Chronic Pain

The Inflammatory Response’s Effect On Chronic Pain & The Entry Point For Low Back Pain

CF 235: The Inflammatory Response’s Effect On Chronic Pain & The Entry Point For Low Back Pain Today we’re going to talk about the inflammatory response’s protection from chronic pain, which is fascinating.. and we’ll talk about where patients should be starting their journey for low back pain.  But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check out my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and your patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #235 Now if you missed last week’s episode, we talked about Chiropractic saving Medicare patients money and adverse events and a better position for preventing strokes when adjusting the neck. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had a big weekend in Frisco, Tx. If you don’t know where Frisco, TX is, it is basically North East Dallas. It’s the home of the Dallas Cowboys training facility. It’s where all of the people you hear about moving to Texas are moving to. The place has growth that is just almost unreal.  They have to be continually building high schools and highways because they can hardly keep up with their growing population.  Anyway, it was the location of the Texas Chiropractic Association’s annual state convention, which is called ChiroTexpo. 

This year, I was asked to teach a 2-hour course. My course is called Chronic Pain And The Up-regulated Central Nervous System. Those of you that are regular listeners here are probably familiar with some of what I cover in the course. My main goal for attendees of my course is more responsible in managing of their patients and more responsible in communicating with them.  I’m trying to kill the habits some have of catastrophizing imaging findings and scaring patients into a ton of treatment by using harmful words, phrases, and analogies.  I had a patient last week whose primary told her that her spine was like a dry twig from osteoporosis.

Seriously?

The daughter was scared to death and the patient didn’t want to move an inch because she had a picture in her mind that her spine was going to start splintering. How awful.  But, you get what I’m saying. I’m trying to use guidelines and research to show why words matter and how we can help solve more chronic pain patients’ issues through good communication and broad management protocols.  So there. Good times in the metroplex.  I got to meet a lot of folks and hang out with some buddies. I got to see Mike Massey from Tennessee. He was speaking on Mastering Medicare. I got to hang out with Jay Greenstein and have some dinner and drinks. He was in town speaking on technology in the profession.

Excellent as always.

I hung out and had dinner with Brandon Steele, his wife and daughter, and my other good friend Craig Benton from Lampasas Texas. I also spent plenty of time with my regular TCA family, Tyce Hergert, Devin Pettiet, Max Vige, Bill Lawson, the new President of the TCA and Todd Whitehead, the new Secretary/Treasurer of the TCA, and always a favorite, Stephen Foster who is the President of Texas Chiropractic College. What a wonderful individual. TCC is fortunate to have him at the helm. 

These connections are important to me and I value them greatly.  I also got to meet a couple of fellow speakers and get to know them better. Kristi Hudson from ChiroHealthUSA out in Mississippi. She’s just got amazing good vibes and energy. You can tell when people are good at heart and she’s great. I also met Dr. Cindy Howard, a functional medicine mastermind, ninja, and Jedi. She’s just simply a force to be reckoned with. Very impressive, excellent attitude, and a new connection I’m excited to have made. 

On top of all of that, I won an award at the awards gala. I won the Executive Director’s award which is amazing and quite an honor.  So, overall, it was a great weekend. I’m recovering from all of the festivities but it was well worth it and I’m looking forward to the next one.  Again, it’s mid-June 2022 and I’m still looking for a chiropractor to come in here and treat in my clinic and grow my clinic. If interested, send me an email and a CV to [email protected] please.

I want to get to know you. But, understand, I’m a go-getter. You’ll need to be as well. But for the right person, this might be the place you’ll want to spend the rest of your career. 

Alright, let’s dive in. But before we do, let’s pay some bills real quick. 

Doctors:  I’ve been telling you about a system that once obtained will help you get more  PI cases.  This system was created by an attorney who exclusively handles accident cases. He got tired of lame approaches by doctors wanting his referrals, so he created this system to teach you how to get the attention and then the love of PI attorneys.  You know these cases are the GOLD of our business.  Very few no-shows, full payment … not health insurance caps or Medicare or Medicaid. Go to: http://www.gettingpicases.com/cs Over 500 doctors nationwide are now using this system…. don’t be left out…  improve your practice, gain free time because of the added income you’ll realize, and appreciate that the attorney, Paul Samakow, is still offering a 100% Money Back Guarantee …  if you give his ideas a fair shake and it doesn’t work, he’ll refund your money…  you have nothing to lose here…

Go to:  http://www.gettingpicases.com/cs

Item #1

The first one is called “Acute inflammatory response via neutrophil activation protects against the development of chronic pain” by Parisien et. al. (Parisien M 2022) and published in Science Translational Medicine on May 11 of 2022 and it’s a hot potato, coming through. 

Why They Did It

They say, “The transition from acute to chronic pain is critically important but not well understood. Here, we investigated the pathophysiological mechanisms underlying the transition from acute to chronic low back pain” On a quick side note, there is the suggestion that neuroplasticity may partially explain the slip from acute to chronic. Isn’t it an interesting thought; tissue has a healing time? If we can get the pain to cease after healing occurs, thus preventing the slip from acute to chronic….imagine how much time, money, and suffering we save the system. Low back pain is the leading cause of disability globally and I would venture a guess that the vast majority of that pain is not acute. It’s chronic. 

How They Did It

  • They performed the transcriptome-wide analysis in peripheral immune cells of 98 participants with acute LBP, followed for 3 months.
  • Transcriptomic changes were compared between patients whose LBP was resolved at 3 months with those whose LBP persisted

What They Found

  • They found thousands of dynamic transcriptional changes over 3 months in LBP participants with resolved pain but none in those with persistent pain. 
  • Transient neutrophil-driven up-regulation of inflammatory responses was protective against the transition to chronic pain. 
  • In mouse pain assays, early treatment with a steroid or NSAID also led to prolonged pain despite being analgesic in the short term; such a prolongation was not observed with other analgesics. 
  • Depletion of neutrophils delayed resolution of pain in mice, whereas peripheral injection of neutrophils themselves prevented the development of long-lasting pain induced by an anti-inflammatory drug.

Wrap It Up

Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers. You can’t tell me that’s not somewhat exciting. I also read an article last week asking if we’re close to curing cancer and, based on some more recent results from the immunotherapy strategies they’re using and studying, they’re optimistic that an end for a lot of cancers may be in sight. 

That’s worth having some excitement over. If we can cure cancer and figure out how to prevent pain from slipping into chronic pain…..damn. Imagine how our world changes. Almost immediately. I’m a dreamer and I’m dreaming right now. What a party that’ll be if they can get it done.  Before getting to the next one, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase.

Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “Where to start? A two-stage residual inclusion approach to estimating the influence of the initial provider on health care utilization and costs for low back pain in the US” by Harwood et. al.   (Harwood 2022)and published in BMC Health Services Research on May 23, 2022 and that’s hotter than Texas in June and July.  For real, folks. It was already hitting 105 and 108 in Amarillo and Dallas this last weekend. That’s nuts. 

Why They Did It

Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

How They Did It

  • They used national private health insurance claims data on  3,799,593 individuals, 
  • Subjects were individuals aged 18 or older 
  • They were retrospectively assigned to cohorts based on the first provider seen for their low back pain
  • They excluded those with back pain, serious conditions, or opioid script in the 6 months prior to the study
  • Outcome measures included imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care). 

What They Found

  • Cost and utilization varied considerably based on the first provider seen by the patient. 
  • The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). 
  • Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. 
  • The frequency and time to serious illness varied little across providers. 
  • The total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205).

Wrap It Up

The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness. Frequency and time to serious illness varied little across providers and the total cost of care was the lowest when starting with a chiropractor.  Superhero sounds engaged. 

 

Boom, snap, slap, kachow, frickin’ face chop. 

So why in the holy mother of common sense are we not being flooded with pain patients coming from the medical community? How is it possible? We keep seeing papers just like this. This just happens to be the newest one. We’ve seen multitudes of this same result.  Evidence-based and patient-centered chiropractic saves money, get patients equal or better outcomes, patients are more satisfied with chiropractic care, and we save the patient and the system money. 

That’s it, the end of the story. It’s time for a profession that acts as they stand on the shoulders of mother evidence and research….like the medical profession, for example….. to begin paying attention to its own damn research and making it mandatory for spinal and joint pain patients to go to an evidence-based, patient-centered chiropractor first for 2 weeks before they even think of making a different move.  If they’re not doing that, they’re 100% ignoring just about every bit of research I’ve seen on this topic in the past 10 years.

Dr. Christine Goertz once told me that it takes on average 18 years for research to filter down to the everyday provider in the field.  So…..just like 8 more years before our offices are inundated, right? That is if they don’t cure chronic pain first.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively 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! Contact Send us an email at dr dot williams at chiropracticforward.com 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. 

Connect

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

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

TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Harwood, K. J., Pines, J.M., Andrilla, C.H.A., (2022). “Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US.” BMC Health Serv Res 22(694).  

Parisien M, L. L., Dagostino C, (2022). “Acute inflammatory response via neutrophil activation protects against the development of chronic pain.” SCIENCE TRANSLATIONAL MEDICINE 14(644).    

The Complexity & Treatment of Chronic Pain

CF 224: The Complexity & Treatment of Chronic Pain Today we’re going to talk about manual therapy for chronic pain the complexities within.  But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 a  round.  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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #224 Now if you missed last week’s episode , we talked about Kids’ Mental Status & Zero Calorie Drinks. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still no real results on trying out the lead generation marketing that I’ve spoken about recently. We’ve tweaked it and will continue seeing if we can make a go of it. Polls have shown it and I forget. Every now and then I recall; people aren’t nearly as interested in wellness and talk about maintenance or preventative. They want RELIEF from pain points. 

As chiropractors, we want them to care about wellness and maintenance, and prevention. But they don’t. Pain is a hell of a motivator. In fact, it’s unmatched as the main motivator. Does that mean there aren’t amazing wellness clinics? Of course not. There are but they’re more the unicorn than the run-of-the-mill horse trotting around. 

Also, more recently, I have a new competitor in town that is copying everything I am doing. Copying my providers and copying my services. But, severely discounting everything. To the point of embarrassment. The Joint is one thing. They serve a specific gap. ‘I feel great. No issues. Just wanna be popped.” They serve that demographic and I can make sense of their discounted rate. They aren’t solving problems there.  But this place that’s copying me now, they are solving problems. Or at least trying to. And charging $29 for that first visit with the exam and all of the rigamarole. That’s rubbish, garbage, clown stuff right there.

I hope the type of chiropractor that listens to this podcast knows better than that. Knows what that does to our industry.  Have you noticed that when a chiropractor owns the clinic, charges are pretty appropriate? When someone that is not a chiro owns it, services are devalued to an embarrassing point. Either that or the chiro is desperate.  All of it equals devaluing what we do. It’s poor form.

My least expensive adjustment is $45 US American Greenback Benjamins. It took me some years to start valuing my service. Now, thanks to research and guidelines and colleagues and mentors, I understand the value, the time, the education, the work, the responsibility, and the effort.  

Hell with anyone that wants to sell an exam, x-rays, report of findings, and adjustment for $29. That’s the way I see it. Pick up your game and be better.   as well.

You’ll be hearing more about it in upcoming episodes.  We all know that the number one type of case that we want is a personal injury case.

Remember, I just said pain is the motivator and if you don’t know why personal injury patients are so valuable, you haven’t been paying attention.  They are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment because it enhances their legal case and gets them more money.

But we know that if they aren’t moving from the start, recovery from pain and getting back to normal might not happen at all. We can help these patients so much and medical practices in most markets are turning them away now.  The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a tough bunch. I have the answer.

An attorney I recently connected with has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. I checked it out personally and I like it. Attorney Paul Samakow is an attorney teaching how to speak to attorneys. His system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Just one of my PI cases averages $3000-$3500 for example. It’s a win-win. 

Go to gettingpicases.com/cs ‘C’ as in cat and ’S’ as in sweet. 

That’s gettingpicases.com/cs

One more time so you get it right:   gettingpicases.com/cs

Alright, let’s get on with the research, shall we?

Item #1

This one is called “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts” by Coronado et. al.  (Rogelio A. Coronado & Joel E. Bialosky 2017)and published in the Journal of Manual and Manipulative Therapy in June 12 of 2017 and that is not hot. It’s not in the freezer. But it’s not hot. 

Why They Did It

They start by saying that chronic pain affects nearly one-third of the American population. That’s pretty stout, yeah? And sitting here 5 years later, we know that it’s only gotten worse.  Then they pop out with something fairly powerful. They say, “For manual physical therapists to play a key role in the management of individuals with chronic pain conditions, simply being a safer option is not good enough. Instead, we must practice in an effective manner as well. Manual physical therapists can effectively treat patients with chronic pain and other musculoskeletal disorders; however, the field is at a crossroads.

The traditional approach to manual therapy assumes that proper technique selection and precise implementation is the primary driver of a successful outcome [10,11]. In this view, the resultant outcomes are directly attributed to the applied intervention. A similar perspective on intervention may be witnessed in traditional medicine when, for example, a pharmaceutical agent is prescribed to manage cholesterol or blood pressure, or a surgical approach is elected based on abnormal imaging findings. We propose manual physical therapists will only be recognized as ideal providers for individuals with chronic pain if we accept an updated paradigm acknowledging the complexity of the manual physical therapy experience and accept the robustness of varying contextual elements inherent in our interactions.  For some clinicians, this will require a revolutionary shift in their perception of the development, maintenance, and modulation of pain [12].

Pain is an experience orchestrated by dynamic sensory, cognitive, and affective processes and is strongly influenced by patient’s expectations, mood, desires, and past experiences. Limiting pain perception to a peripheral impairment is outdated and a more comprehensive, albeit complex, approach to manual therapy accounts for a myriad of interacting factors impacting chronic pain outcomes.”

What did the five fingers say to the face? Slap!!

That was like Will Smith Rocking Chris Rock…..

“Maladaptive neuroplastic changes are evident in patients presenting with chronic pain conditions, suggesting intriguing targets for effective treatments. “Pain sensitivity can serve as a proxy measure for central sensitization – a phenomenon that may impact prognosis and treatment response – and perhaps provide a more effective therapeutic target for treating patients with chronic pain” How many times have you heard me talk about upregulation and pain sensitization?? This is it, right here.  Patients with chronic musculoskeletal pain often report co-existing psychosocial complaints known to worsen their prognosis and limit the effectiveness of interventions.

Manual therapists are in need of clinical strategies to minimize the influence of negative psychosocial factors and boost positive thinking and outlook. Just a diagnosis with zero treatment has been shown to be helpful. How many times have you heard that words matter?? With our words alone, we can push someone into chronic pain or bring them more toward the surface. 

“Manual therapy is often a component of a comprehensive treatment package and multiple interventions may interact to influence clinical response.” – exactly – a broad management approach and not one single intervention solve the puzzle.  “Patient education is an important component of a manual physical therapy interaction and the manner and content of education, specifically related to pain, can greatly influence treatment effectiveness. “ – If you’re not properly educating and explaining without the catastrophization and doctor dependency garbage we see in our profession, then you’re missing the boat and doing more damage than good.  “Manual physical therapists should recognize the multidimensional nature of chronic pain as well as the complex interactions of contributing factors accounting for manual therapy-related treatment effects.

Continuing to attribute an effective manual physical therapy intervention to the correction of a peripheral impairment is too simplistic and prevents conscious attempts to augment contributing factors known to enhance outcomes in patients with chronic pain. While perhaps a safer avenue than opioids, we believe the continuation of an outdated approach to manual physical therapy will result in suboptimal provision of care.” While this is geared to PTs it’s speaking to us chiros equally and we better pay attention because, in my learning and in my experience, it’s hitting every nail right on the head. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

  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 preventatively 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!

Contact Send us an email at dr dot williams at chiropracticforward.com 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. 

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

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

TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

Bibliography

Rogelio A. Coronado & Joel E. Bialosky (2017). “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts.” J Man Manip Ther 25(3): 115-117.        

Sitting On Your Butt And The Future Of American Pain

CF 214: Sitting On Your Butt And The Future Of American Pain Today we’re going to talk about Sitting On Your Butt And The Future Of American Pain” But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #214 Now if you missed last week’s episode , we talked about the Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain. Make sure you don’t miss that info. Keep up with the class.    On the personal end of things….. Short ans sweet today folks becauuse I have just 3 days to fit in 5 days of work. Come Thursday, I’m off to Delray Beach, FL. Now that sounds amazing and all vacation-y right?/ Well it’s bidniz. I’m taking my wife and duaghter so it’s vacation-y for them but for me, I was invited to be part of a nationwide chiropractic mastermind. To help each other solve their problems, to network, and to conquer. And that’s the stuff I love being a part of. I can’t wait to put the things I learn into effect here in my cliniic and I can’t wait to help someone else that can maybe learn something from me. Who knows what they can learn from me? Guitar maybe. Lol So, the front desk girl I bragged on. She got a better job I guess. Working only 3 days a week and making the same money. Can’t blame her. I jsut got the back office staff filled and now to fill the front desk.  Time’s are tough folks. But that’s OK. I’ve been at it 24 years. No keeping this old dog down. I was here far before any staff and I don’t plan on going anywhere any time soon.  So, off to Indeed I go to find a new employee.  Let’s get on with the show so I can go hire someone.    Item #1 The first one this week is called ‘Association between sedentary behavior and low back pain; a systematic review and meta-analysis” by Mahdavi, et. al. (Mahdavi SB 2021) and published in Health Promotion Perspective in 2021 so that means it’s steamy hot.    Why They Did It Sedentariness is a substantial risk for many chronic diseases. We aimed to investigate the correlation of sedentary behavior and its indicators with low back pain (LBP) among adults and children   How They Did It
  • Original articles published up to April 28, 2020, using PubMed, Embase, Web of Science and Scopus were evaluated
  • We reviewed 49 English articles with analytical observational study design, of which, 27 studies with cross sectional/survey design were retained in the meta-analysis
  What They Found
  • Among adults, sedentary lifestyle was a considerable risk factor for LBP; prolonged sitting time and driving time were the significant risk factors. 
  • Sedentary behavior was associated with LBP in office workers. 
  • Moreover, excess weight and smoking were associated with LBP. 
  • Among children, sedentary lifestyle was a remarkable risk factor for LBP; prolonged TV watching and computer/mobile using and console playing time were significant risk factors for LBP. 
  Wrap It Up Sedentary behavior, whether in work or leisure time, associates with a moderate increase in the risk of LBP in adults, children and adolescents.   Item #2 The last one this week is called, “Decoding the mystery of American pain reveals a warning for the future” by Case et. al. (Case A 2020) and published in Proceedings of the National Academy of Sciences of the United States of America in September of 2020.    Why They Did It There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain.   How They Did It Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly.   What They Found Disaggregating the cross-section of ages by year of birth and completion of a bachelor’s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age-a result not found for those with a bachelor’s degree.  Thus, the gap in pain between the more and less educated has widened in each successive birth cohort.  The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950.  If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare. Dayum…..I know I need to get an associate in here because my back hurts all the damn time and I don’t have time to be running around town looking for a chiropractor that can fit me in.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively 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!   Contact Send us an email at dr dot williams at chiropracticforward.com 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.    Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.   Website
Home
  Social Media Links https://www.facebook.com/chiropracticforward/   Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/   Twitter   YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Case A, D. A., Stone AA., (2020). “ecoding the mystery of American pain reveals a warning for the future.” Proc Natl Acad Sci U S A 117: 24785-24789.   Mahdavi SB, R. R., Vahadatpour B, Kelishadi R, (2021). “Association between sedentary behavior and low back pain; A systematic review and meta-analysis.” Health Promot Perspect 11(4): 393-410.    

Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain

CF Ep. 213: Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain Today we’re going to talk about Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain But first, here’s that sweet sweet bumper music    

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into  sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #213 Now if you missed last week’s episode , we talked about Intermittent Fasting & Dementia And Your Level Of Activity. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, no…it’s not just you….I’m a little slower than normal right now. For most of us, that’s the nature of the beast. We just slow down in January because most of us take insurance and most of those plans re-set in January. People haven’t met their deductibles. They don’t like to spend their own money.  And that’s OK. Speaking from 24 years of experience, it’s normal and you’ll start seeing it pick back up around mid to late February. Definitely by March.  Like I sadi last week, this is the time that we start playing catch up and taking care of all of the stuff that’s been sitting on the back burner.  So start dusting off that stack on your desk and working through it while you have the time.    I want to be honest. Which I always am. I think I’m in a mid-life crisis. I’m tired of replacing employees. Re-hiring, etc. I’m tired of the same old questions we get from patients. I’m tired of dealing with the day-to-day stuff I’ve dealt with. Some of you will love what you’re doing so much that you’ll want to die in your office at 84 years old working on someone. 

And wouldn’t that be an awful experience for the patient? Just as a side thought. Lol. 

Anyway, that’s not me. When I’m answering the question about why someone’s neck is hurting for the umpteenth time, the call for more freedom of time gets stronger.  And stronger and stronger.  That’s the reason that over the last few years I have started cultivating the side gigs. The exit strategy. Looky here; I write and perform music, I paint, I draw, I play the guitar, I build furniture, I sculpt, I throw the discus and want to compete in old man track meets, and I love spending time with my family and traveling.  So…how the hell do you do all of that while you’re in a clinic all day every day your entire life? The answer is….you don’t. You don’t do the things that feed your soul. You either don’t do them at all, or you don’t do them very often.

Until you’re 65 or so for most people. Well, I don’t plan on being most, folks. So, how do you own the practice instead of the practice owning you? Great question. I don’t know but here are some of the avenues I’m using to try to walk the path. 

  • Specialization and Board Certification
  • Nurse Practitioner
  • Associate chiropractor – If you’re interested in working for me, email me folks. [email protected] I’m looking. 
  • Real Estate Investing
  • Voice Over
  • Authorship
  • Speaking and Mentoring

In fact, I have a big presentation coming up at the Texas Chiropractic Association’s MidWinter Conference in Lubbock, TX on February 18th. It’s called Chronic Pain And The Upregulated Central Nervous System. I’m in the process of building that talk as we speak.  If that sounds like something your group or association could use, email me at [email protected] and let’s connect.

I’d love to come present for you and your peeps. 

So, anyway, I do all kinds of things. But those are the biggies.  Get your exit number in place. Even if you’re brand new. You gotta have your loans paid. You gotta have your retirement finances in the process. You gotta have investments working. Once that’s handled, what is the exit number that would make you secure to make your exit.  Or to make a Hybrid Exit. What’s that exactly? A Hybrid Exit would look different for different folks. For one person that might mean treating patients 2 days per week. For others, it might mean strictly being the owner but exiting patient treatment completely. It could mean a million things but, at the price point some of us make per year, it can be difficult to build enough side gig to replace that income.  For me, just looking at the numbers and potential, while keeping risk mitigation in mind, real estate seems the quickest way when you combine that with the clinic integration and hiring an associate chiro. Combining these three may get me there.  Then you throw in this voice-over blessing that I started last year…..wow. That was out of nowhere, was a complete surprise, and an amazing blessing. Voice over, by itself, has more than funded the down payment and the furnishing of our very first short-term rental house and investment I’ve been mentioning more and more recently. 

Let’s be honest though, you don’t have to be in voice-over to invest. You just have to keep the overhead down and save up enough for a downpayment. The rest will take care of itself. And the earlier you start, the faster you get there. I’m 49 and wish I’d had this mentality at 29. Damnit. 

But it’s never too late to start taking better care of your future, your physical health, and your mental health. That’s where I’m at.  I’ll keep updating you. 

Item #1

This first one is called “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial” by Cholewicki et. al. (Cholewicki J 2021) and published in PM&R on October 31, 2021.

Aye chiwawa!

Why They Did It

Neck pain (NP) affects as much as 70% of individuals at some point in their lives. Systematic reviews indicate that manual treatments can be moderately effective in the management of chronic, nonspecific NP. However, there is a paucity of studies specifically evaluating the efficacy of osteopathic manipulative treatment (OMT). The authors wanted to evaluate the efficacy of OMT in reducing pain and disability in patients with chronic NP. And I’m glad they are because they’re right, there is a paucity of research on neck pain. Low back gets all the attention while neck pain…..treating neck pain is the main thing we chiros get beat up over. So why the hell not knock out a ton of high-level research on chiro, manipulation, and neck pain while continuing to highlight the low risk of adverse effects for its treatment? Can we finally get past this chiropractors cause strokes issue? Is there increased risk? Sure. But that doesn’t mean we go arounnd causing them. There are bad patients that shouldn’t be worked on and there are bad chiros that are far too rouugh. But for the most part, its not dangerous whatsoever.  Take the UFC for example

How They Did It

  • Single-blinded, cross-over, randomized controlled trial.
  • University-based, osteopathic manipulative medicine outpatient clinic.
  • 97 participants, 21-65 years old, with chronic, nonspecific NP
  • Participants were randomized to two trial arms: immediate OMT intervention or waiting period first. 
  • The intervention consisted of 3-4 OMT sessions over 4-6 weeks, after which the participants switched groups.
  • Primary outcome measures were pain intensity (average and current) on the numerical rating scale and Neck Disability Index.
  • 38 and 37 participants were available for the analysis in the OMT and waiting period groups, respectively

What They Found

  • The results showed significantly better primary outcomes in the immediate OMT group for reductions in average pain, current pain, disability, and improved secondary outcomes related to sleep, fatigue, and depression. 
  • No study-related serious adverse events were reported.

Wrap It Up

OMT is relatively safe and effective in reducing pain and disability along with improving sleep, fatigue, and depression in patients with chronic NP immediately following treatment delivered over approximately 4-6 weeks. One big thing here, this improvement was seen with 3-4 visits over 4-6 weeks. Shouldn’t that have been standardized and consistent from patient to patient? Like 4 visits over 6 weeks for example. Not a range. Next thing, this is about chronic pain. Is 3-4 visits over 4-6 weeks really enough to start addressing the issue of chronic pain? To introduce proprioception, movement, function, and all that good stuff?? No is the answer but, they still showed improvement. I’d love to see the outcomes in a design like this with a more robust and appropriate treatment schedule or frequency. 

Item #2 Thsi one is called “You don’t need expensive CBP BS protocols with biased research done by the stakeholders to entice the 9 out of 10 patients that naturally have a decreased cervical curvature into a 70 visit $5,000 treatment plan to fix a lack of cervical curve that a 20 year research project proved is no big deal anyway.  Oh wait….sorry….check that. The actual title is “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain” by Lee et. al. (Lee 2020) and published in Annals of Rehabilitation Medicine on May 29 2020 and it’s hot enough! Sorry for the mistake. I’ll try to pay more attention to the research paper titles. I’m undiagnosed ADD like that. I take the eye off the ball every here and there. I’ll try to tighten that up a bit. 

Anyway

Why They Did It

  • This research was done by medical doctors so there is no chiropractic bias to this lack of curvature research information. 
  • The authors say they wanted to explore if the modified cervical and shoulder retraction exercise program restores cervical lordosis and reduces neck pain in patients with loss of cervical lordosis.

How They Did It

  • This study was a retrospective analysis of prospectively collected data. 
  • Eighty-three patients with loss of cervical lordosis were eligible. 
  • The eligible patients were trained to perform the modified cervical and shoulder retraction exercise program by a physiatrist, and were scheduled for a follow-up 6 to 8 weeks later to check the post-exercise pain intensity and lateral radiograph of the cervical spine in a comfortable position. 
  • The parameters of cervical alignment (4-line Cobb’s angle, posterior tangent method, and sagittal vertical axis) were measured from the lateral radiograph.
  • Forty-seven patients were included.
  • The mean age was 48.29±14.47 years

What They Found

  • Cervical alignment and neck pain significantly improved after undergoing the modified cervical and shoulder retraction exercise program. 
  • The upper cervical lordotic angle also significantly improved. 
  • In a subgroup analysis, which involved dividing the patients into two age groups (<50 years and ≥50 years), the change of the sagittal vertical axis was significantly greater in the <50 years group

Wrap It Up

The modified cervical and shoulder retraction exercise program tends to improve cervical lordosis and neck pain in patients with loss of cervical lordosis. So……if we’re evidence-based and patient-centered, we are not taking advantage of others. We don’t see patients as sales targets. We aren’t seeing them as targets to close on. We aren’t seeing them with dollar signs in our eyes.  Rather, we are seeing them as human beings that are in our clinic to place full faith, trust, body, mind, physical well-being, and their entire futures in our hands.

If we are honoring this idea and honoring our patients, we are teaching them about this, we are teaching them about moving, we are teaching them how to self-manage at home, and we are doing what we can within a responsible and appropriate 2-4 treatment plan….give or take.  You know…..being a doctor and doing doctor stuff instead of doing street corner huckster stuff like I see so many fellow chiropractors doing.  It’s sad. We don’t have to put up with it in our profession. We just have to stop ignoring it and start calling it out and not putting up with it. We can run this behavior out of our profession. If we choose to. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus.

The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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 preventatively 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!

Contact Send us an email at dr dot williams at chiropracticforward.com 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. 

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

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

TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Cholewicki J, P. J., Reeves NP, DeStefano L, (2021). “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial.”

PM R.   Lee, M., Jeon H, Choi J, Park Y, (2020). “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain.” ARM 44: 3.  

Pain And Clumsiness & Treatment Escalation

CF 202: Pain And Clumsiness & Treatment Escalation Today we’re going to talk about pain that causes clumsiness and we’ll talk about treatment escalation.  But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #202 Now if you missed last week’s episode , we talked about breast plan illness and treating chronic pain centrally. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things may have leveled out last week. We shall see. Still busy as can be but instead of 215 in a week, I believe last week was more around 185. This is exactly what we averaged weekly before COVID so I can live with that. I didn’t feel 100% overwhelmed. Tired, yeah. But not overwhelmed.  Let’s talk about the staff.  Have you ever hired a staff member that started out as a kid and just blossomed into something pretty darn special? Wouldn’t it be nice if we could predict these things? Unfortunately, hiring can be a bit of a crapshoot. The ones that look the best turn into clowns. Then you have the ones that are meh and stay meh. Then you have the ones you kind of aren’t sure about and they either sink or swim.  I found a swimmer.

I hired the daughter of one of my long-time friends. I didn’t want to hire her because I didn’t want to treat her differently because of my friendship with her mother and I also didn’t want to risk losing a friend because a problem popped up and I had to fire her daughter. Or something of that nature. You never know what’s going to happen but that was my thought process.  Anyway, she was the best applicant so I hired her. I had an office manager that had been there for roughly 11 years. She trained her up well. Her only job had been with Kohl’s so she’d been in retail and was only about 19 I think. Maybe 20. She was a kid. It took her a bit to settle in I think but once she did, she blossomed.  Fast forward a year or two and my long-time office manager got an offer for more money and she took it. This could have been catastrophic. But then this girl the had started as a kid stepped up and said, “I got it.” 

And no kidding…..she had it. She started marketing. She started setting up meetings with the staff where the weekly meetings and training had kind of fallen off. She started going to networking events. Now, a year after taking over as office manager, she’s the ‘go to’ for the entire office, she’s worked every position including billing and the front desk, and at 23 years old, I have every bit of confidence in that girl.  I told that story for no real reason but to just say ‘isn’t it a bit hinky?’ Wouldn’t it be nice to be able to bottle that up and figure out how to tell who’s going to crash and who’s going to soar? I know everyone has a different opinion on relationships in the office but my opinion, and my personality, is for my staff to be funny, professional, a little bit ornery, and a bit like family.

I care about my staff.  I root for them and they root for me. We tease each other non-stop but we are a family. I spend more time with those girls than I spend with my own family. That’s a big deal. Why would I want a boss-employee relationship with people I basically spend my entire life with? I’d rather them be bought in. Be like family. And when they’re no longer on my team, they’re still on the team to an extent because they became part of the family.  I could be wrong but of all of the people that have worked for me over the years, I can only think of maybe 3 that left on bad terms. Out of maybe 30 or more people.

That sounds like a high turnover rate but honestly, I’ve been in the job for 24 years almost and right now alone I have 13 employees. So, there have been plenty come and go over the years for different reasons. Going back to school, leaving to have babies, moving out of town. It is what it is. 

Most just don’t leave on bad terms and that’s the way I’d like to keep it. I hear horror stories about other chiropractors throwing fits, kicking furniture, yelling down at their staff, and basically acting like children in a grown-up’s body. That’s embarrassing for them.  Leaders come in all shapes and sizes but for me, funny, professional, friendly, respectful, and family sum it up. And love. I love most of the staff that has worked for me. Yes, I paid them.

But they also dedicated themselves to my clinic. That means something and I value it.  Alright, let’s hop in

Item 1    

https://www.frontiersin.org/articles/10.3389/fpain.2021.756771/full?fbclid=IwAR1LIiNtb03NVWKifKRNNnefXg2CYDjWcUynCfIFU3WcnoqzIX58m_Rzw3Y

This one is called “Does my neck make me clumsy? A systematic review of clinical and neurophysiological studies in humans” by Harman et. al. (Harman S 2021) and published in Frontiers in Pain Research on October 11, 2021 and that’s spectacularly steamy. 

 

Why They Did It

Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness.

How They Did It

Six electronic databases were systematically searched,  records identified and assessed including a risk of bias.  Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Eighteen studies were retrieved and assessed;  the overall quality of evidence was moderate to high.  Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. 

What They Found

Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia.  All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits.

Wrap It Up

Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness. In the Fellowship program for Neuromusculoskeletal Medicine, we actually learned a great deal about this.

Which is why I’ve included it this week. We know that when sensory information comes in if there is an alteration in the signal or in it’s processing, there will be alterations in the motor portion of the sensorimotor capability leading to aberrant movements and motion.  What if incidental pops and clicks were due to faulty sensorimotor and aberrant movement? It can be due to instability, sure. But it can also be to a smudged brain map. We know that when patients have chronic low back pain, the brain map can be smudged. Our brains have a map of our bodies.

Every joint, its capabilities, and it’s limitations. Chronic pain smudges that map. We also know that a large portion of our proprioception and sensory information also comes from our deep upper cervical muscles. In combination with the inner ear and eyes.  It doesn’t take a stretch of imagination to see chronic pain, either in low back or neck, or neck dysfunction being the source of issues for balance, proprioception, and accurate motor function.  It’s all fascinating, folks! Good stuff. 

Item #2

https://www.jmptonline.org/article/S0161-4754(21)00035-X/fulltext?dgcid=raven_jbs_etoc_email

This one is called “Risk of treatment escalation in recipients vs. non recipients of spinal manipulation for musculoskeletal cervical spine disorders; an analysis of insurance claims.” by Anderson et. al (anderson BR 2021) and published in June of 2021 so hot! 

Why They Did It

The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine.

How They Did It

  • They used retrospective analysis of insurance claims from 2012-2018 from a single Fortune 500 company.
  • They categorized 58,147 claims into 7,951 unique patient episodes.
  • Treatment escalation included claims where imaging, injection, emergency room, or surgery was present.

What They Found

  • Treatment escalation was present in 42% of episodes overall: 2,448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. 
  • The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation

Wrap It Up

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation.  In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain. So, how many times have you seen patients that had fusions that they should have never had?

Many or most times based on MRI images from MRI’s they probably should have never had. Conservative care first, folks.  Failure to respond to conservative care. Conservative care being spinal manipulative therapy, exercise, laser, massage, acupuncture, yoga, tai chi, cognitive behavioral therapy, and I will add one from the anecdotal observation that is backed by non enough research….and that’s spinal decompression. I’ve never seen anything like it for discs and radiculopathy. Plain and simple.  Once those have been tried and failed, then you look at meds. Then you look at injections. Then you look at surgery. 

Understanding that cauda equina and progressive neurological deficits are really the main reasons for surgery. Pain, by the way, is not a reason for surgery.  No cauda equina? No altered sensory, motor, or reflexes? No surgery. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations.  So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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  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 preventatively 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!

Contact Send us an email at dr dot williams at chiropracticforward.com 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. 

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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

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TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

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  

Bibliography

Anderson BR, M. W., Long CR, (2021). “Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.” J Manipulative Physiol Ther 44(5): 372-377.

Harman S, Z. Z., Kendall J, Vindigni D, Polus B, (2021). “Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans.” Front Pain Res 2: 756771.      

Breast Implant Illness & Treating Chronic Pain Centrally

CF 201: Breast Implant Illness & Treating Chronic Pain Centrally

Today we’re going to talk about breast implant illness and then we’ll talk about chronic pain and new research around treating it centrally vs. peripherally.  But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for your patient education and for you. It saves time in putting talks together or just staying current on research. It’s categorized into sections and it’s written in a way that is easy to understand for practitioner and patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #201 Now if you missed last week’s episode, we talked about the state of chiropractic through ChiroUp and Chiropractic Economics. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Last week, you heard me mention spending time in Chicago at the American Council of Chiropractic Consultants and Chiropractic Forensic Sciences conference. I also mentioned getting to hang out with Dr. Michael Massey and talked a little about who Dr. Massey is and what he does. What I failed to mention is that he and Dr. Rob Pape, together, started a practice management group called Practice Mechanics. Along with that, they have a Practice Mechanics podcast and they had me on as a guest recently.  It was a lot of fun and it was me answering questions rather than asking them. It was really just a great conversation about the profession, this podcast, the book I recently released, my future goals, and all kinds of other goodies. Go to the Practice Mechanics podcast and pull the trigger on episode 10. Then sit back and laugh at my dumb answers!  It really was a great conversation and I was fortunate to have Mike and Rob bring me on and lead me through it. These last couple of months have truly been a whirlwind. As mentioned, I was just in Chicago.

At the beginning of September, I was in Washington DC.  In August we integrated with the nurse practitioner. Late August we got an intern from Parker College. Future doctor Drake Gardner from the Tulsa, OK area. Good dude with a bright future. Then, about early September our new patient per month count exploded and rose back to where it was back before the Rona invaded our lives. In fact, I broke a record. We had somewhere around 85-90 new patients in September. In just one week I had 31 new patients. By myself. And I do a thorough exam. It’s not one of those vitalistic  “live and die by the subluxation” knock down the high spot exams.

It’s not one of those exams oh crazy Chiro out in Oklahoma that tries to teach others to do like 9 new patients exams and 99 patients in 3 hours with one table. Durrr.

It’s one you would expect from an Ortho Diplomate.  Anyway, the point is not to brag but to say damnit…., I’ve been cooking. And cooking hot with gas. And also to discuss what happens when you get so busy you are running the risk of not being able to keep up.

When your schedule is full I have been told you need to either hire help or raise prices to thin the herd. How do we feel about that? I don’t know. I’m a capitalist. I don’t like turning away business. But I’m also empathetic. I don’t want to price myself out of the market and I don’t want people to wait a week to come to see me.

And….it’s only been this way for about 4 weeks. Who’s to say it’ll be this way in six months? I could hire someone and they stop piling in and then I’m screwed.  The safer bet is to raise prices a touch. You can always backtrack that by simply putting them right back where they were.

But here’s what’s going to happen. Nothing.

I’m going to be overworked and half crazy for a while until I am 100% clear that the surge in business is here to stay. Then I’m going to try to hire an associate. And I’ll be overworked like crazy until that happens. So work work work is on my horizon. I will try my best to continue this podcast as long as I can.

Right now, I’m having to type it up on a Saturday night because I simply won’t have time during the week. We’ll see how it goes. Right now, my commitment to pumping new episodes out every week is strong. I’d offer a Patreon page and maybe try to generate some income from the podcast itself but guess what? I don’t have time!! Lol.

This all sounds doom and gloom but it’s all good. I’m blessed. I hope you are blessed as well. Griping about busy makes a guy feel guilty. But I’m not griping about being busy. I’m griping about being overwhelmed and having no time to do the things I need to do every week outside of hands-on patient treatment.  That’s really what it comes down to. So stick with me. I’ll keep doing what ai do and we’ll see what comes of it, my friends.

What I do know is that I appreciate you all. Your time and attention to this podcast make it worth every second. That all turned out a little fussier than I meant. I’m usually very positive and I am positive. I’m just sharing what’s going on. I think I’m in a transition period basically. These points that stress us force us into change. My responsibility is to make certain that the change is positive and productive. 

Let’s dive in!

Item #1

The first one is called “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands” by Dijkman et. al. (Dijkman HBPM 2021) and published in JAMA Open on September 20, 2021 and that’s a lotta hot!

First, if you don’t know anything about this topic, I think you might be shocked. 

Secondly, let’s talk about why I would include this paper on this podcast.

What does silicone breast implant leakage have to do with us as chiropractors? Well, one of my Facebook friends was openly discussing silicone leakage and illness and how she was getting her removed, and what a miserable time she had been having recently due to this leakage.  I’d never heard of this being an issue so I started looking into it a bit. While some older research was pretty meh about it all, more recent research has shown an association between silicone breast implants and certain autoimmune diseases.  Healthline says, “These studies suggest that silicone breast implants potentially raise your risk of developing an autoimmune disease such as rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and sarcoidosis.”

They also add, “The World Health Organization and the U.S. Food and Drug Administration have identified another possible  This relates breast implants to a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, breast implants are known to cause other potential risks such as:

  • scarring
  • breast pain
  • infection
  • sensory changes
  • implant leakage or rupture”

In addition to what Healthline shared, the body of this paper says, “Breast implant illness is used to describe various complications associated with silicone breast implants, ranging from brain fog, hair loss, fatigue, chest pain, sleep disturbances, irritable bowel syndrome, headaches, chronic pain all over the body, and autoimmune diseases, such as lupus and fibromyalgia.” How many of these people do we see every day? So, it’s been on my radar way out on the periphery and when I saw this paper come through JAMA recently, it made sense to put it on your radar screens as well. How many patients do we have that could potentially be going through this and just never made the connection in their minds?

Why They Did It

To evaluate the existence of silicone gel bleed and migration over a long time period, including the period in which the newer cohesive silicone gel breast implants were used.

How They Did It

  • It was a single-center case series, 
  • Capsule tissue and lymph node samples were collected from women who underwent removal or revision of silicone breast implants from January 1, 1986, to August 18, 2020
  • Data were extracted from the pathological reports and revision of the histology if data were missing. 
  • All tissues were examined using standard light microscopy
  • A total of 365 women had capsular tissue removed, including 15 patients who also had lymph nodes removed, and 24 women had only lymph nodes removed. 
  • Exposures  Silicone breast implants.
  • The main outcome was presence or absence of silicones inside or outside the capsule. 
  • 389 women with silicone breast implants

What They Found

384 women (98.8%) had silicone particles present in the tissues, indicating silicone gel bleed.  In 337 women (86.6%), silicone particles were observed outside the capsule (ie, in tissues surrounding the capsule and/or lymph nodes), indicating silicone migration.  In 47 women (12.1%), silicone particles were only present within the capsule.  In 5 women (1.2%), no silicone particles were detected in the tissues.  Patients were divided into 2 groups, with 46 women who received cohesive silicone gel breast implants and 343 women who received either an older or a newer type of breast implant.  There were no differences in silicone gel bleed or migration between groups 

Wrap It Up

In this case series including women with noncohesive or cohesive silicone gel breast implants, silicone leakage occurred in 98.8% of women, indicating silicone gel bleed, and in 86.6% of women, migration of silicone particles outside the capsule was detected.  We did not see differences in silicone gel bleed or migration between women who received the newer cohesive SBIs and those who received noncohesive SBIs. So, now it’s on your radars and this info could give you another avenue toward helping your patients get out of pain. 

Item #2 Our last one today is called, “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial” by Ashar et. al. (Ashar YK 2021) and published in JAMA Psychiatry on September 29, 2021 and it’s bringing the heat! They say, “Approximately 85% of cases are primary CBP, for which peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury.” I talk to my patients every day all day about beliefs, hurt vs. harm, and fear avoidance. 

Why They Did It

To test whether a psychological treatment (pain reprocessing therapy [PRT]) aiming to shift patients’ beliefs about the causes and threat value of pain provides substantial and durable pain relief from primary chronic back pain and to investigate treatment mechanisms. PRT seeks to promote patients’ reconceptualization of primary (nociplastic) chronic pain as a brain-generated false alarm. PRT shares some concepts and techniques with existing treatments for pain rand with the cognitive behavioral treatment of panic disorder.

How They Did It

  • This randomized clinical trial with longitudinal functional magnetic resonance imaging (fMRI) and 1-year follow-up assessment was conducted in a university research setting from November 2017 to August 2018, 
  • There was a 1-year follow-up. 
  • Clinical and fMRI data were analyzed 
  • The study compared pain reprocessing therapy with a placebo treatment and with usual care in a community sample.
  • Participants randomized to pain reprocessing therapy participated in 1 telehealth session with a physician and 8 psychological treatment sessions over 4 weeks. 
  • Treatment aimed to help patients reconceptualize their pain as due to nondangerous brain activity rather than peripheral tissue injury, using a combination of cognitive, somatic, and exposure-based techniques. 
  • Participants randomized to placebo received a subcutaneous saline injection in the back; participants randomized to usual care continued their routine, ongoing care.

What They Found

Of 151 total participants, 33 of 50 participants (66%) randomized to PRT were pain-free or nearly pain-free at posttreatment,  That’s compared with 20% randomized to placebo  And 10% randomized to usual care.  Treatment effects were maintained at 1-year follow-up

Wrap It Up

The authors concluded, “Psychological treatment centered on changing patients’ beliefs about the causes and threat value of pain may provide substantial and durable pain relief for people with chronic low back pain.” This is why the American College of Physicians included cognitive behavioral therapy in their recommendations for first-line treatments for chronic back pain. You can have all of the issues you can imagine present on an x-ray but the main culprit resides in the noggin.  Ever heard of phantom limb pain? The pain lasted so long that the pain migrated more and more into the central, pain making part of the brain too.

They finally chopped off the peripheral problem; the limb. But it still hurt. They got rid of the peripheral source but did nothing to address the central source. THAT’S what we talking about when we mention the biopsychosocial aspect of pain. It’s no longer just a biomedical approach or issue. It’s much more when we talk about chronic pain. And it’s fascinating. 

Folks, it’s about the up-regulation or sensitized central nervous system in chronic pain patients. It’s about their beliefs about their current and future abilities. It’s about fear avoidance. It’s about de-conditioning. It’s about not understanding the difference between hurt vs. harm. It’s about them being mind screwed by healthcare practitioners that didn’t understand how to properly and optimistically relay findings and a diagnosis to them.  It’s about building them back up. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associaitons. So quite griping about the profession if you’re doing nothing to better it. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

 

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 preventatively 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!

Contact

Send us an email at dr dot williams at chiropracticforward.com 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. 

Connect

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

Website

Home

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TuneIn

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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  

Bibliography

  • Ashar YK, G. A., Schubiner H, (2021). “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.” JAMA Psychiatry.  
  • Dijkman HBPM, S. I., Bult P, (2021). “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands.” JAMA Netw Open 4(9).    

Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey.  But first, here’s that sweet sweet bumper music

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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. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go 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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #190 Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far.  Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been.  But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning.  Item #1 Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot! Why They Did It The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain. The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain.  In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable. Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle.  Here are their main points:
  • On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight
  • Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile
  • Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone 
  • Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care
  • CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index
  • While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate
First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is on obesity and stigma. Suggestions from these experts include first recognizing that weight bias exists even among pediatric health care providers [20]. Additionally, language must be very carefully considered. Puhl et al. [20] offer the practical and sensitive suggestion to ask the patient and family about preferred words or terms in discussions about weight-related health Third, like other health care professionals, we would benefit from a greater understanding of the complexity of obesity and the “potential benefits and disadvantages of introducing weight-management discussions with patients” [14](p865). Certainly, there will be times when weight-related discussions would be contraindicated by the patient’s and/or family’s psychological or emotional state. However, when weight needs to be raised in relation to a child’s chronic pain, it may be best received in the context of health implications. Obesity is a multifactorial disease with strong genetic contributions. It is also associated with systemic inflammation, metabolic syndrome, and increased risk for diabetes and cardiovascular disease, as well as chronic pain. In fact, most are unaware that obesity is a risk factor for migraines in pediatric populations. That said, weight-related health or weight-related pain discussions cannot focus entirely on losing weight. For many, it is a struggle to change their weight status, and even if it is possible, this process takes time. We must not ignore managing pain while we wait for possible weight reduction. CHIROUP ADVERTISEMENT Item #2 Our second one today is called “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia” by Curtis et. al.(K Curtis 2021)  and published in Pain Medicine in June of 2021…….pork chops and apple sauce.  Why They Did It To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). How They Did It
  • A total of 17 patients completed the study
  • A cohort study with a delayed treatment arm used as a comparator.
  • Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada.
  • Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire.
  • Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period
  • HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks
  • Both groups were assessed at baseline, after HBOT intervention, and at 3 months’ follow-up.
What They Found
  • HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients
  • The efficacy of HBOT was evident in most of the outcomes in both groups
  • This improvement was sustained at 3-month follow-up assessment.
Wrap It Up HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment. I don’ tank about you but I’m not going to go out and buy an oxygen chamber this afternoon but, it’s interesting and I’ve always heard positive things about them so this one peaked my interest a bit. I figured it would with you as well.  Item #3 The last one is called “A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies” by Toye et. al. and also published in Pain Medicine in June of 2021….Smoke show!! You know, it’s almost like I got an email from Pain Medicine last week highlighting some of their newest research in their June edition. Weird how all of these articles were all in the same month and in the same episode here. Right? Why They Did It There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. How They Did It
  • A synthesis of qualitative research using meta-ethnography.
  • We used the seven stages of meta-ethnography. 
  • We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. 
  • We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
  • We screened 1,328 titles and included 195 studies.
Wrap It Up The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively 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! Contact Send us an email at dr dot williams at chiropracticforward.com 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.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ 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 Bibliography
  • K Curtis, P., J Katz, PhD, C Djaiani, BSc, G O’Leary, MD, FRCPC, J Uehling, MS, CCRP, J Carroll, BHA, D Santa Mina, PhD, H Clarke, MD, PhD, FRCPC, M Gofeld, MD, PhD, FRCPC, R Katznelson, MD, FRCPC, (2021). “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia.” Pain Med 22(6): 1324-1332.
  • Keri R Hainsworth, P., Monica L Gremillion, PhD, W Hobart Davies, PhD, Stacy C Stolzman, PT, MPT, PhD, Steven J Weisman, MD, (2021). “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves.” Pain Med 22(6): 1243-1245.
       

High Impact Chronic Pain & Cannabinoids – What’s The Latest?

CF 185: High Impact Chronic Pain & Cannabinoids – What’s The Latest? Today we’re going to talk about…. But first, here’s that sweet sweet bumper music

Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

https://www.amazon.com/dp/B096RST3WW

 

 

Chiropractic evidence-based products

Integrating Chiropractors

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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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #185 Now if you missed last week’s episode , we talked about predicting frailty and we talked about a 30-year study on disc degeneration. Fascinating stuff as always. Make sure you don’t miss that info.  Keep up with the class. 

On the personal end of things…..

This is the season of big. Big stuff happening these days.  I have some cool stuff on the horizon in 2022 I’m looking forward to. It looks like I’ll be joining a high-level group of doctors that’ll be meeting virtually throughout the year and in-person 4 times a year to get the best, most current evidence-based guidelines and to solve each others’ biggest practice issues. More information to follow but I can’t emphasize how pumped I am to get that rolling. The worst part is that I have to wait until 2022.

But honestly, that’ll be here before we know it. If you’ve been following along lately, we are going through this Nurse Practitioner medical integration and our NP starts here in our clinic on August second.

That’s more than HUGE!

I released my first book on June 8th called ‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’ which is live and for sale on Amazon and from my website at www.chiropracticforward.com as we speak  It’s a hell of a good reference for practitioners and content creators. It has mostly current research divided into sections for quick reference and it’s some of the most impactful and significant research you’ll find for our profession. Go get a copy. Then we have an intern coming from Parker University to hang out with us through the Fall semester. That’s a first for me. We’ll see how it goes. He seems like a great dude with a cool little family. It should be a good deal.

We also have a trip coming up to Washington DC at the end of August, the TCA. Reds me to put together an hour-long presentation on research for their Leadership Conference, and some friends just asked me to officiate their wedding vow renewal.  So, how’s your Summer going? In terms of numbers, I’m frustrated. I hear Chiros telling me how they’re right back where they were and all that good stuff. Not me. I’m still at about 140 a week right now. I averaged 185 a week before the Rona jacked everything up.  If you had any big breakthroughs as far as getting people to return, email us at [email protected]  and I’ll share in the next podcast. Maybe we can help all of our listeners get back to where they were. 

It sure can’t hurt. I know that. Takers eat well but givers sleep well. Be a giver and I’ll help spread the word.

Item #1

The first one today was spurred because of a question that popped up in our private Facebook group last week. I posted an article I wrote that I give to all of my chronic pain patients in my clinic. It’s basically a dive into chronic pain and the current thinking.  In the article, there is a mention of how pain pathways that are laid down become permanent. One of the questions by a group member was that, if it’s true that the pathways are permanent, then doesn’t that go contrary to the idea of neuroplasticity.

If you don’t know what that is, that’s the ability of our central nervous system to adapt to new normals or adapt to training and to change and function in ways that overcome certain challenges.  So if we have neuroplasticity, how can pathways be permanent, basically. 

What a great question. I hadn’t considered this before. After thinking on it a bit, my response was, “Can’t we have neuroplasticity yet still permanent pathways that give us a tendency toward chronic pain? You can have all kinds of neuroplasticity (thank God) but won’t the CNS still store the information/memory/etc? I went on to add that, “I believe that’s the thinking behind the original teaching.

Dr. James Lehman also describes ‘high impact chronic pain’. These are essentially people who tend to have chronic pain forever and can only control it through periodic treatment/therapy. That would also imply that neuroplasticity is complicated and may have its limitations. Something that we can definite leverage in our favor, but not a cure all?” So, following my comments, Dr. Lehman shared this research article focusing in on High Impact Chronic Pain.

Thank you to Dr. Lehman for the research citation and thank you to Nathan for an excellent question.  If you’re not in our Chiropractic Forward Facebook group, go do that.  IT’s called, “Prevalence and Profile of High-Impact Chronic Pain in the United States” by Pitcher et. al. (Pitcher MH 2019) and published in the Journal of Pain in February of 2019…..it’s a little steamy but not quite hot enough for my beloved sound bite. Damnit. 

Why They Did It

They say, “The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development.  The newly proposed concept of high-impact chronic pain incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population yet remains uncharacterized at the population level.” So it’s basically chronic pain AND disability rather than just chronic pain. 

How They Did It

As such, we used the 2011 National Health Interview Survey (N = 15,670) to 

  1. assess the likelihood of disability in the overall chronic pain population, 
  2. estimate the prevalence of High-Impact Chronic Pain, and 
  3. characterize the disability, health status, and health care use profile of this population in the United States.

What They Found

  • Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions
  • disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others.
  • High-Impact Chronic Pain affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011.
  • The High-Impact Chronic Pain population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use.

Wrap It Up

High-Impact Chronic Pain clearly represents a more severely impacted portion of the chronic pain population. Understanding this heterogeneity will contribute to developing more effective legislation promoting safe and cost-effective approaches to the prevention and treatment of chronic pain.  PERSPECTIVE: High-Impact Chronic Pain is a powerful new classification that differentiates those with debilitating chronic pain from those with less impactful chronic pain. By addressing the multidimensionality of chronic pain, this classification will improve clinical practice, research, and the development of effective health policy.

 

CHIROUP ADVERTISEMENT

 

Item #2

OK, I’m about to be uncool…..I get it. Unless you happen to be in pain and benefit from it, I’m about to take a recently unpopular stance here. Old buy coming through. But I’m Gen X so don’t pull that, ‘OK, Boomer,’ BS on me. It’s powerless against the forces of research so don’t even try it.  Look, admit that you can’t follow only the research you like that confirms your biases and ignore and discount only the ones you don’t like that fly in the face of your beliefs or preferences. 

Let’s be clear, if opioids are the only thing that can possibly help with pain, why wouldn’t we use that. It’s a tool, albeit a dangerous one, but a tool we have at our disposal. The same goes for cannabinoids. I support it being used for medical purposes 100%.

So don’t misunderstand. What I cannot get behind is its recreational use. I never understood why folks need to have a completely altered reality by partaking in drug use, really of any kind, all day every day. Now, I get it….some folks have had awful experiences. It calms them. Helps them deal with it. Some have sleeping or anxiety disorders. I get it. And let’s be clear, I like to drink beer on the weekends here and there and I partake in some shots as well too. That’s definitely some altered reality but it’s few and far between. 

I’m talking about the wake and bakes that just have a normal life but they like it so they do it every day? I’m a no on this. You’ll never convince me that inhaling smoke of any kind daily is healthy, good for you, productive, or conducive to a better life long-term. You can’t do it. Because it’s not possible.  Not only that, but you are influencing your children when they go to copying your behavior.  So…..here I go being uncool.  This one is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, of 2021 a smoking steamy plate of Shazam. 

Why They Did It

The authors wanted to answer the question, “To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?”

What They Found

  • In this cohort study, linear mixed-effects model analysis using 1598 magnetic resonance images from 799 participants revealed that cannabis use was associated with accelerated age-related cortical thinning from 14 to 19 years of age in predominantly prefrontal regions.
  • The spatial pattern of cannabis-related cortical thinning was significantly associated with a positron emission tomography–assessed map of cannabinoid 1 receptor availability.

Wrap It Up

Results suggest that cannabis use during middle to late adolescence may be associated with altered cerebral cortical development, particularly in regions rich in cannabinoid 1 receptors.

 

Item #3

I’m just going to drive the depths of my uncool-ness to new depths here, folks. Don’t mind me.  This one is called, “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status” by Han et. al. (Han B 2021) and published in JAMA Psychiatry on June 22, 2021. Ouchy wa wa. 

Why They Did It

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. The authors wanted to answer the question, “Are there associations between cannabis use and suicidality trends in young adults, and do they vary as a function of sex and depression?”

How They Did It

They examined 281 650 adult participants in the 2008-2019 National Surveys of Drug Use and Health data

What They Found

Past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. 

Wrap It Up

From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and major depressive episode. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors. Alright, that’s it. I’ll try to be cooler next week. In fact, I KNOW I’ll be cooler next week because we have the amazing Dr. Brett Winchester coming up as a guest so don’t miss him. He’s on the top of the mountain. Let’s find out how he got there, shall we? 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. 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com. 

Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

https://www.amazon.com/dp/B096RST3WW

Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively 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!

Contact

Send us an email at dr dot williams at chiropracticforward.com 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. 

Connect

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link https://player.fm/series/2291021

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

TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

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  

Bibliography

  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Han B, C. W., Einstein EB, Volkow ND, (2021). “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.” JAMA Netw Open 4(6): e2113025.
  • Pitcher MH, V. K. M., Bushnell MC, Porter L., (2019). “Prevalence and Profile of High-Impact Chronic Pain in the United States.” J Pain 20(2): 146-160.

 

Adjustments As Immune Boosters & Pain – Mind or Matter?

CF 182: Adjustments As Immune Boosters & Pain – Mind or Matter? Today we’re going to talk about adjustments being immune boosters and then we talk about osteoarthritis and if pain is mind or matter.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #182 Now if you missed last week’s episode , we talked about NSAIDS causing GI events and we talked about chronic pain and how it’s being handle within the VA system. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. As seems to be the common thread lately, time is short this week. I am preparing for the book launch tomorrow. Now I’m recording this on Monday, June 7. And the lunch is Tuesday, June 8 so when you get this when you hear this, it’s already up and live. I would love for you to go and purchase yourself a copy of my new book. It is called the remarkable truth about chiropractic: a unique journey into the research. It has been a long time coming and it is finally finished. For those of you that reached out enjoying the lunch team, thank you so much. I have some special people in my life and I am grateful for each of them. So, about the time I am recovering from the New Orleans trip, it’s time to take two days off this week to go to the state chiropractic convention which is called Cairo Texaco.  Of course, we missed the chiropractic conference last year because nobody could be in the same room with each other for fear of dying a slow and painful death. But this year is different. We are looking forward to seeing each other again and shaking hands and hugs and conquering the chiropractic world yet again.  Going to your state conference and being involved in your state association is one of the most important and impactful things you can do for yourself, your business, and your profession. If we are to ever get the message of evidence-based, patient-centered practice to be big business and the way things are done, it Hass to be done through leadership, activity, and guidance on our part. And that starts not only locally, but also on the state level.  So I implore you to get active in your state association. Get to know the players. And once they get to know you and respect you, and you can start to steer the ship a bit. It takes all of us. Including vitalists by the way, because some evidence chiropractors have taken it so far that they don’t even use spinal manipulative therapy. Do you have to have a vitalist to offset that?  But, the point is to get active and if you don’t recall part of the podcast from last week, I don’t wanna hear that crap about not having time. Nobody has time. But if not us, then who?  Make it a priority and just get involved. Dive in. Raise your hand. Volunteer. It’s that simple Seriously, nobody has time. It’s like voting. If you don’t vote, don’t bitch. If you don’t get active in your state association and maybe eventually your national association, don’t bitch. Sit down and let the A Team handle it.  Sorry for the harsh tone there but after being so active for so long and watching the benchwarmers gripe about everything all the time no matter what…..well…..I’m over it.  Here we go.  Item #1 Let’s step into it here, shall we. It’s called “The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review” by Heidi Haavik, [1] the vitalist’s brand new hero, and it was published in Medicina on May 25, of 2021.  Servin’ it up fresh!  Why They Did It Heidi says, “The current COVID-19 pandemic has necessitated the need to find healthcare solutions that boost or support immunity. There is some evidence that high-velocity, low-amplitude (HVLA) controlled vertebral thrusts have the potential to modulate immune mediators. However, the mechanisms of the link between HVLA controlled vertebral thrusts and neuroimmune function and the associated potential clinical implications are less clear. This review aims to elucidate the underlying mechanisms that can explain the HVLA controlled vertebral thrust–neuroimmune link and discuss what this link implies for clinical practice and future research needs.” How They Did It
  • A search for relevant articles published up until April 2021 was undertaken. 
  • Twenty-three published papers were found that explored the impact of HVLA controlled vertebral thrusts on neuroimmune markers, of which eighteen found a significant effect. 
  • These basic science studies show that HVLA controlled vertebral thrust influence the levels of immune mediators in the body, including neuropeptides, inflammatory markers, and endocrine markers. 
  • This narrative review discusses the most likely mechanisms for how HVLA controlled vertebral thrusts could impact these immune markers. 
What They Found
  • The mechanisms are most likely due to the known changes in proprioceptive processing that occur within the central nervous system (CNS), in particular within the prefrontal cortex, following HVLA spinal thrusts. 
  • The prefrontal cortex is involved in the regulation of the autonomic nervous system, the hypothalamic–pituitary–adrenal axis and the immune system. 
  • Bi-directional neuro-immune interactions are affected by emotional or pain-related stress. Stress-induced sympathetic nervous system activity also alters vertebral motor control.
Wrap It Up She says, “There are biologically plausible direct and indirect mechanisms that link HVLA controlled vertebral thrusts to the immune system, suggesting HVLA controlled vertebral thrusts have the potential to modulate immune function. However, it is not yet known whether HVLA controlled vertebral thrusts have a clinically relevant impact on immunity. Further research is needed to explore the clinical impact of HVLA controlled vertebral thrusts on immune function” OK, Heidi is way more intelligent than I am so I’m not debating or arguing with her. I would just say that is getting hit in the butt with a board influential on the immune system as well? How about exercise? Having sex? What about getting slapped in the face?  Then I would wonder how long-lasting any effect on the immune system is, is any effect a strong enough effect on the immune system to actually be able to fight of viruses, and…..if its that effect needed 3 x per week? Once per week? Would trying to maintain this immune boost lifetime lead to worse things like spinal instability? I have my doubts on this line of research but will definitely be watching. Wouldn’t it be great if she can prove it 100%? I doubt that’s going to happen so don’t hold your breath, please.  CHIROUP ADVERTISEMENT Item #2 Our last one today is called “Factors associated with pain intensity and magnitude of limitations among people with hip and knee arthritis” by Kopp et. al. [2] and published in the Journal of Orthopaedics in the May-June 2021 issue and you can’t get any steamier than that my friends.  Why They Did It The pain and limitations associated with osteoarthritis of the hip and knee have a notable variation that does not correspond directly with pathophysiology. The purpose of this study is to assess the influence of location of the arthritis on pain intensity and magnitude of limitations accounting for personal and psychological factors. How They Did It
  • 154 patients with osteoarthritis of the hip or the knee were enrolled in this prospective cross-sectional cohort study. 
  • Patients answered questionnaires which included demographics, site of arthritis, laterality, pain intensity,(PROMIS PF CAT), and psychologic questionnaires 
What They Found
  • Magnitude of limitations was independently associated with years of education, work status, time spent exercising, catastrophic thinking (PCS-4), and symptoms of depression.
  • They accounted for 50% of variability in physical function, with the major contributor being catastrophic thinking. The model for pain intensity included time spent exercising and fear of painful movement (TSK-4). Anatomic site and radiographic severity of arthritis were not associated with either physical function or pain in our patient sample.
Wrap It Up This study confirms that limitations and pain from osteoarthritis of the hip and knee are more closely related to personal and psychological factors, less effective cognitive coping strategies such as catastrophic thinking and kinesiophobia in particular, than to pathological and anatomical factors such as location and severity of arthritis.  Care that incorporates incremental correction of common misconceptions that accompany the nociception from osteoarthritis have the potential to improve function and comfort in people with osteoarthritis. The power of the mind folks. Use it to your advantage. Remember, words matter. Be optimistic, relay confidence and be supportive. Never be pessimistic or communicate in a catastrophic way. Ever.  See what happens.  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.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively 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! Contact Send us an email at dr dot williams at chiropracticforward.com 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.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ 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 & VloggerBibliography 1. Haavik, H.N., I.K.; Kumari, N.; Amjad, I.; Duehr, J.; Holt, K, The Potential Mechanisms of High-Velocity, Low-Amplitude, Controlled Vertebral Thrusts on Neuroimmune Function: A Narrative Review. Medicina, 2021. 57(6): p. 536. 2. Kopp B, F.K., Goldberg T, Ring D, Koenig K,, Factors associated with pain intensity and magnitude of limitations among people with hip and knee arthritis. J Orthopaedics, 2021: p. 295-300.  

NSAIDS And GI Events & Chronic Pain In The VA System

CF 181: NSAIDS And GI Events & Chronic Pain In The VA System

Today we’re going to talk about NSAIDS and their relation to GI events and then we’ll talk about how primaries are handling things within the VA system for their chronic pain veterans here in the US.  But first, here’s that sweet sweet bumper music    
Chiropractic evidence-based products

Integrating Chiropractors

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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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #181 Now if you missed last week’s episode, we talked about Sitting on your butt and what that’ll get you and we talked about catastrophizing MRI results. Both for the practitioner as well as the patient. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. New Orleans was great. We stayed a little longer than we normally do but it was good. They acted like it’s been a bit of a ghost town down there since COVID came along. Restaurants were still closed and some of the ones open were understaffed. The door guy at our hotel was trying to hire our Uber driver today on the way to the airport. Life is getting there but it is most definitely not back to normal and business as usual just yet. We’ll get there though.  Priorities. Let’s talk briefly about if. Here’s some honest talk about what ‘I didn’t have the time” really truly means. This is actually a blog I just wrote for my personal website but it’ll work for you as a chiropractor and business owner as well.  We all seem to be short on time, don’t we? Emails, notifications, pings, bells, chimes, and phone calls just to name a few. It seems that we are always on call and expected to respond.  That goes for our actual jobs but it goes for our personal lives too. Social media alerts alone are enough to make a person lose it.  So when someone says, “You know, I just didn’t have the time,” you want to believe them. Because it makes sense. Life has just gotten very busy and more complicated than it has ever been before. Weren’t computers and technology supposed to make our lives easier? But then you remember that people still make time to go to the movies. They make time to go out to eat. They make time go to the park with their kid. At least they should be! When it comes to observing my own kids, they make time for friends, sitting around on their phones, or lounging and watching TV. Time is available. It may be in short supply for some of us, but it is most definitely available. I heard a saying once that went like this, “Saying that you didn’t have time to do something is just a less abrasive way of saying that it wasn’t a priority.” That hit me between the eyes.  Because it’s so very true. I’ve seen this in my kids’ and acquaintances’ actions and I’ve seen it in my own actions. When I’m interested in something and when I really want it, I can typically make it happen. Because it’s a priority. It’s a focus and our focus goes where energy flows. Or something like that I’m sure came from Tony Robbins. When I want to get better at one of my hobbies, I obsess a little about it and I make the time for it. The point is, when it’s important, we make it a priority and we make the time. We get it done. Stop using a lack of time as an excuse to not get the things done you know need to be done. Maybe it’s marketing. Maybe it’s calling that one attorney you need to speak with but don’t really really want to speak with. Maybe it’s going to a Chamber of Commerce event. Maybe it’s writing that blog or starting that podcast you’ve wanted to start for a while.  Make it a priority. Make the time. Item #1 This first one is called “A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain” by Kikuchi et. al. [1] and published in Pain Medicine in May of 2021.  Hot stuff, coming up.  Why They Did It The authors say the reason for the paper is that the real-world burden of gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in Japanese patients with osteoarthritis (OA) and/or chronic low back pain (CLBP) remains unreported. How They Did It
  • Used the Japanese Medical Data Center database to retrospectively evaluate anonymized claims data of medical insurance beneficiaries employed by middle- to large-size Japanese companies who were prescribed NSAIDs for OA and/or CLBP between 2009 and 2018.
  • 180,371 patients were included in the analysis
  • 32.9% had OA
  • 53.8% had CLBP
  • 13.4% had both OA and CLBP
  • NSAIDs were administered as first-line analgesics to 161,152 (89.3%) of the patients in the sample
What They Found
  • The incidence of GI events was 9.97 per 10,000 person-years
  • The risk of developing GI events was high in elderly patients and patients with comorbidities and remained similar for patients receiving oral vs. topical NSAIDs
  • Longer treatment duration and consistent NSAID use increased the risk of GI events
Wrap It Up NSAID-associated GI toxicity imposes a significant health and economic burden on patients with OA and/or CLBP, irrespective of whether oral or topical NSAIDs are used. Well, that’s what it’s about isn’t it? It’s about getting people well without the use of drugs or surgery if possible. I’m not advocating never using medicine. Medicine is vital to our health and our lives but let’s don’t pretend they don’t have consequences. They do. Even the mild ones.  CHIROUP ADVERTISEMENT Item #2 Our last item today is called “Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study” by Leonard et. al. [2] and published in Pain Med on September 24, 2020 and that’s just hot enough! Why They Did It Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers’ and administrators’ perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. How They Did It
  • They conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments.
  • Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis.
  • They interviewed 49 participants from 25 facilities from April through September of 2017
What They Found
  • They identified three themes
  • First, the Veterans Health Administration’s integrated health care system is both an asset and a challenge for multimodal chronic pain care
  • Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment.
  • Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients.
Wrap It Up Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources. I know where we fit in. IF they’re using an evidence based, patient-centered chiropractor in the mix, their patients are getting off of the pharmaceuticals, they’re sleeping better, they’re not thinking of suicide as much, and they’re beginning to become a part of their lives again.  I see it all of the time because we see veterans straight from the VA. You’re getting it from he horse’s mouth. We make such a difference in these people’s lives. But we still battle that BS all of the time don’t we? No matter how good you try to be, you still have that jackass primary somewhere inside the system spoiling the water. Locker room poison. Just bashing chiropractors when they don’t have any experience themselves regarding the things they’re saying.  Keep trudging though. If we were wrong, we’d have been eliminated generations ago.  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.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     
Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
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 preventatively 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! Contact Send us an email at dr dot williams at chiropracticforward.com 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.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ 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   Bibliography 1. Shogo Kikuchi, M., PhD, Kanae Togo, PhD, Nozomi Ebata, Koichi Fujii, MD, PhD, MBA, Naohiro Yonemoto, PhD, Lucy Abraham, MSc, CPsychol, Takayuki Katsuno, MD, PhD,, A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain. Pain Med. 22(5): p. 1029-1038. 2. Chelsea Leonard, P., Roman Ayele, PhD, MPH, Amy Ladebue, BA, Marina McCreight, MPH, Charlotte Nolan, MPA, Friedhelm Sandbrink, MD, Joseph W Frank, MD, MPH,, Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. Pain Med, 2020. 22(5): p. 1167-1173.