CF 169: Living With Chronic Pain, Screen Time, & Low Back Pain Delivery
Today we’re going to talk about living well with chronic pain, screen time, and changing the delivery of low back pain care.
But first, here’s that sweet sweet bumper music
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You have found yourself smack dab in the middle of Episode #169
Now if you missed last week’s episode, we were joined by a couple of key players in the Texas Chiropractors’ fight against the Texas Medical Association for the right to diagnose patients, treat the Neuromusculoskeletal system rather than just the musculoskeletal system, and the right to perform VONT testing. All in one court attack. And we won after losing twice. It’s crazy. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I’ve talked in the last 3-4 weeks how my life has become complicated and how I’m working through it slowly. This week feels like it’s leveling out a little. I hate to say that and jinx it but I’m a glass is a half full type of dude.
Let’s start with a new one though that’s stressing me out a little and may pertain to some of you as well. I’ve started getting some trickles of complaints here and there on one of my staff members. A key staff member. Now, what do you do when that happens? First, it probably depends on the complaints, wouldn’t you agree?
If they’re egregious, well then they gotta go. These aren’t. These are more personality conflicts and they’re from females. I’ve never had a male complain about her. So, what’s going on there?
Second, if they’re not necessarily fire-able offenses, what do we do to correct them? Are they just strictly personality-driven and there’s nothing we can do to change the inherent behavior of a person? Or….can she be trained to suppress a certain aspect of her nature? If it’s built into her nature that is.
I buy into staff. I care about staff. On this, I’m in no hurry to get rid of an employee. Not at all. Mostly because she’s really good at a lot of key aspects of her job. Like….REALLY good. I’m rooting for her. I want her to succeed.
For that reason, I have found some training for her to do. I want her to have every tool at her disposal that I can provide to give her the chance to succeed and do well. Not everyone is a natural. Sometimes we need training. Sometimes people don’t even realize certain aspects of their personality are off-putting to others.
I’m sure I have certain off-putting parts of my personality. Just nobody ever tells me about it. Either because I’m the doctor in the office, or I’m the boss in the office, or because I’m 6’4” and big as hell.
Anyway, we are getting her some training, supporting her, and keeping our fingers crossed because she’s a hard worker, she’s smart, and I think she can be a valuable part of our team.
Now, for the good stuff…..Last week I mentioned my pickup dying.
Always get a second opinion on your vehicle when they tell you that you need a new engine for $6500 because I remembered a good friend of mine is a mechanic. We took it to him and it turns out it just need an oil pump and parts and labor ran us about $800. No sweat. I’m back up and running.
The computer that contained my entire life was able to be backed up just before its demise so the new one is getting up and running. My old programs are getting up and running. And my life is returning to some sense of normal as more and more of the computer and the software starts to behave the way it is supposed to behave.
So, yes, we have valleys and peaks but hold on and try to enjoy the ride. We are going through the medical integration slowly but surely. We have found our medical director. He’s been one of my long-time friends and actually used to be a chiropractor so it’s perfect. He knows me well, knows how I treat patients, and knows how I approach healthcare. I think it’s an amazing fit.
Now, we are searching for a nurse practitioner to help us make it all happen. Here’s the key on that though, it has to be someone that fits my personality and my approach. It has to be an NP that doesn’t mind learning from a damn chiropractor if you know what I mean. If it’s someone that sees chiropractors as lowly servants, well that won’t work out at all now, will it? I’d rather lose $20,000 than put up with something like that.
But if it’s someone that is open and eager to learn about the biopsychosocial aspect of pain, communicating correctly with patients, and things of that nature, then we probably have a fit. For example, some NPs can be told that the Canadian Medical Association Journal published a systematic review where 13 of 14 papers showed no effect for using gabapentin in radiculopathy. They can get that info and ignore it. That’s not the NP for me.
On the other hand, they can see the paper and say to themselves, “Maybe we don’t want to prescribe anti-convulsants for radicular pain after all.” THAT’S my kind of NP. That’s who I’m looking for. As always, I’ll let you know how it goes.
But, the long and short of it is, we’re getting past the loss of the office manager, all of the big oopsies are starting to get sorted out, we have big stuff still on the worry plate but life is starting to retreat from the danger zone. The crisis zone if you will. It’s still on high alert but the alarm bells are going silent again. Thank God.
Our first one today is called ““Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments” by Znidarsic et. Al. (1) and published in Pain Medicine in January of 2021….dammit, it’s hot.
I want to point out that the first three listed authors on this paper were a DO and two PhDs and out of 18 authors, there was only one DC on the list. In addition, several of the authors were MDs. Three of them to be exact.
Why They Did It
To evaluate the effectiveness of a multidisciplinary, nonpharmacological, integrative approach that uses shared medical appointments to improve health-related quality of life and reduce opioid medication use in patients with chronic pain.
How They Did It
- Retrospective, pre-post review of “Living Well with Chronic Pain” shared medical appointments (August 2016 through May 2018)
- The appointments included eight 3-hour-long visits held once per week at an outpatient wellness facility.
- It included patients with chronic, non–cancer-related pain.
- Patients received evaluation and evidence-based therapies from a team of integrative and lifestyle medicine professionals, as well as education about nonpharmacological therapeutic approaches, the etiology of pain, and the relationship of pain to lifestyle factors
- Experiential elements focused on the relaxation techniques of meditation, yoga, breathing, and hypnotherapy, while patients also received acupuncture, acupressure, massage, cognitive behavioral therapy, and chiropractic education
- Patients self-reported data via the Patient-Reported Outcomes Measurement Information System (PROMIS-57) standardized questionnaire.
- 178 participants completed the PROMIS-57 questionnaire at the first and the last visits
What They Found
- Statistically significant improvements in all domains were observed between the pre-intervention and post-intervention scores
- Average opioid use decreased nonsignificantly over the 8-week intervention, but the lower rate of opioid use was not sustained at 6 and 12 months follow-up.
Wrap It Up
Patients suffering from chronic pain who participated in a multidisciplinary, nonpharmacological treatment approach delivered via shared medical appointments experienced reduced pain and improved measures of physical, mental, and social health without increased use of opioid pain medications.
This one is called “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” by Madigan et. al. (2) and published in JAMA Pediatrics on January 28, 2019. Not all that hot. Little steamy but not enough for my favorite soundbite. Unfortunately.
I’ve highlighted some of these screen time posts before because they just make me crazy and I have to say, I’m guilty of having my kid on electronics years ago. And I’ve spent the last 15 or so years trying to keep them off of the electronics. We all make mistakes and turning our kids over to electronics is one of the biggest I think.
Why They Did It
The authors wanted to answer the question, “Is increased screen time associated with poor performance on children’s developmental screening tests?”
How They Did It
- This was a longitudinal cohort study using a 3-wave, cross-lagged panel model in 2441 mothers and children in Calgary, Alberta, Canada, drawn from the All Our Families study.
- Data were available when children were aged 24, 36, and 60 months.
- Data were collected between October 20, 2011, and October 6, 2016. So…5 years.
- At age 24, 36, and 60 months, children’s screen-time behavior (total hours per week) and developmental outcomes (Ages and Stages Questionnaire, Third Edition) were assessed via maternal report.
What They Found
A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months.
Wrap It Up
The results of this study support the directional association between screen time and child development. Excessive screen time can impinge on children’s ability to develop optimally; it is recommended that pediatricians and health care practitioners guide parents on appropriate amounts of screen exposure and discuss potential consequences of excessive screen use.
This last one is called “Transforming low back pain care delivery in the United States” by George et. al. (3) and published in Pain in December of 2020 and that’s a stout stack of steam stuff right there. This paper has our friend and previous guest, Dr. Christine Goertz, on it. She is amazing so I can only assume the rest of these authors are as well.
They say, “Low back pain (LBP) continues to be a challenging condition to manage effectively. Recent guideline recommendations stress providing non-pharmacological care early, limiting diagnostic testing, and reducing exposure to opioid pain medications. However, there has been little uptake of these guideline recommendations by providers, patients or health systems, resulting in care that is neither effective nor safe. This paper describes the framework for an evidence-based pathway that would transform service delivery for LBP in the United States by creating changes that facilitate the delivery of guideline adherent care.”
They’re saying that the guidelines and the recommendations are there but people aren’t listening. On both sides in my estimation. You have MDs going straight to shots and surgery and even the ones that are open to referral are just going straight to the PT. If the PT fails, then it’s shots and surgery rather than spinal manipulative therapy, or laser, or yoga, or maybe the PT wasn’t good at diagnosing the issue and providing targeted exercise.
On the other hand, we have chiropractors moving bones when they should be stabilized. Or ordering x-rays over and over and over. Or treating 100 times for a curve problem that probably isn’t that big of a problem.
They go on to say, “An evidence-informed clinical service pathway would be intentionally structured to include; a) direct linkages to community and population-based resources that facilitate self-management, b) foundational LBP care that is appropriate for all seeking care, c) individualized LBP care for those who have persistent symptoms, and d) specialized LBP care for instances when advanced diagnostics and intensive treatments are indicated.”
“There is an urgent need to transform LBP care by optimizing clinical care pathways focused on multiple opportunities for non-pharmacological treatments, carefully considering the escalation of care, and facilitating self-management.”
We have chiropractors telling people to come to see them weekly to ward off disease, build the immune system, and things of that nature. That’s creating dependency on the clinic and it is not supported by any research. Certainly not in the context that so many vitalist chiropractors yell out and are so obnoxious about. Patients need to be taught at-home self-management techniques to deal with their pain. The rest is unnecessary noise.
They close with this, “Such approaches have the potential to increase patient access to guideline adherent LBP care as an alternative to opioids, unwarranted diagnostic tests, and unnecessary surgery.”
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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!
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….
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.
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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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
- Josie Znidarsic, DO, Kellie N Kirksey, PhD, Stephen M Dombrowski, PhD, Anne Tang, MS, Rocio Lopez, MS, Heather Blonsky, MAS, Irina Todorov, MD, Dana Schneeberger, PhD, Jonathan Doyle, MCS, Linda Libertini, Starkey Jamie, LAC, Tracy Segall, LMT, Andrew Bang, DC, Kathy Barringer, LISW, Bar Judi, CYTERYT 500, Jane Pernotto Ehrman, MEd, RCHES, Michael F Roizen, MD, Mladen Golubić, MD, PhD, “Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments, Pain Medicine, Volume 22, Issue 1, January 2021, Pages 181–190, https://doi.org/10.1093/pm/pnaa418
- Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 2019;173(3):244–250. doi:10.1001/jamapediatrics.2018.5056
- George SZ, Goertz C, Hastings SN, Fritz JM. Transforming low back pain care delivery in the United States. Pain. 2020 Dec;161(12):2667-2673. doi: 10.1097/j.pain.0000000000001989. PMID: 32694378; PMCID: PMC7669560.