Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

 CF 173: Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

Today we’re going to talk a lot about pain. Nutrition for chronic pain, CBT and CFT for chronic pain, we’ll talk about TMJ treatment, and we’ll talk about deaths in 2020. This episode is full of info so let’s dive in. 

But first, here’s that sweet sweet bumper music


OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #173

Now if you missed last week’s episode , we talked about useless research and we talked about insult vs. inflammation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I don’t know if I mentioned it or not but I got my book back from Dr. Chris Howson up in the Great State of North Dakota. He spent some time editing it. Dr. Howson is the inventor of the Drop Release tool and is just a super dude on top of being brilliant. If you don’t know about Drop Release, go check it out at It’s pretty cool and something you can use to speed up soft tissue work in your practice. 

Now that we have gone through that process, I am teaching myself the way to self-publish this dude. When there are so many options, it can be daunting. It’s hard to know exactly where to go and how to do it. 

So that is the process I’m undergoing currently. Fortunately, I just noticed a colleague of mine that has recently published a book and it’s #1 on Amazon in its category. I reached out to her and she gave me a path to follow. So down the path I go. 

Still working on the medical integration here at the office. I’ve been having weekly calls with the integration consultant we are using. We are using Dr. Tyce Hergert down in Southlake, TX who has been integrated for 5-6 years at this point. Maybe even longer. He’s been through it for sure. If you are going through integration and need a little guidance, email me at and I’ll get you in touch with Dr. Hergert. 

Our attorney and CPA group got together and got it all figured out so we are moving forward with that aspect of it. Now, if we can just get that Nurse Practitioner hired. I made a mistake that could be seen as misleading. On the Indeed ad I placed, I put the wage at $65/hr. What wasn’t in the ad because there wasn’t a place for it, is that we have only about 33 hrs of hands on time per week. We are starting our NP off at around $85-$90k per year. 

I think one of the NPs got PO’d at me because I was absolutely hiring her. No doubt. She was the one. When it came down to it, she asked my the yearly salary. I told her and she said she wouldn’t and couldn’t do it for less than $125k/year. 

Well, damn. Back almost at square one on that end of things. I had made my mind up on her. Not only that, I think she was mad at me. Lol. So, I went and changed it to the yearly salary to make sure I wasn’t being misleading in any way. 

Now, the goal is to start at $85k and have them up to $120k within 3-4 years. But you can’t start something brand new at that level when you have no clue how it’s going to all work out and come together. It’s already a huge risk to start with. Why make any riskier from the get go?

So, that’s where all of that stands for now. Getting the book together, getting the medical entity rolling, and getting busy as hell again. Oh my gosh. It’s going to take a minute to get used to treating the numbers we were treating back before COVID came along. Today, as I found a little window to start typing today, I’ve got 56 on the schedule. That hasn’t happened since December of 2019. Maybe January of 2020. Maybe. 

February 2020 came along and destroyed business. BAM…..30% at least was gone. We went from 185-200 visits per week all the way down to 115 or so. It wasn’t awesome. I’m not going to lie. OK, it was awful actually. We paid the bills but nobody made any money. That’s for damn sure. 

Now, for the last 2-3 weeks, things are beginning to get a little crazy again. Thank goodness. I hope you are experiencing the resurgence I am experiencing. I think deep down, we all know it’s going to be OK but it’s sure refreshing to finally start to feel it and see it. 

Onto the research!

Item #1

The first one today is called “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review” by Elma et. al. [1] and published in the Journal of Clinical Medicine in March of 2020 and that’s only a little smoky but still hot enough!

Why They Did It

They say, “Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain”

How They Did It

  • (PRISMA) guidelines were used
  • Online databases PubMed, Embase, and Web of Science were used 
  • 20,316 articles screened and only 12 found eligible to be included in this review
  • They consisted of 9 experimental and 3 observational studies

What They Found

  • 7 out of 9 experimental studies showed a pain-relieving effect of dietary changes
  • Protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold

Wrap It Up

In an interesting conclusion, the authors say, “Plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.”


Item #2

This second one is called “CBT and CFT for Chronic Pain” by Graham Hadley and Matthew Novitch [2] and published in Current Pain and Headache Reports on April 1, 2021. Dammit stand back, we got a hot one. 

Why They Did It

Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA. 

  • Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life. 
  • Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors. Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort….
  • and as we just covered, diet might play a part in it as well. 
  • Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. 
  • This itself increases healthcare costs, and treatments can be invasive and have risks of their own. 
  • Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. 
  • As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. 
  • Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions. 
  • Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. 
  • Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. 
  • While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.
  • CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner
  • With a robust set of data, one can conclude that CBT and CFT are exceptional therapeutic methods in improving chronic pain or the overall well-being of our patients. 

Item #3

This one is called “The Leading Causes of Death in the US for 2020” by Ahmad et. al. [3] and published in JAMA on March 31, 2021 and that’s definitely some hot stuff right there. 

This is more of an article rather than research and it won’t take us long to hit the high points here. 

  • Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer
  • Cause-of-death data are based on the underlying cause of death, which is the disease or condition responsible for initiating the chain of events leading to death.
  • The provisional number of deaths occurring in the US among US residents in 2020 was 3 358 814, an increase of 503 976 (17.7%) from 2019
  • COVID-19 was the third leading cause of death in 2020, with an estimated 345 323 deaths, and was largely responsible for the substantial increase in total deaths from 2019 to 2020.
  • Substantial increases from 2019 to 2020 also occurred for several other leading causes. Heart disease deaths increased by 4.8%, the largest increase in heart disease deaths since 2012

I know……I know….car wrecks were reported as COVID and all that. I know….you do you boo. 

Item #4

This last one is called “Manual therapy for temporomandibular disorders: A review of the literature” by Kalam ir et. al. [4] and published in Journal of Bodywork and Movement Therapies in January of 2007. Definitely not hot. 

Why They Did It

The contemporary biopsychosocial health paradigm emphasizes a reversible and conservative approach to chronic pain management. Manual therapy for temporomandibular disorders (TMDs) claims to fulfil these criteria. An assessment of the utilization and efficacy of manual therapy for this condition is therefore required. 

How They Did It

  • A review of the literature pertaining to manual therapy for TMDs was undertaken between September and December 2005. Keywords used in the search were: TMD, manual therapy, massage, manipulation, mobilization, adjustment, chiropractic, osteopathy, physiotherapy, exercise.
  • A four member reviewer panel identified eight (n=8) randomized controlled trials of sufficiently reliable power to be suitable for inclusion in the review, of which only three included manipulative treatment of the temporomandibular joint. 

Wrap It Up

The results of manual therapy trials for this condition suggest that manual therapy is a viable and useful approach in the management of TMD. Manual therapy has also been shown to be more cost effective and less prone to side effects than dental treatment. 

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 


Remember the evidence-informed brochures and posters at 

Subscribe Button

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!


Send us an email at dr dot williams at and let us know what you think of our show and tell us your suggestions for future episodes. 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 


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.



Social Media Links

Chiropractic Forward Podcast Facebook GROUP




Player FM Link



About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger



1. Elma O, Y.S., Deliens T, Coppieters I,, Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med, 2020. 9(3): p. 702.

2. Hadley G, N.M., CBT and CFT for Chronic Pain. Current Pain Headache Reports, 2021. 25(35).

3. Ahmad F, A.R., The Leading Cause of Death in the US for 2020. JAMA, 2021.

4. Kalamir A, P.H., Vitiello A,, Manual therapy for temporomandibular disorders: A review of the literature. J Bodyw Mov Ther, 2007. 11(1): p. 84-90.