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.
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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!
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube 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.
Today we’re going to talk all about fibromyalgia. How many patients come to you diagnosed with Fibromyalgia? I don’t know about you but I have a lot of them in my practice. How much do you know? What are the treatment recommendations? What’s the cause?
OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You did the hippy hippy shake into Episode #88. does everyone remember that song from the 80s or 90s or whenever the hell that was?
We can’t get started without mentioning the sponsor of the first half of our show,
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that saves you money by eliminating the need for running cable TV or looping the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living and to encourage referrals while presenting the benefits of all of the different products and services you offer.
It works by using a tailor-fit video playlist that only promotes the products and services available in your specific practice. Not only that but the videos are replaced automatically on a weekly basis so there’s no need to manually update your playlist or learn any complicated software. You truly can just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
I just signed up to be at the Forward ’19 event in St. Louis from September 20-22. I’ve been in the FTCA group and a member of the website for some time so it’ll be good to see these folks in person, put some voices to the faces, and learn some good stuff.
Remember, 10%. 10% better every day, every month, every year. I’ve completed the DACO coursework but trust me, I’m nowhere near knowing it all. Continually attending events like this is the right step toward excellence though. I feel pretty confident in saying that.
No, I don’t have a secret code, I’m not paid to tell you about the event. It’s just that Forward ’19 is an evidence-informed conference and as a person that considers themselves evidence-informed, I feel like it my duty to an extent to make sure you all know about these things. It is on me to promote evidence-informed events when and if I know about them.
Before we get into any research on Fibro, for the newbies in the crowd, let’s define fibro shall we? According to the Mayo Clinic website it as follows:
“Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.”
Alright, that’s a good start right there and, if you listened to our free two-part masterclass episodes with Dr. Anthony Nicholson called Decoding Chronic Pain, if you listened to those, you heard a lot about a sensitized or up-regulated central nervous system. Those were episodes 79 and 80 and they are priceless if you are interested in solving the chronic pain enigma. I’m linking them in the show notes. GO LISTEN. Make yourself better.
Fibromyalgia is thought to be another consequence of this sensitized, up-regulated central nervous system we have discussed so many times here.
A combination of things are playing a part but, in general, there are five main elements to the causation of Fibro
THE FIVE MAIN ELEMENTS
There is a familial and genetic predisposition – family members of fibro patients have an 8 fold increased risk
There are environmental stressors acting as triggers – such as physical trauma, psychological and emotional stress, and even infections.
There is dysfunction of the hypothalamic pituitary axis and autonomic nervous system
There are functional impairments in pain and sensory processing
There are cognitive, behavioral and psychological impairments
According to Dr. Anthony Nicholson from the CDI DACO program, It is a brain that has essentially switched into over-protective mode and now remains caught in that state.
He goes on to say, “Consider the clinical landscape for a moment…
Chiropractors see patients with painful movement machinery and diagnose functional M/S disorders; Gastroenterologists see this same class of patients and diagnose functional bowel disorders and non-ulcer dyspepsia; dentists diagnose functional TMJ disorders, urologists are confronted with unexplained pelvic pain, vulvodynia and irritable bladder; and neurologists evaluate unexplained facial pain and chronic headache.
And if all of these conditions could be due to central nervous system dysfunction, it could explain why we see all of them respond together to a management approach that is able to switch this hyper-vigilant central neurology back to a more normal level of sensory interpretation.
And could it be that that reduces the abnormal motor and autonomic behaviors that are driven by a brain that perceives the body to be in danger or under threat?“
Some of the biggies on the differential diagnosis list are
hypothyroidism
anemia
diabetes
and undiagnosed cancer
Also middle aged women are the most likely to have fibro so you’ll want to explore
Rheumatoid arthritis
Lupus
Osteoarthritis
and Polymyalgia Rheumatica
Luckily Perrot, et. al. came up with a hell of a screening tool. In fact they found that a positive answer to more than 5 of the following 6 questions had a sensitivity of 90.5% and a specificity of 85.7% when differentiating Fibro from other conditions like RA, ankylosing spondylitis and osteoarthritis.
Would you like to know the questions? Well of course you would. Here they are
I have pain all over my body
My pain is accompanied by continuous and very unpleasant general fatigue
My pain feels like burns, electric shocks or cramps
My pain is accompanied by other unusual sensations throughout my body, such as pins and needles, tingling or numbness
My pain is accompanied by other health problems such as digestive problems, urinary problems, headaches or restless legs
My pain has a significant impact on my life, particularly on my sleep and my ability to concentrate, making me feel slower generally
A key part to getting these patients well again is to get their brains to un-learn that movement is painful. Introducing the fact that movement doesn’t necessarily hurt can be done through nice, gentle adjustments wouldn’t you agree? When you think about it?
Understanding the difference between hurt and harm. Sometimes, we need these people moving whether it hurts a bit or not and, as confidence, strength, and ability increases, you’ll see they have un-learned that movement is bad and that it hurts.
One of the biggest things with fibro patients is understanding that they just don’t inhibit pain very well.
A point of particular interest here is that Evidence suggests that opioid pathways are normal or even increased in activity, which probably explains why opioids are generally ineffective analgesics in these patients
On the other hand, serotonin and noradrenalin systems are under-active, which explains why most compounds that raise both serotonin and noradrenalin (such as tricyclic antidepressants, duloxetine and tramadol) have been shown to be effective in controlling symptoms in FM patients.
I’m not going to pretend to be a genius here. This is all info from my DACO learning and Dr.s Anthony Nicholson and Matthew Long with CDI in Australia. THEY really are the geniuses in my opinion.
They say, “a useful approach with patients be to encourage exercise to stimulate her CNS system but avoid activities that are too intense as this may sensitize them further. Also, improving posture and movement habits is likely to reduce the effect of fatigue on the major postural muscles that drive a constant nociception.”
They point to a systematic review by Schneider (2009), strong evidence supports aerobic exercise and cognitive behavioral therapy (CBT); moderate evidence supports massage, resistance training, acupuncture and spa therapy; and limited evidence exists for spinal manipulation, movement re-training, vitamin and herb supplements and dietary approaches.
Overall, the evidence strongly recommends a multifactorial approach that emphasizes education, targeted medications, exercise and cognitive therapy.
Let’s get to a few papers real quick and then we’ll wrap up our Fibro episode, shall we? I have papers covering resistance training and chiro when treating women with fibro, I have tobacco use in fibro patients, and I have acupuncture for fibro…..
Real quick though, I need to recognize one of our show sponsors. If you’re a regular listener of our podcast, you know I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the Chiropractic Forward train.
Let me tell you about it.
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You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
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Item #1
The first one is called “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” by L. Ge, R D’Souza, and T Oh and published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes in February 2019(Ge L 2019). Hot stuff, stand back…
Why They Did It
To evaluate the association between smoking and cognitive function in patients with fibromyalgia
How They Did It
They surveyed 668 patients with fibro.
They were categorized by smoking status
They did outcome measures on all sorts of things including cognitive function, symptom severity, quality of life, fatigue, sleep, anxiety, and depression.
What They Found
“In patients with fibromyalgia, smoking is a risk factor for cognitive dysfunction. Moreover, smokers with fibromyalgia were more likely to report increased severity of fibromyalgia symptoms, worse quality of life, more sleep problems, and increased anxiety compared with nonsmokers with fibromyalgia.”
As a sidenote
Did that one surprise anyone? Smoking is awful. It’s awful all around for everything, every condition, and even the way you smell. It’s awful. If you smoke like I used to years ago, get a book called, “The Easy Way To Quit Smoking” by Alan Carr and start seeing it for what it is.
You smoke because you’re bored? How boring is it to stand outside in the cold wind smoking a cigarette by yourself?
You smoke because it gives you confidence? How confident are you when are anxious about how you smell or what smoking is doing to your health on a daily basis.
Smoking does the exact opposite of what you think it’s doing, basically.
Exit sidenote
Item #2
The second paper I have here is called “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia” by Lynn Panton, Arturo Figueroa, and a gaggle of others. It was published in The Journal Of Alternative and Complementary Medicine in March of 2009(Panton L 2009). Old man river….
Yes it’s 10 years old but that doesn’t matter.
Why They Did It
The objective of this study was to evaluate resistance training & resistance training combined with chiropractic treatment on fibro in women.
How They Did It
Both groups finished sixteen weeks of resistance training consisting of 10 exercises performed two times per week. Of course, one group had only the resistance training while the other added in chiropractic treatment two times per week.
What They Found
“In women with FM, resistance training improves strength, FM impact, and strength domains of functionality. The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality.”
Item #3
Our last item is called “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials” by Xin-chang Zhang, Hao Chen, Wen-tao Xu, et. al. published in Journal of Pain Research in January of 2019(Zhang X 2019). Hot potato, get ‘em while they’re hot.
Why They Did It
The stated goal here was to determine the effect and safety of acupuncture therapy on the pain intensity and quality of life in patients with FM.
How They Did It
There was a search done through PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and one and on. They were collecting randomized controlled trials to performa meta-analysis according to the Cochrane systematice review method.
They identified 12 studies that fit the criteria
What They Found
The meta-analysis showed that acupuncture was significantly better than sham acupuncture for relieving pain and improving the quality of life. At long-term, the effect of acupuncture was also superior to that of sham acupuncture without any serious adverse events.
Payah
So there you have it. Tell me you learned something. Tell me you picked up a fibro nugget and tell me you’re better for having listened. Send me an email at dr.williams@chiropracticforward.com
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Ge L, D. S. R., Oh T, (2019). “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” Mayo Clin Proc Innov Qual Outcomes 3(1): 78-85.
Panton L, F. A., Kingsley JD, (2009). “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia.” J Altern Complement Med 15(3).
Zhang X, C. W., Xu W, (2019). “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.” J Pain Res 12: 527-542.
Today, it’s like the olden days here at the Chiropractic Forward Podcast. That’s right. No guests, just moiah. Me. Unfiltered and onery as usual. I’ve had stuff piling up in my archives and we’re going to sprint through some of it and see what sticks. We’re going to talk about the multifidus and some new research on it having to do with disc degeneration, we’ll talk about why what provider you see after low back injury can make all the difference, and we’ll talk about some hint that fibromyalgia and even POTS is theorized to be caused by craniocervical instability. Maybe?
It’s a heaping plate of knowledge noodles so keep your seat, the Italian mama that feeds you too much is in the kitchen. But first, here’s that yummy like a meatball bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have shimmied into Episode #84
Before we get started,
I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again on a loop in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, to encourage referrals, and to present the benefits of the specific and different products and services you offer.
It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. With this system, you tcan truly just set it and forget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice and…your discounted rate will be locked in for as long as you have a subscription.
So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take your practice to the next level with GoChiroTV.
And thanks to them for being involved in what we’re trying to accomplish here.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
Our first paper to cover is called “Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration” and is authored by G. James, D. M. Klyne, et. al. and was published in European Spine Journal in May of 2019(James G 2019).
Why They Did It
The authors here say that chronic low back pain….chronic…longstanding low back pain literally changes and remodels the multifidus muscles. They go on to say that physical activity reduces the local inflammation that comes before multifidus fibrosis during intervertebral disc degeneration (IDD), but its effect is unknown. This study aimed to assess the development of fibrosis and its underlying genetic network during intervertebral disc degeneration and the impact of physical activity.
This research was actually done on mice. To keep the entertainment value of this podcast as high as possible, I’m not going to get specific here as far as substance P, MMP2, blah blah blah. We’ll just head right to the conclusion of the paper.
They say “these data reveal the fibrotic networks that promote fibrosis in the multifidus muscel during chronic intervertebral disc degeneration. Furthermore, physical activity is shown to reduce fibrosis and regulate the fibrotic gene network.”
So they’re saying move it move it move it.
Item #2
This next paper is called “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain” and is authored by TC Azad, D Vail, and J. Bentley et. al. It was published in the esteemed Spine Journal in February of 2019. (Azad TD 2019)
Why They Did It
The authors wanted to determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. I’d say that’s a great question to be asking these days. When we have 72,000 die in one year from opioid-related causes, that should be up there on the ‘what the hell’ list wouldn’t you agree?
How They Did It
The study was a retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.
They identified 478,981 newly diagnosed opiate-naive patients.
They estimated the risk of early opiate prescription and long-term opiate use based on the provider type at initial diagnosis.
What They Found
40.4% of the patients received an opiate prescription within 1 year and 4% met the criteria for long-term use.
The most common provider was family practice. They were associated with 24.4% risk of early opiate prescription and a 2% risk of long-term opiate use.
Risk o freceiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine or at an urgent care.
Risk of Long-term opiate use was highest for aptietns initially diagnosed by pain management doctors or by physical medicine and rehabiliation providers.
Wrap It Up
Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.
Looky here ya see, I’m just going to lay it out for you. Zero percent of opiate-naive patients get prescribed OR hooked on opiates from seeing a chiropractor. Zero.
I’ll even go further than that and say that approximately 70-80% of them get good to excellent results and improvement of their complaint. I know this through the ChiroUp tracking system they use across the country.
You know what else I know through the ChiroUp tracking? I know that these results happen in only about 7 visits. Kow a Chow!! I know you can’t see it but you can picture that karate chop placed precisely to deliver a virtual coup de grace.
Alright, Enough silliness. On to out final item here.
But before we do that – Let’s take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train.
Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #3
Item #3 is an article titled “Could Craniocervical Instability Be Causing myalgic encephalomyelitis/chronic fatigue syndrome, Fibromyalgia & POTS?” written by Cort Johnson and published in Health rising.org on February 27, 2019. (Johnson 2019)
This was actually sent to me by a cardiologist friend of mine and I’m really glad he sent it my way because it’s interesting as hell. Follow along.
I’ll read you the first paragraph here, “Jeff had a typical ME/CFS onset: he was a young, healthy and active individual before being felled by a viral infection and a high temperature. The infection left him with headaches, dizziness, muscle weakness and pain, sound and light sensitivity, and a general sense of being worn down that was exacerbated by exercise – which he soon had to stop altogether. Socializing was the next activity to go as he buckled down to focus on getting through graduate school.”
The article goes on to talk about all of his various visits to specialists and how nothing seemed to work. In fact, he continued to decline in health all of the way to the point that he was essentially bedridden with little to no tolerance for any kind of exertion. We’re talking little energy to chew food and being wheeled into the bathroom to take a shower. Serious stuff.
Turning his head one way could cause him to nearly lose consciousness and he felt a little like a bobble doll when he walked. His head felt heavy.
Doing his own homework to try to basically save his own life, he stumbled across craniocervical instability, aka atlantoaxial instability, aka cranial-cervical syndrome and things started to make sense for Jeff.
Here’s another quoted paragraph from the article, “The strange headaches, the heavy head, the problems turning his head in one direction, the autonomic nervous system issues – they could all be explained by loosened or lax ligaments at the junction between his skull and his vertebrae which kept his head properly situated atop his body.
With his head destabilized, his spinal column was contacting and compressing his brainstem – throwing his autonomic nervous and sensory systems out of whack. His ANS had become so disturbed that even during sleep when it theoretically should have been mostly at rest – it was oscillating up and down causing bizarre heart rates.”
Craniocervical instability has been associated with conditions like rheumatoid arthritis, Ehlers Danlos Syndrome, Downs Syndrome, and other inflammatory conditions. The doctors were dismissive that, outside of any of these conditions, that he could actually have it.
Just to expound on Ehlers Danlos a bit, one in 15 of EDS patients have craniocervical instability. 1 in 15 is a pretty good amount. Just another good reason to familiarize yourself with the Beighton scale and see if your EDS patients have other issues like we’re discussing here.
It seems the correct imaging for CCI is a dynamic CT scan with flexion and extension view but not everyone can get dynamic CTs can they? I believe flexion and extension x-rays can give you a hint as well.
So, skipping to the end of the story, Jeff had a fusion of the top two vertebrae to his skull and all symptoms poof disappeared. Which is awesome and good for him for diagnosing his issue and for being an advocate for himself. Those medical doctors can be a bit pesky when you go against what they think.
The article also says there are only a few neurosurgeons in the world that can perform this sort of fusion. I sent the article to another friend of mine who just happens to be a neurosurgeon himself. He said that the whole article was really interesting and he was glad I sent it but he was confused why they think that there are only a few in the world that can do this surgery. He said they have to do it all of the time but, admittedly, it’s because of trauma. Not CCI.
Still, it seem this is a surgery most neurosurgeons can do if needed.
Great article, and great story that I’m linking in the show notes for you so click on it and check it out for yourself. There is a ton more with differenct patient stories so give it a read through. It’ll make you better.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
That’s Chiropractic!
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Azad TD, V. D., Bentley J, (2019). “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain.” Spine 44(3): 211-218.
James G, K. D., Millecamps M, (2019). “ISSLS Prize in Basic science 2019: Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration.” Euro Spine J 28(5): 893-904.
Johnson, C. (2019). “Could Craniocervical Instability Be Causing ME/CFS, Fibromyalgia & POTS? Pt I – The Spinal Series.” Health Rising.
CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia
Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.
DACO
As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes.
You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode.
Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?
The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out.
DACO Classes
So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache.
Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues.
If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at dr.williams@chiropracticforward.com
I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.
Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly.
Onto the Discussion
Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff.
If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too.
Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap.
Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything.
Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that.
Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol.
Consumer Loyalty
Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses.
Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!
Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”
What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”
That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?
I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey.
I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse.
That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally.
Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”
The Big 4
They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:
Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols.
Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself.
Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself.
Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol.
Reviews
They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol.
They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve.
But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform.
OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly.
Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves.
Before my face gets too red and I start to stutter, let’s move onto the next topic.
Next Paper
This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015).
And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on.
Why They Did It
The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.
It was a randomized controlled trial with a one-year follow-up.
What They Found
The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.
I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that.
I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind.
Last Paper
OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes.
Why They Did It
The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”
Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise.
The medical care consisted of medications and/or epidural injections.
The group exercise classes were supervised by fitness instructors in senior community centers.
The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs.
A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.
