded up on the doors? One door…..any damn door?

Another would be the father of a friend of mine. He died waiting on a referral to a pulmonologist through the Choice Program. He couldn’t just go and make his own appointment. Not if he wanted it covered anyway. The VA system failed this decorated Vietnam Vet whereas medical professionals made it clear to him that his pulmonary hypertension could be treated after seeing a specialist to determine his specific level of PH. Well, the referral didn’t come and time ran out. Doesn’t seem right does it?

Let’s get to the musculoskeletal part of things. Military services leads to a high rate of chronic pain. That is just the facts. Knowing this fact, it is not surprising that veterans succumb to opioid overdose at twice the rate of the general population. That is just astonishing. It’s understandable but astonishing just the same. Not only were they twice as likely to succumb to opioid overdose, but they were twice as likely to be prescribed opioids in the first place!

One would think with the new recommendations from international low back experts published in The Lancet, new recommendations from the American College of Physicians, and the mountains of randomized controlled trials showing the efficacy of Chiropractic Care of low back pain, you’d expect to have an automatic referral from the VA primary care physicians. But, again, common sense doesn’t alway seem to reign in the medical kingdom. Money, politics, group-think, and false dogmatic believes of yesteryear tend to control the thought process. In my opinion, of course. 

If you are unaware of the body of research, I’m sure this just sounds like belly-aching. I’m telling you as straightforward and as honestly as I can, chiropractic’s effectiveness has been proven through research so many times I can’t begin to count. We have been shown to be as effective or more effect than medication including NSAIDS. On top of that, we recently talked about research showing opioids having less effectiveness than NSAIDS. Veterans need a source of treatment for their musculoskeletal pain that is non-pharmacological, cost-effective, and has a high degree of overall effectiveness. 

Everything and everyone already mentioned in this podcast (The Lancet, ACP, etc…) agrees one of those options is Chiropractic specifically. Especially when it comes to vets with low back pain.

With all of that in mind, let’s get into the paper that recently came out in the Journal of the American Medical Association (JAMA). It’s titled “Effect of Usual Medical Care Plus Chiropractic Care vs. Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain,” and authored by Dr. Christine Goetz, DC, PhD. 

It was published in May of 2018(Goertz C 2018). 

Why They Did It

The authors recognized the need for non-pharmacological low back pain treatments and hoped to determine if chiropractic care being added to traditional medical care resulted in a better outcome than if the chiropractic care was left out completely for vets with low back pain. 

How They Did It

  • For you research nerds, the paper was a 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation
  • It was conducted from September 28, 2012 to February 13, 2016
  • The sites studied included 2 large military medical centers and 1 smaller hospital at a military training site. 
  • Active duty aged 18-50 with low back pain originating in the musculoskeletal system were accepted for the study
  • Outcomes used were low back pain intensity measured through the Numerical Rating Scale (NRS) and disability using the Roland Morris Disability Questionnaire. 
  • Secondary outcomes measured were perceived improvement, satisfaction, and medication use. 

What They Found

  • 250 patients at each site were accepted. 
  • 750 total
  • The mean participant age was 30.9
  • 23% were female
  • 32.4% were non-white
  • Adjusted mean differences in scores at the 6-week mark were statistically significant favoring usual medical care PLUS Chiropractic Care. 
  • There were no serious related adverse effects. 

Wrap It Up

The authors concluded, “Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care.”

I realize this is a brand new paper. I also realize that Dr. Goertz is among the leaders of the body of research when it comes to chiropractic. This is exactly why I question the need for further research to understand longer-term outcomes. We have had longer-term outcomes research. Plenty of them as a matter of fact. 

If you go to this paper’s website and click on the link you’ll find in the show notes, ( https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2680417 ) you’ll notice that you can click on a “Comments” icon just under the “Download PDF” icon. 

If you navigate to that Comment section and click on it, you’ll notice the following quote from May 21, 2018 from Dr. Frederick Rivara, MD, MPH at the University of Washington in Seattle, “As a sufferer myself of chronic low back pain, I was very interested to see the results of this comparative effectiveness trial. To me, it points out the importance of integrated care for the treatment of chronic conditions. What are the likely barriers to implementing this in medical practices in general? Do we really need more research on the right treatments for low back pain?” Here is Dr. Rivara’s stated conflict of interest at the end of the quote: he’s the Editor in Chief of JAMA Network Open. The Editor in Chief made that statement folks. He gets it. Now it’s time for the rest of the medical kingdom to get it.

Key Takeaways

  1. We don’t need any more research into whether low back pain is effectively treated with chiropractic care. It’s been done a hundred times over. What we need is acceptance and a shift in the groupthink of the medical field. When it comes to treating vets with low back pain, there is no better starting point than chiropractic care. 
  2. We also need to chiropractors to step up and take the golden scepter the medical field had dangled out there. It’s ours for the taking. 
  3. We also need more research into the effectiveness of chiropractic care for headaches and neck pain. The research is there supporting our effectiveness. No doubt about it. But, it needs to be there by the hundreds just like you see in low back pain. There needs to be so much of it that the deniers start to look like flat-Earthers in the healthcare world. 

This week, I want you to go forward with doing some of your own research on vets and opioids, on Chiropractic and low back pain, and on the Choice Program through the VA. We can help our active military and our vets. We can help them better than anyone else for their low back pain and that includes physical therapists. There is research showing that exercise/rehab + chiropractic is more effective than exercise/rehab alone(Korthals-de Bos IB 2003, Coulter I 2018). 

Either way you boil it down, we win. We can help these people so help me figure out how we get that message out there and how we’re supposed to reach out and grab it for our profession. 

Subscribe Button

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I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

Bibliography

Coulter I (2018). “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.” Spine 0(0).

Goertz C (2018). “Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial.” JAMA 1(1): E180105.

Korthals-de Bos IB (2003). “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.” British Medical Journal 326(7395): 911.

 

CF 023: How Can Research Help You Talk To The Medical Profession?

How Can Research Help You Talk To The Medical Profession?

This week we’re going to be discussing Chiropractic integration and how can research help you. Getting closer to the center of healthcare rather than being far out on the outer ring about to be spun into the cold dark void of space. 

First though, bring on that bumper music to get the party started. 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. You have beamed yourself right into Episode #23. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.

Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. 

I’d also like to let you know that I am starting to accept bookings for public talks. Do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. 

Part of my function is to show where we can fit more and more into mainstream health and why we fit. That’s where the research continues to smile on Doctors of Chiropractic. What does research tell us on this journey to expand and integrate?

Let us be honest with one another here when we say that there is a reason our profession is misunderstood. There is a reason that we have been treated unfairly for generations; since our inception. 

I would say the number one reason is that several in our profession over the years have professed chiropractic to be a miracle cure for any and all ills. Let me give you an example to demonstrate my point. I remember sitting in a seminar and the speaker who will remain unnamed was telling us that their patient had cancer and several adjustments caused it to encapsulate and then work out of the body into a large skin tag looking sort of thing before it finally just fell off. Cancer free!! Thanks to chiropractic!!

Young impressionable chiropractors-to-be lapped that speech right up and likely went on to tell scores of colleagues and patients all about this. And, this person is still out giving seminars and speaking to impressionable minds. 

Is it true? Who knows? I hate to denigrate something I truly don’t understand, but, I admit, I doubt it. And, if it were repeatable, this person would be in some hall of fame and would be the most famous person in healthcare because he discovered the cure for cancer. I mean, it gets no bigger than curing cancer does it?

Honestly though, it doesn’t matter what I think about it. What matters is whether or not boasts like this serve to further progress this profession or serve to make us walk the proverbial professional plank. If chiropractors can do clinical studies on such a thing, then get it done and quit talking about it. Prove what you say. You saw cancer work itself out of the body after your treatment? That is amazing, but in this day and age, it should be documented. You can get with a cancer research center and attempt to repeat your findings and prove what you think to be true. 

I’m being dramatic here but you get my point. I’m not trying to pick fights with this podcast. I’m trying to be honest and make sense. I realize that turns some off and I hate that because I truly feel civil discourse is in short supply in 2018. 

You find some claims in our profession that just lack any backing as far as research goes and I’d like to see our profession either put up or shut up basically. If you say you can do it, prove it and show us all through accepted research protocols and studies. “Because I said so,” no longer works.

Reason #2: I’d say, if you listened to episode #9, referenced and linked in the show notes, then you know that the American Medical Association and the state medical associations have done quite a job over the generations in de-valuing the chiropractic profession. 

Take the idea that chiropractors cause strokes in their patients. We spent three episodes of this podcast methodically dismantlying this crazy myth. I am referring to Episodes #13, #14, and #15 referenced and linked in the show notes along with the associated blog we posted on the matter called, “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/

The myth has no basis in fact and research clearly demonstrates this. Yet, you will still get arguments about how Doctors of Chiropractic cause strokes. The Chiropractic Forward Facebook page is proof enough of this. Fighting against long-held beliefs is a hard thing to do and all of the research in the world will never change some minds. However, that doesn’t mean we stop showing it to everyone! 

I will say with some sense of satisfaction that networking and forming relationships with medical providers has never been easier than it has become within the last several years and that is a stepping stone and absolutely welcome and a blessing. 

One thing I hear from straight chiropractors from time to time is that guys and girls like me are “Medi-Practors.” What does that mean exactly? Well, I would say it implies that we want to be medical doctors. But, they use the term for any chiropractor that even uses therapies like electric stim, ultrasound, or any other modality outside of just an adjustment. 

I would simply say that I personally have no desire to prescribe medications. In fact, when I have a car wreck patient, I’m actually glad I can just say, “I’m sorry, I can’t prescribe you anything since chiropractors treat conservatively and naturally and do not prescribe medications.” It’s liberating. I love that we do not treat that way. 

On the other hand, I certainly recognize the use of medicine and the benefits of some medicine. I’m not necessarily against medication. I’m certainly against long-term medication when lifestyle change could prevent being on medication. I’m absolutely against a mentality that simply treats the symptom with pharmaceuticals rather than addressing the cause or the source. 

As I say in almost every episode, spinal pain is a mechanical pain and it makes sense that mechanical pain responds better to mechanical treatment rather than chemical treatment. In addition, patients should have the guarantee of the best treatment that causes the least harm and, folks, when it comes to non-complicated spinal pain, that’s exactly what chiropractic is. How can research help you relay this message is powerful.

This podcast, in case you’ve wondered, is a bit cathartic for me. And, I will admit, doesn’t seem to stir as much fussing as I originally expected. In fact, most chiropractors listening are in agreement with me so I certainly feel a sense of validation there and I appreciate the support. 

As you should know by now, I enjoy covering research papers so let’s get to that now that my grumpier side decided to show itself. Back to our regularly scheduled program. 

Here’s one called “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context” by Stochkendahl et. al. published in Chiropractic & Manual Therapies on April 26th of 2018. Brand new stuff. 

Why They Did It

Even thought the guidelines are there for managing non-complicated musculoskeletal pain, there has been little to no decrease in work disability. Right now, Norwegian chiropractors have legislated sickness certification rights but the Danes and the Swedes do not. The authors were looking to describe, compare, and contrast the views and experiences of Scandinavian chiropractors when engaged in the prevention of work disability and sickness absence. 

How They Did It

The study was a two-phased sequential exploratory mixed-methods design. 

In a comparative qualitative case study design, the authors explored the different experiences amongst chiropractors in regards to sickness absence from face-to-face interviews.

What They Found

  • 12 interviews conducted
  • The chiropractors’ ability to manage sickness absence depended on four key factors:
  1. legislation & politics
  2. the rationale for being a sickness absence mangement partner
  3. whether an integrated sickness management pathway existed or could be created
  4. the barriers to service provision for sickness absence management. 

Wrap It Up

The authors concluded, “Allied health providers, in this instance chiropractors, with patient management expertise can fulfill a key role in sickness absence management and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of work disability prevention practices(Stochkendahl M 2018).”

And then this paper by F. Gedin, et. al. called “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden” published in Journal of Bodywork and Movement Therapies in February of 2018

Again, pretty recent stuff. 

Why They Did It

The authors were simply trying to get patient reported feedback from those patients in Sweden seeking treatment via chiropractic for their back pain. 

How They Did It

  • The study was a prospective observational study
  • It included those 18 years and older having back pain of any duration 
  • It included 23 chiropractic clinics
  • The patient questionnaire was performed at baseline, and at 4 weeks
  • Questionnaires used were the Numerical Rating Scale, Oswestry Disability Index, health-related quality of life (EQ-5D index)
  • Visual Analog Scale or VAS

What They Found

There were statistical improvements over the 4 weeks for all patient reported outcomes. 

Wrap It Up

The authors’ conclusion was, “Patients with acute and chronic back pain reported statistically significant improvements in PRO four weeks after initiated chiropractic care. Albeit the observational study design limits causal inference, the relatively rapid improvements of PRO scores warrant further clinical investigations(Gedin F 2018).”

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.

Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

REFERENCES

Episode #9 with Dr. Tom Hollingswortth: The Case Against Chiropractic in Texas

https://www.chiropracticforward.com/2018/02/15/episode-9-dr-tom-hollingsworth-case-chiropractic-texas/

Episode #13: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 1)

https://www.chiropracticforward.com/2018/03/15/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Episode #14: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 2)

https://www.chiropracticforward.com/2018/03/22/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Episode #15: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 3)

https://www.chiropracticforward.com/2018/03/29/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

“DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/Bibliography

  • Gedin F (2018). “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden.” Jounral of Bodywork & Movement Therapies.
  • Stochkendahl M (2018). “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context.” Chiropractic & Manual Therapies 26(15).

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 021: Crazy Update On Run-Away Healthcare Spending in America

Crazy Update On Run-Away Healthcare Spending in America

In today’s podcast, we are going to talk about the crazy, run-away healthcare spending in America and we’re going to use an article straight from the leading authority, the Journal of the American Medical Association, to help us out.

Before we get started, I want to share with you how much have enjoyed getting this podcast up and running. I strongly doubt it’s as popular as the other great chiropractic podcasts that have been up and going for a couple of years now. Heck, Chiropractic Forward has just been going since December so, at this point, one would expect for us to still be trying to gain attention and trying to gain some ears. And…..we are. No doubt.

But I can say that is has been pure joy to look up the downloads for each episode and seeing that, no…..its not just me that finds this stuff fascinating. Lol. You guys and gals are starting to listen and starting to pay attention.

We’re still struggling for those like and retweets on Twitter.

That’s the frustrating part if I’m being honest. To KNOW that you have put together an effective article on how chiropractors do not cause strokes and then to have such a hard time getting the word out. It’s frustrating to be sure but it’s also part of building something new and exciting.

So, I will simply continue to remind you that we need your help if we are to make a difference and I will keep reminding you to like our Facebook page, follow us on Twitter, sign up for our weekly reminder newsletter through the form on our homepage, and share us with your network.

We would certainly appreciate that help. Some of you may have actually gotten to see me arguing the stroke issue on our Facebook page. My gosh, some people, you could hit them with a research book full of papers in your favor and some would still argue just to try to prevent being wrong.

Not only do I get to argue about stroke or whatever the topic may be, it always strays into generalized ignorant statements like, “Chiropractic is bunk.”

I can use research to absolutely wipe the floor with people like that. And, the irritating thing is that the people, or trolls spouting off like that are usually computer majors, musicians, or something else completely removed from healthcare.

It is enough to make a man insane if you allow it. So I don’t.

Anyway, check us on Twitter and Facebook. Every now and then, you may find an enthusiastic discussion. lol. To say the least.

Since I haven’t yet, I’ll introduce myself, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.

You have shaked, shimmied, and rolled into Episode #21

I’d like to start by saying that it is good to see the medical world beginning to examine itself with a clear lens. We have seen them turn blind eyes to many things we notice and research notices. As we have mentioned, there has been little attention given to the updated recommendations in favor of chiropractic, massage, and acupuncture in February of 2017. It is yet to be known what, or if anything, will change following the series of low back pain papers recently published in The Lancet (March21, 2018).

I have been mentioning how I feel that the opioid crisis has opened many many doors recently in regards to the medical field, clinical pathways, and in they way they are starting to look at the costs. Kudos to those in the medical field for beginning to call out their own protocols and questions them for effectiveness vs. risk. Some procedures may be effective here and there but, in general, if the squeeze is not worth the push, then there is little to zero return on investment and it should be abandoned. Obviously, one’s health is different than a business stat sheet but the metaphor is a valid one I believe.

Obamacare was supposed to heal all of our healthcare woes, right? From what I can tell, all it did was squeeze out the middle class. The folks that make too much to be subsidized but do not make enough to not really care about the new jacked health insurance rates.

For example, the premiums here in Texas have doubled or tripled in many cases while the insurance companies cover less and less. The co-payments have gone from $15-$20 all the way up to $50 and even $100. The deductibles have gone from $250 or $1,000 all the way up to $5000 or $10,000. In addition, the insurance companies are now reimbursing healthcare providers less. in many cases, 3/4 less.

Did you know that here in Texas, where a medical radiologist was once reimbursed up to $28+ or so for reading a neck series, they now get paid in the ballpark of $7 for the same series? I promise the doctors are not living less of a life than they were prior to Obamacare. Not at all. But, what is likely happening unconsciously is they are probably reading more x-rays more quickly to attempt to make up for the reduction in their pay.

Would you agree that this may put patients at more risk? I’m not saying doctors make a conscious decision to put patients at risk but, if a professional in ANY industry has a house in town, a house and boat on the lake, 3 cars, time share on a private plane, and things of that nature, when their income is cut by 3/4 in some cases, they will tend to find ways to make that up in ways that make sense to them. Regardless of profession or industry.

Maybe Obamacare just makes them more efficient rather than raising the patient risk. I do not have the answer on this but I do know that radiologists are responsible for everything on a film and their license is at risk on each and every film. When the government cut their pay that dramatically, the government began putting people at more risk. In my opinion of course.

I am firmly on the side of the medical field on this issue. The same type of thing is currently happening with the chiropractic industry as well. We are being reimbursed at smaller and smaller rates. We are seeing our covered patients being turned into cash patients whether we like it or not. The co-pays and deductibles are so high, the could just as easily be cash patients for our purposes. For this very reason, you are seeing more and more chiropractors in America begin to look at changing over to a cash-based practice model and drop insurance contracts all together.

I’m not certain every bit of this discussion is completely on topic but let me tie it up and bring it home through the use of this research paper. This paper appeared in the Journal of the American Medical Association (JAMA) on March 23, 2018. It was titled “Health Care Spending in the United States and Other High-Income Countries” and was authored by Irene Papanicolas, PhD (Papanicolas I 2018).

Why They Did It
Healthcare spending in America is a long-time hot topic and issue that has never been adequately addressed. Part of the problem is that we Americans spend more than other high-income countries with little information that shows that any efforts to control expenses has done anything to help the problem.

These authors attempted to compare the big ticket items in healthcare in America with the same items in ten other high-income countries in an attempt to learn where improvement might be made here at home.

How They Did It
Information was mostly gained from the Organization for Economic Cooperation and Development (OECD) from 2013-16. The OECD is an international organization comparing underlying differences in structural features, types of health care and social spending, and performance for several high-income countries.

What They Found
In 2016, America spent 17.8% of its gross domestic product on healthcare while the other 10 nations spent from 9.6%-12.4%.
Surprise, surprise….pharmaceutical costs spending per capita in America was $1443 vs. from $466-$939 in the other 10 countries. American doctors and patients love those pills. That is healthcare spending in America at its best.
90% of Americans are insured while 99%-100% were insured in the other 10 countries.
The U.S. has the highest proportion of private insurance when compared to the other 10 countries, which is 55.3%.
When it comes to smoking, Americans actually have the second lowest rate sitting at 11.4%
When we talk about obesity, the US has the highest proportion at 70.1%. Others range from 23.8%-63.4% for comparison purposes.
The US life expectancy was the lowest at 78.8 years.
US infant mortality was the highest rate of the 11 countries.
There was no real difference in the American physician workforce, nurse workforce, etc., when compared to the other 10 countries.
America has comparable numbers of hospital beds
Americans use MRIs and CTs when compared to the other 10 countries.
The US had similar rates of utilization for acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease, hip replacements, knee replacements, and coronary artery bypass graft surgery.
Administrative costs of care in American stood at 8% while the same measure in the other 10 countries ranged from 1%-3%.
Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.

Wrap It Up
The authors of the paper concluded that, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations.

Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries”

My own wrap up would be that America spends twice as much money on healthcare while we have the highest rate of obesity, double the amount of pharmaceuticals, lower life expectancy, higher infant mortality, and higher administrative costs when we are compared to 10 other countries of similar income. Healthcare spending in America is out of hand.

That’s not good, folks. Not good at all. When do the pharmaceutical companies stop controlling the medical profession and the medical profession turn it around to control the pharmaceutical companies? When does that happen exactly?

Did you know that, from 1948 until 1996, there was a TV ban on running liquor ads? You may see beer or wine ads but you would never see Jim Beam running a commercial between Alf and Different Strokes. But, how often do we see pharmaceutical ads on TV these days? It’s a shame to be honest. Shouldn’t the doctor be the one that is informed on medications rather than a 320 million people that are almost completely uneducated on pharmaceuticals? Should patients be going into doctors’ offices ready to pressure them into a certain medication because they saw it on TV?

It is absolutely insane and should have been stopped at the first mention of it. To make it fair or legal or whatever may be the case, they state a long laundry list of all of the things that may happen to you if you take it. But, the information is delivered and people are influenced.

If a patient goes in for something like erectile dysfunction, the doctor tells them what they need. They don’t tell the doctor!! Do you see the problem here? If the patient goes in for potential blood clots, the doctor should be telling them they need a certain type of thinner. That is not the patient’s place in any country on the entire planet.

Not only do the pharma companies control patient mentality in this way but they attempt control of the physicians. Pharma reps are skilled at what they do. They are highly trained and very well-paid to effect influence in their market’s physicians. They take them on dinners, bring the office lunches, pay for trips, etc. You can spot them at any doctor’s office you go to. Just look for the well-dressed person in the waiting room with a clip board and a bag of goodies. That’s them!

I had a general practitioner that I had to finally fire. I had been living a bit unhealthy for several months when I went for a yearly checkup. My blood pressure was high. He immediately tried to put me on life-long meds. I was overweight and drank a 12-pack of Bud Light here and there while traveling in a band playing music. You might say that I used to be a little bit ornery. Again, I was admittedly behaving badly. His diagnosis was that I was depressed and needed an anti-depressant. Really?

Instead of trying some behavior modification, according to him, I needed life-long blood pressure meds and life-long antidepressant meds. Where does this mentality come from? What if we treat the CAUSE rather than the SYMPTOM?

First, I lost weight and started to behave. Guess what? My blood pressure returned to normal. As a result of ceasing traveling in a band, I basically quit drinking beer outside of social events. Boom! I was no longer depressed according to his definition.

This may seem like an extreme example to some but, it is my estimation that this sort of “doctoring” and “pill pushing” is far more common than one may even dream.

I am in no way against the medical field or against surgery or against medicine. I am against simple pill fixes. I’m against long-term meds when not needed. There are some conditions like diabetes or genetic high blood pressure that require long-term meds but, in many cases, they should be avoided. I’m against the medical field performing shots and surgeries and using opioids for musculoskeletal pains when the research is clear when it recommends chiropractic, massage, etc.. for those pains.

Basically, the medical field needs to stop thinking the pills are the be all – end all of healthcare and start looking more to the cause rather than just treating the symptoms. The physicians need to take the reins of their profession away from the pharmaceutical companies and wield the power over pharma that they attempt to wield over chiropractic and other alternative means of healthcare.

Enough about them for this episode. I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.

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

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

Bibliography
Papanicolas I (2018). “Health Care Spending in the United States and Other High-Income Countries.” JAMA 319(10): 1024-1039.

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

Low Back Pain: A Major Global Challenge

On the Chiropractic Forward podcast this week, we are going to do a review of The Lancet article on Low Back Pain. It is a recent paper published in march 2018 that we hope will have a powerful impact in the months and years to follow. 

Before we get started with this review of The Lancet article on Low Back Pain, I want to draw your attention our website at https://www.chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. 

You have illegally u-turned into Episode #16 and criminals are welcome so make yourself at home. Again, we are doing a review of The Lancet article on Low Back Pain.

I’ve been battling a head cold and depending on the day, the head cold is winning. I hope you’ll excuse my graveled voice and my nasal presentation. I’ll do my best on this review of The Lancet article on Low Back Pain. 

Those of us that are hungry for new research and the recommendations that arise from the body of literature being constantly created were excited last week about the release of significant reports coming out in a highly respected research journal called The Lancet. 

Founded in 1823, The Lancet is published weekly is is one of the oldest, most respected, and most well-known medical journals in the world so when it was announced a series of papers were to be published in The Lancet having to do with low back pain, as you may imagine, those of us interested in the research world and musculoskeletal complaints were all ears. 

Not only was the article noteworthy due to its being published in The Lancet, but it was also exciting for those of us in the so-called alternative healthcare world because there were several Doctors of Chiropractic sitting on the steering committee for the series of reports. For some reason, chiropractors are still considered by many to be alternative while this group of papers suggest chiropractic may be a lot more than simply “alternative.”

There are a couple of things in my mind that stand out as reasons for such a series of papers. The first being that low back pain has become a major problem globally and show no sign of stopping the growth of it impact. The second reason would be the ineffectiveness of the treatments commonly used or recommended. This includes surgery, epidural steroid injections, and, the most notable of failed treatments, opioids.

The series of Low Back Pain papers were compiled by a team of leading experts on back pain. The team was made up of an international spectrum  of varied backgrounds. They met for a workshop in Buxton, UK, in June, 2016, to start the journey and the process of setting the outline and some sort of structure for each paper. 

It was quite an undertaking from quite the group of experts. This is not a group of papers to be ignored since these authors and researchers are among the best of the best globally. 

The papers were broken down as follows:

      1. What low back pain is and why we need to pay attention.
      2. Prevention and treatment of low back pain: evidence, challenges, and promising directions. 
      3. Low back pain: a call for action

In this article, I will cover the first of the three papers with plans to highlight the next two papers in the coming weeks so be sure to return for those important discussions. 

How They Did It

For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:

  • MEDLINE (PubMed)
  • Scopus. 
  • Google Scholar
  • African Index Medicus Database

In this review of The Lancet article on Low Back Pain I think it’s important to re-iterate the authors assertion that, in order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.

Summary of the introduction of the first paper. 

  • Low back pain is now the leading cause of disability worldwide.
  • Only a small percentage have a well-understood, definite cause for their low back pain. Examples of well-known and udnerstood causes are things like a vertebral fracture, malignancy, or infection.
  • Things that seem to raise the risk of having low back pain complaints would be populations that smoke regulary, people that have physically demanding jobs or routine jobs or jobs that keep them mostly sedentary throughout the day and throughout the work week, people with physical and mental issues that add to a low back complaint or contribute to a low back complaint, and overweight/obese people. These populations are all at risk for developing low back pain.
  • 540 million people were affected at any one time globally.
  • A systematic review (3097 participants) found several MRI findings had a reasonably strong association with low back pain, including Modic type 1 change, disc bulge, disc extrusion, and spondylolysis. To further define Modic 1 changes, in regular vertebral endplate bone, the trabeculae shoud be like a type of scaffolding. Within the trabeculae there is red bone marrow producing blood cells. In a Modic type 1, the trabeculae are fractured intermittently and the patterns are more erratic and the marrow is absent. In the marrow’s place now is serum which is the same substance one can find in a blister. 

Symptoms associated with low back pain

Radicular Pain and Radiculopathy

  • Radiculopathy is usually called sciatica and mostly occurs when there is involvement where the nerve root exits the spine.
  • The authors noted that the term sciatica is used inconsistently by doctors and the public in general and should probably be avoided all together. 
  • The diagnosis of radicular pain relies on clinical findings, such as history of dermatomal leg pain, leg pain that is actually worse than the back pain, aggravation of the symptom when bearing down such as in coughing, sneezing, lying on your back and raising heels off of the table or in going from seated to standing, and straight leg raise test. General rule of thumb for an SLR is that pain in the first 30 degrees of leg elevation hints at a disc origin since that is the movement that first starts to tension the nerve at the root.
  • Patients presenting with low back pain in addition to radicular pain or radiculopathy tend to have worse outcomes than those presenting with low back pain alone.

Lumbar Spinal Stenosis

  • I tell my patients that the simplest way to explain stenosis is to say that a hole that nerves run through has become smaller and, as a result, the nerves sometimes have pressure on them that can cause them to be somewhat dysfunctional. 
  • Lumbar spinal stenosis is clinically characterized by pain or discomfort with walking or standing that radiates into one or both legs and can be eased resting and almost always by lumbar flexion (neurogenic claudication). They call this the shopping cart sign. Meaning, if a person gets relief from leaning on a shopping cart, it sure may be stenosis. If it is aggravated by leaning back or by inducing a “swayback” type of movement, that sure may be stenosis. As a sidenote and from my own studies, if lumbar extension (or swayback) does not hurt, but then rotation in either direction at the endpoint of lumbar extenstion actually does increase the pain, then the patient is likely suffering from a lumbar facet complaint. 
  • Lumbar stenosis is commonly caused by narrowing of the spinal canal or intervertebral foramina as a result of a combination of degeneration such as facet osteoarthritis, ligamentum flavum hypertrophy, and bulging discs. Two or three of these factors can combine to reduce the size and space available for the neural structures to pass through. Obviously that can create issues.
  • Experts tend to agree that the diagnosis of stenosis requires both the presence of the symptoms in addition to imaging findings demonstrating stenosis.

Other causes of Low Back Pain

  • Vertebral fracture, inflammatory disorders, malignancy, infections, intra-abdominal causes.
  • The US guideline for imaging advises deferral of imaging pending a trial of therapy when there are weak risk factors for cancer or axial spondyloarthritis. What does that mean exactly? That means a trial of conservative care. The authors will delve further into this in the second paper from the Lancet series but I will butt my head in here with the opinion of the American College of Physicians. Their updated recommendations from February of 2017 reflect that doctors should be recommending Chiropractic, massage, and/or ice for acute low back pain and should recommend Chirorpactic, acupuncture, and/or exercise/rehab for chronic low back pain. These recommendations are to precede taking even ibuprofen. 

Prevalence

  • Approximately 40% of 9-18-year olds in high-income, medium-income, and low-income countries report having had low back pain.
  • Low back pain prevalence increased 54% since 1990.
  • It is the number one cause of disability globally

Work Disability

Social Identity & Inequality

  • MacNeela and colleagues reviewed 38 separate qualitative studies in high-income countries. They showed found common traits, including: worry and fear about the social consequences of chronic low back pain, hopelessness, family strain, social withdrawal, loss of job and lack of money, disappointment with health-care encounters (in particular with general practitioners), coming to terms with the pain, and learning self-management strategies.
  • Froud and colleagues reviewed 42 qualitative studies from high-income countries, and found that many people living with low back pain struggled to meet their social expectations and obligations and that achieving them might then threaten the credibility of their suffering, with disability claims being endangered. Sometimes we have to almost force low back patients back into the workforce and, did you know that studies show in general that the sooner people are returned to work, the better they tend to recover from the low back pain complaint?
  • Schofield and colleagues found that individuals who exit the workforce early as a result of their low back pain have substantially less wealth by age 65 years, even after adjustment for education. This is just an obvious statement. It makes sense that people that quit working earlier than 65 end up making less money by the time they reach 65. You can also throw the expense of dealing with a back pain complaint in on top of the loss of wages. 
  • Globally, low back pain contributes to inequality. At first, when I read this, it struck me as being silly. Everything’s about inequality these days isn’t it? Certainlly in America it seems. But, this is a little different when you read through the explanation. The authors go on to say that in low-income and middle-income countries, poverty and inequality might increase as participation in work is affected. In addition, regulations on how to properly re-introduce a person into the workforce are absent, and workers are likely to be placed right back into the job they were originally injured without proper re-introduction. The authors felt this might place more strain on family and community livelihoods.

Cost of Low Back Pain

  • Costs associated with low back pain are commonly tallied as direct medical costs, meaning the cost of the doctor’s bill. They are also tallied in terms of indirect costs; meaning the cost of being out of work and the loss of productivity at the work place.
  • Most studies underestimate the total costs of low back pain
  • Although we do not think of low back pain in these terms yet, the truth is that low back pain, in terms of a real problem as far at the cost to treat and the overall indirect costs, are right up there with the biggest issues the global pupulation faces. Issues such as cardiovascular disease, cancer, mental health, and autoimmune diseases. That’s huge. 
  • In the USA, 44% of the population used at least one complementary or alternative health-care therapy in 1997; and the most common reason was low back pain. with 70,000 plus chiropractors in the United States, I can tell you with some confidence the profession most associated with alternative treatment for low back pain or spinal pain of any sort is chiropractic care. 
  • The USA has the highest costs, attributable to a more medically intensive approach as well as higher rates of surgery compared with other high-income countries. We see patients every week that have gone through needless surgeries. Surgeries for which there is plenty of high-level research proving its ineffectiveness yet you see the popularity for these surgeries continuing to rise. 

Natural History

  • A systematic review (33 cohorts; 11 166 participants) provides strong evidence that most episodes of low back pain improve substantially within 6 weeks, and by 12 months average pain levels are low. However, two-thirds of patients still report some pain at 3 months and 12 months
  • The best evidence suggests around 33% of people will have a recurrence within 1 year of recovering from a previous episode.

Risk Factors and Triggers for Low Back Pain Episodes

      • A systematic review (5165 participants) found consistent evidence that people who have had previous episodes of low back pain are at increased risk of a new episode. Likewise, people with other chronic conditions, including asthma, headache, and diabetes, are more likely to report low back pain than people in good health
      • a UK cohort study found psychological distress at age 23 years predicted incident low back pain 10 years later. The Canadian National Population Health Survey with 9909 participants found that pain-free individuals with depression were more likely to develop low back pain within 2 years than were people without depression
      • systematic reviews of cohort studies indicate that lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of low back pain episodes. We know that obesity and lack of exercise has become an American trait that needs to be reversed. 
      • A systematic review found the genetic influence on the liability to develop low back pain ranged from 21% to 67%, with the genetic component being higher for more chronic and disabling low back pain than for inconsequential low back pain.Don’t we all have patients that present to us claimng that their bad back just runs in the family? Mom and Grandma had a bad back so that must be why they have a bad back is the common sentiment. It seems there may be a bit of validity there. 
      • An Australian case-crossover study (999 participants) showed that awkward postures, heavy manual tasks, feeling tired, or being distracted during an activity were all associated with increased risk of a new episode of low back pain. Similarly, work exposures of lifting, bending, awkward postures, and tasks considered physically demanding were also associated with an increased risk of developing low back pain in low-income and middle-income countries

Psychological Factors

For this review of The Lancet article on Low Back Pain, the presence of psychological factors in people who present with low back pain is associated with increased risk of developing disability even though the mechanisms are not fully understood

Social and Societal Factors

      • Cross-sectional data from the USA (National Health Interview Survey 2009–10, 5103 people) found that those with persistent low back pain were more likely to have had less than high-school education and had an annual household income of less than US$20,000. 
      • Suggested mechanisms for the effect of low education on back pain include environmental and lifestyle exposures in lower socioeconomic groups, lower health literacy, and health care not being available or adequately targeted to people with low education.
      • To go along with lower wages, the lower socioeconomic groups are commonly in routine and manual occupations and ahve increased physical workloads is associated with disabling low back pain

Conclusion

In this review of The Lancet article on Low Back Pain, the authors concluded, “Low back pain is now the number one cause of disability globally. The burden from low back pain is increasing, particularly in low-income and middle-income countries, which is straining health-care and social systems that are already overburdened. Low back pain is most prevalent and burdensome in working populations, and in older people low back pain is associated with increased activity limitation. Most cases of low back pain are short-lasting and a specific nociceptive source cannot be identified. Recurrences are, however, common and a few people end up with persistent disabling pain affected by a range of biophysical, psychological, and social factors. Costs associated with health care and work disability attributed to low back pain are enormous but vary substantially between countries, and are related to social norms, health-care approaches, and legislation. Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden.”

Key Takeaway:

Obviously, if you followed us all the way through on this review of The Lancet article on Low Back Pain, low back pain is an issue that must be addressed in a more effective way globally and irregardless of national ranking in terms of the economy. Just because it’s musculoskeletal doesn’t mean it can be ignored and kicked to the curb while the big stuff like heart disease, diabetes, and cancer are treated. The research for the big stuff is adequately funded but, honestly, in general, most general practitioners don’t have the first clue of what to do for low back pain. I personally suggest they turn to their own American College of Physicians for updated recommendations on chronic and acute low back conditions if I were them. 

Authors

Steering Committee

Rachelle Buchbinder – Australia

Jan Hartvigsen – Denmark

Dan Cherkin – United States

Nadine Foster – UK

Chris Maher – Australia

Martin Underwood – UK

Maruits van Tulder – Netherlands

For this week’s Next Steps in this review of The Lancet article on Low Back Pain, be sure to send us an email at dr.williams@chiropracticforward.com and let us know what you thought or contribute to the show for next week. We love hearing from you all. Also, go and follow Jan Hartvigsen https://twitter.com/JanHartvigsen, and Chris Maher https://twitter.com/CGMMaher on Twitter. 

Next week we will review the second paper of this three paper series. Next week’s paper is called “Prevention and treatment of low back pain: evidence, challenges, and promising directions.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn. This review of The Lancet article on Low Back Pain is just an example of what you can look forward to.

We cannot wait to connect again with you next week for review of The Lancet article on Low Back Pain Part Two. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Be sure to check out part of our Chiropracrtors Cause Strokes Myth. This is a link to Part Two:

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

References:

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

This week, we are talking about acute and non-acute low back pain. What are current healthcare guidelines? Why does it matter to chiropractic patients and non-chiropractic patients and are those in the medical field getting (and implementing) the information?

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.

We’re going to have more fun this week than stepping on a nail. Which I have done.

Before we dive in, it was so nice we had to do it twice. What am I talking about? I’m talking about bringing on Tyce. Tyce Hergert that is down in Southlake, TX. Owner and operator of Chiropractic Care Center of Southlake as well as Southlake Physical Medicine where he oversees an integrated practice. Dr. Hergert is also the immediate former President of the Texas Chiropractic Association so now he can say what he really thinks. He was the big cheese, the illustrious potentate of chiropractic in Texas.

Although it’s highly unlikely, should you enjoy what Tyce shares with us here today, go and listen to his other guest spot which can be found in Episode #6. You can find episode #6 at the following link:

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

Welcome to the show Tyce. Nice to have you back.

I would say that a chiropractor would be completely oblivious to not understand that Chiropractic is considered to be on the fringe of healthcare by many to most in the medical field. It’s just a fact and chiropractors deal with this daily. We Chiropractors are used to feeling like the black sheep of the healthcare family off in a corner keeping all to ourselves.

In other articles, podcasts, and videos of mine, you’ll notice I have covered the Wilk vs. AMA case. I’ve covered the Doctored film by Jeff Hayes spotlighting mistreatment of chiropractors. I’ve also covered current attacks on Texas Chiropractors by the Texas Medical Association. It is all very well-documented at this point.

Chiropractic is currently undergoing an amazing renaissance. This is due to a couple of key factors. The first being the need to develop non-pharmacological treatment recommendations in the midst of a national opioid addiction crisis. A crisis that has killed thousands and thousands in the last several years. The second reason being the body of high-quality research that is consistently coming to light almost every month showing the effectiveness of Chiropractic and evidence-based chiropractors.

Do you feel this renaissance, Tyce, or is it just me living inside my head?

With all of the new information and new healthcare laws emerging, the questions going forward SHOULD be, “Is the medical field and is the insurance industry listening and implementing?” We shall see. So far, the answer is, “Absolutely not.” In fact, it’s almost defiant.

Is that an accurate statement Tyce? You’re my checks and balance guy on everything.

Let’s begin with the most glaring denial of Federal Law by the insurance companies right now. It has to do with Section 2706 of the Patient Protection and Affordable Care Act. Also commonly known as “Obamacare.” Section 2706 of the PPACA is entitled the nondiscrimination In Health Care section of the Federal Law and is intended to keep insurance companies and health plans from keeping chiropractors and the services they provide out of the system.

It reads as follows, “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”

On the American Chiropractic Association’s FAQ site for 2706, they state, “It is important to understand that Section 2706 and its assurance of non-discrimination in terms of participation and coverage requires that doctors of chiropractic not be discriminated against in the provision of any “essential benefit” that is within their scope of practice.”

Here’s the rub on 2706: part of its purpose is to reimburse chiropractors performing the same services under their scope and license at the same level financially as any other profession that provides that service.

For instance, under the PPACA Section 2706 Federal Law, chiropractors are to be paid the exact same for an 99203 exam code as a doctor of medicine or osteopathy is paid.

Would you agree with that assessment Dr. Hergert? Is this your understanding of the law?

Plain and simple. This is not happening. With so many chiropractors now integrating their practices with medical directors, physician assistants, nurse practitioners, and physical therapists like Dr. Hergert has in Southlake, it’s painfully clear that doctors of chiropractic are being discriminated against when it comes to reimbursements for the same codes performed.

In fact, chiropractors are integrating with these other professions just so that they can finally GET the reimbursements that the other practitioners are allowed! It is madness and clearly violates Section 2706 of PPACA.

Dr. Hergert, you are a great resource here since you’re in the middle of the two professions. What is your experience on this?

Tyce: The carriers will come right out and tell you they don’t think they have to play by this rule.

Also, there is violation of the law if an insurer does something such as applying caps on specific services provided by one healthcare provider whereas the cap does not apply to another type of provider. It is my understanding that United Healthcare has moved to a $65 visit cap on chiropractic care here in Texas.

Am I misinformed here Tyce? Does United Healthcare only put caps on Chiropractors or are they capping services with all providers?
Tyce: That gets very frustrating for those patients with a $50-70 copay.

It is the American Chiropractic Association’s opinion that a violation exists if the insurer or plan denies specific forms of care that is otherwise covered if it is a chiropractor providing the service and it is within their scope and licensing. I would suggest that a medical doctor probably gets services such as non-surgical decompression covered under insurance but chiropractors are routinely denied coverage.

Are there any better examples of this disparity, Tyce, since I don’t know any medical doctors that have their patients perform decompression?

There is a possible violation of Federal Law when Chiropractors are denied inclusion into a plan or group purely based on the profession. For example, it is my understanding that FirstCare won’t cover Chiropractic. Is that a violation of 2706?

Is that a violation? I suppose I could offer an opinion if I were a lawyer. I’m not sure why exactly other providers are allowed coverage while chiropractors are left out in the cold. Here is a great example though that I’m aware of here locally. there is a local insurance network that will remained un-named that charges $200 per year for chiropractors to be included for coverage however, medical professionals pay nothing to be included. Could that be a violation of the nondiscrimination law? I would say it smells a little fishy.

In my opinion, Federal Law is being violated all over the place in regards to Section 2706 of PPACA. I’m not sure how it can be perceived any other way.

What can you add here Tyce that I may have left out?
Tyce: What this means for patients is you can’t use that shiny new insurance policy that is costing you more than a $250k house payment would. You have to fork over the more money to pay for your chiropractic care.

Moving on from Section 2706…..I love talking about the New Recommendations For Acute and Chronic Low Back Pain.
It is becoming more and more aggravating that we chiropractors are not seeing a flood of acute and chronic low back pain patients. If you read my articles, watch my videos, or listen to my podcast with any regularity, you have no doubt been informed several times over of these new recommendations which, at this point aren’t that new anymore. They have been around for about a year now.

It is my opinion that no long-held beliefs or protocols will change if new information isn’t continually pounded and yelled about from the top of the roofs with megaphones. In marketing, experts have said that it takes a target 7 times of being exposed to information before it is finally received and, hopefully, acted upon.

I know that the medical field has NOT been exposed to this information at least 7 times because of two factors:
1. I have spoken to several medical practitioners here locally and not a single one of them has heard of or were aware of these new recommendations.
2. I am not seeing an incredible, overwhelming influx of acute and chronic low back pain new patients coming through my doors as a result of medical referrals.

Tyce, are you seeing an incredible influx of new low back patients from the medical field these days?

Is this willful disregard for the changing recommendations and a “clinging on” to old dogmatic beliefs passed down from the AMA years ago? I think some of it most certainly is.

Is it that a few bad seeds in the Chiropractic profession are giving the rest of us a bad image? I would say some of it most certainly is.

What I think it is mostly based on, however, is the fact that medical professionals are busy, they’re stressed, and many times over-worked and they simply don’t always have the time or opportunity to stay completely up on every new recommendation or updated protocol.

What do you think about it, Tyce?
Tyce: “You’re not down with, what you’re not up on.” Most don’t know. They didn’t get this info in school, and the pharma reps aren’t out spreading the good news.

With that being said, let’s be clear; the issues of low back pain, its economic impact, and the national opioid epidemic crisis in America combine to make these new recommendations that much more important.

Let’s start with the American College of Physicians. Remember, the American College of Physicians was proven in the Wilk vs. AMA case to have played a part in collaborating with the AMA in an attempt to rid the Earth of Chiropractic. I think that’s important to note as we go through the information because the ACP is historically known as a detractor or the chiropractic profession to put it mildly.

In response to the opioid epidemic gripping the nation currently, the American College of Physicians developed new recommendations for treating acute and chronic low back pain.

Why They Did It
• The American College of Physicians developed this guideline in order to provide updated recommendations on treatment of low back pain.
• With these recommendations, the ACP hoped to influence clinicians AND patients to make the correct decision for care in acute, subacute, or chronic low back pain conditions.

How They Did It
• They based their recommendations on a systematic review of randomized controlled trials and other systematic reviews.
• The research they reviewed included those papers available through April of 2015.
• The research included only those on noninvasive pharmacologic and nonpharmacologic treatments.

What They Found
• Recommendation #1: patients with subacute or acute low back pain should seek nonpharmacologic treatments such as Chiropractic, Massage, Acupuncture, and superficial heat BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
• Recommendation #2: patients with chronic low back pain should seek nonpharmacologic treatments such as Chiropractic, Exercise/Rehabilitation, Acupuncture, & Cold Laser Therapy BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
• Recommendation #3: In patients with chronic low back pain that have had no relief from nonpharmacological means, the first line of treatment would consist of NSAIDs like Aleve, Tylenol, Ibuprofen, etc.. As a second-line treatment, the clinician may consider tramadol or duloxetine. Opioids would be a last option and only if all other treatments have been exhausted and failed and even then with lengthy discussion with the patient in regards to the risks and benefits of using opioids. (Graded as weak recommendation)

Let’s recap: in February of 2017, the American College of Physicians, historically a Chiropractic profession detractor and attacker, now recommends Chiropractic as a first-line treatment for acute and chronic low back pain.

Dr. Hergert, does that make you feel warm and fuzzy inside because it does me?

Next, let us discuss the American Medical Association. If you thought the American College of Physicians was guilty of Chiropractic-hating, the American Medical Association is, or was, “Pablo Escobar” or the “El Chapo” of the attacks on the Chiropractic profession. The “El Jefe” of the Chiropractic haters, and the group that not only sat in the driver’s seat but also OWNED the entire truck of destruction back before Wilk vs. AMA came along. I believe I have been watching too much Netflix.

As a side note, I have realized that I have a wife, a daughter, and an all female staff at my office and…..I’m not the El Chapo or El Jefe of really anything. My son and I just walk around following orders pretty much. Tyce, you’re married with two daughters right?

On April 11, 2017, the Journal of the American Medical Association published a study on their website titled “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis,” authored by Neil Page, MD et. al. In the format of this research paper, they refer to chiropractic treatment as spinal manipulative treatment or SMT. But, because spinal manipulative therapy is what we chiropractors do the most and what we are most identified with, I’m replacing the term “SMT” with “chiropractic adjustment.”

Is that fair, Tyce? I think it’s fair.

Why They Did It
Considering that spinal manipulation, or the chiropractic adjustment, is a treatment option for acute low back pain, and that acute low back pain is one of the most common reasons for visits to the doctor’s office, the authors wanted to systematically review the studies that have been done in the past dealing with the effectiveness as well as the harms of chiropractic adjustments in the treatment of acute low back pain.

How They Did It
• The researchers used searches of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature.
• The search spanned 6 years from January 2011 through February 2017 for randomized controlled trials of adults with low back pain comparing spinal manipulative therapy with no treatment or with alternative treatments.
• The accepted papers also had to measure pain or functional outcomes for up to 6 weeks.
• The data extraction was done in duplicate.
• The quality of the study was assessed through use of the Cochrane Back and Neck Risk of Bias tool.
• Finally, the evidence was assessed using the GRADE criteria which stands for Grading of Recommendations Assessment, Development, and Evaluation.
• 26 eligible randomized controlled trials were identified and accepted

What They Found
• 15 of the RCTs, totaling 1699 patients, showed moderate-quality evidence that chiropractic adjustments had a statistically significant association with improvements in PAIN.
• 12 of the RCTs, totaling 1381 patients, showed moderate-quality evidence that chiropractic adjustments have a statistically significant association with improvements in FUNCTION.
• NO RCTs reported any serious harms or adverse event as a result of undergoing chiropractic adjustments.
• There were only minor events reported like some increased pain, muscle stiffness, and headache in roughly 50%-67% of those treated in the large case series. I would be interested to hear more about this statement by the authors. That is not what we commonly see in our practice. Sometimes, if the patient is new and is not accustomed to chiropractic adjustments, they may experience some soreness or stiffness the next day which is to be expected following a change in the body.
• I want to be as thorough as I can here….Tyce, do you see 50%-67% minor harms in your daily practice?

Wrap It Up
In true AMA fashion, instead of just coming out and saying, “Chiropractic adjustments showed moderate quality evidence for effectiveness in pain as well as in function,” the authors instead stated in conclusion, “Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.” Heterogeneity is defined as, “The quality or state of being diverse in character or content.” In my opinion, this is to give themselves and “out” by implying there was not enough focus to the RCTs to truly state their findings as fact.

Nonetheless, when the AMA comes even remotely close to endorsing anything having to do with Chiropractic, I’ll take it. And so should those in the medical field that commonly come in contact with those seeking help for their acute and chronic low back pain.

So…….We Should Be All Set For Success Now Right? Maybe they’re about to open up a chiropractic low back pain wing of the hospital, right?

That is what you’ think but there is new information from the White House that this simply is not the case despite the obvious ramifications. You can find the link in the show notes but on page 57 of The President’s Commission On Combating Drug Addiction and The Opioid Crisis report, the authors say, “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” This is straight from the White House.

At the bottom of page 57, you will also see that it says, “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

What say you Tyce?
Tyce: You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

In addition, policies that discriminate against chiropractic or chiropractors run in violation of Section 2706 of PPACA. It comes full circle.
I know you have something good to say here Tyce…

Tyce: The beautiful thing we get to see in our office, since we have both medicine and chiropractic working together, is the end of the story…people getting off the mind altering drugs, healing, and getting their lives back. All we do is follow these simple guidelines.

I have a question to pose to the entire Chiropractic profession: How in the heck do we deal with this?

It has to be through either the legislature at the state and federal levels or it has to be through the legal system. A guarantee I feel comfortable making is that the insurance companies won’t begin enforcing it on their own.

Mobilization and unification of the Chiropractic profession is probably where it starts.

Some steps toward that end include:
• Join or get involved with your state association. They’re the only ones effectively fighting for you and your rights on the state level.
• Join or get involved with your national association. They’re the only ones effectively fighting for you and your rights on the national level.
• If possible, build relationships with your state and national legislators.
• Donate to all of the above in the largest amounts you are comfortable with.
• Tell your friends and your colleagues about what is going on and help them get involved if they’re so inclined.
• Follow the news of your industry closely and stay knowledgeable about your profession. Both the good AND the bad.

Tyce, you have served for years and you’re still serving your profession. What you got on this?
Tyce: “Be part of the solution. You don’t have to dedicate 24/7 to the crusade….but you could do a little more. Right?”

A Chiropractic profession that is unified and playing offense instead of defense is powerful and is one of the worst nightmares of some folks I know out there in the world. Personally, as a side note, I like to see people like that squirm just a little don’t you? It just feels good. Makes what’s left of my hair stand up.

So won’t you consider helping if you haven’t before? If you don’t know where to start, email me at dr.williams@chiropracticforward.com and I will help you get on your way.

Tyce, I want to thank you for taking the time to come on the podcast and share your genius with us. With our history, I’m sure that Chiropractic Forward podcast listeners can count on your being a guest many many times. And, the next time will be the third time and I can say something like, “It was so nice, we had to do it thrice, with Tyce….or something stupid but entertaining like that.” Thanks for joining us today.

When Chiropractic is at its best, you cannot beat the risk vs reward ratio.

Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.

 

In the meantime, here are some of our recent podcasts that may be of interest:

CF 012: Proven Means To Treat Neck Pain

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

CF 010: Surprise Unique Information Shows Chiropractic May Work On The Brain Too

 

 

 

 

We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

References and Source Material
1. https://www.amarillochiropractor.com/startling-medical-professional-attacks-chiropractic/
2. https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
3. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
4. https://www.acatoday.org/Portals/60/Docs/Advocacy%20and%20Reimbursement/2706/2706-FAQs.pdf?ver=2015-12-23-125425-503
5. https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
6. https://jamanetwork.com/journals/jama/article-abstract/2616395?widget=personalizedcontent&previousarticle=2616379
7. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf