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

How Can Research Help You Talk To The Medical Profession?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

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

What They Found

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

Wrap It Up

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

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

Again, pretty recent stuff. 

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

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

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

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

Social Media Links

iTunes

REFERENCES

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

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

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

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

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

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

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

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

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

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

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

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

Crazy Update On Run-Away Healthcare Spending in America

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CF 018: Pt. 3 – Review of The Lancet Article: Low back pain a call to action

Review of The Lancet Article: Low back pain a call to action (Part Three)

On the Chiropractic Forward podcast this week, we are going continue a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow. This week it will be a review of paper #3 from the Lancet series – low back pain a call to action.

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

Welcome to the podcast today, you have strolled right into episode 17. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go. And this week it’s low back pain a call to action.

As I mentioned at the top of the show, this week, I want to continue with the series published in The Lancet on March 21, 2018. For a quick re-cap this week…. The Lancet is one of the oldest and most respected medical journals in the world. It has been around since 1823. In addition to the credibility of the journal, this series of papers dealing with Low Back Pain was compiled and authored by the leading experts on the matter globally. On top of that, the experts were a group of interdisciplinary practitioners which meant they ranged from medical doctors and PhD’s, to physical therapists and chiropractors.

Essentially, EVERYONE had a seat at the table so, it is the general consensus at this point that this series of papers is as current, as credible, and as accurate as can be had at this point in time and in our understanding of Low Back Pain.

The three papers were broken down as follows:

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

Last week, we reviewed the first of the three papers which was titled, “What low back pain is and why we need to pay attention.” We went through it note by note and section by section trying to strip away the embellishments to simply boil it down to a leisure read and, hopefully, an enjoyable learning process.

We will do the same this week with the third paper of the series titled, “Low back pain a call to action.”

I want to start this week in the same way we started last week: by discussing how the papers were accomplished.

How They Did It

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

•MEDLINE (PubMed)

•Scopus

•Google Scholar

•African Index Medicus Database

In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.

This week, we’re going to review the last of the three papers from a recent series published in The Lancet on March 21, 2018. If you don’t know the impact or why this series is so important, please review the last two episodes of the Chiropractic Forward Podcast at www.chiropracticforward.com or the last two articles of my blog over at amarillochiropractor.com/blog. That will get you up to speed. In short, the series on low back pain was compiled and authored by an international panel of experts on the matter. Essentially, the best of the best.

This last of the three papers is titled “Low Back Pain A Call To Action.”

Summary

We have already covered several times that low back pain is now the leading cause of disability globally and is only growing in significance because the global population is living longer. The issue may be more profound in low to middle-income countries. In addition, most low back pain doesn’t even appear to be directly related to any specific trigger or origin.

In many cases, patients are being restricted from attempting resolution of the back pain via conservative approaches such as self-management support, specialized interventions like spinal manipulations (I added that part) and multidisciplinary rehab.

The panel suggests the following:

  1. Address the political aspect. They recommend calling on the World Health Organization to make low back pain one of its priorities by putting it on the target list in an effort to increase attention and decrease treatment that is not recommended initially. They recommend calling on political, medical, and social leaders to make sure public health initiatives are properly funded and geared toward the prevention of low back pain and treatment.
  2. Public health challenge.
    • Change priorities – Make low back pain a priority. Create and implement ways to prevent it and combine these strategies with other strategies that are chronic and somewhat related. Strategies such as weighing the right amount, being active physically, and maintaining good mental health as well. These tactics treat more than simply low back pain. The panel also recommends strategies that can modify the factors putting the population at risk of developing low back pain.
    • Change systems and change practice – Provide early recommendations for maintaining work load as much as possible and/or return to work as quickly as possible. Attempt to ensure early ID of people that are at risk of developing long-term, chronic disability as a result of low back pain. Address co-morbidities raising a person’s risk of developing low back pain and promote a healthier lifestyle in addition to altering disability benefits and get people back to work as soon as possible. And lastly, address low back pain through multidisciplinary rehabilitation in an effort to return the patient to work quickly.
  3. Healthcare challenge –
  • Change culture – The panel appears to me to be promoting the use of a Public Relations campaign to focus and promote living well with low back pain, self-management, staying healthy, and to change the public perception of low back pain.
  • Change clinician behavior – After developing the best evidence-based systems, there will be a need togged everyone on the same team in regards to the way clinicians refer and treat, the patients, as well as the professional journals.
  • Change systems – There is a need to develop and implement systems allowing a patient to receive the right care at the right time. Clinical pathways will need a re-boot and will need to become consistent across interdisciplinary lines and differing clinical settings.
  • Tackle Vested Interests – The panel discusses the fact that governments and insurance companies need to regulate in a manner consistent with evidence-based treatment for low back pain and eliminate conflicts of interest. Regulation through contracts, and payment schedules for treatments with little to no evidence for effectiveness.

The idea that a healthy weight and regular physical activity will help reduce low back pain must enter the global subconscious through public programs, especially in low to middle-income countries.

An assertion I fully agree with the authors on is that, thus far, healthcare dollars have been wasted on treatments that are ineffective and, many times, downright dangerous. The risk vs. reward ration just doesn’t make sense more times than not currently. No too mention the issue of opioid addiction which we all should know the stats on by now.

Boiling it down, the panel aims to get rid of practices that harm and create waste while, at the same time, opening the door to effective and affordable means of treating low back pain to patients in need. The authors are quoted here as saying,”Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”

The authors promote the idea of implementing a positive health concept as the umbrella idea aiming for prevention of long-term disability. This includes alternative to treatments and cures and promotes more meaningful lives. This truly is a low back pain a call to action recommendation.

Another great quote from this third paper is as follows, “Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care.”

The panel also calls for an active monitoring system in order to assess and keep an eye on the recommendations implementation as well as the outcomes of the changes.

To read more for yourself, follow this link to the third paper:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext

If access is unavailable, just simply register at The Lancet. It is completely free of charge.

If you are research minded, if you are a low back pain patient, or if you are a practitioner regularly coming in contact with low back pain patients, it is my opinion that taking the time to read these three papers yourself is of utmost importance.

Please find the links to the papers in the “References” section and get it done. Together, we can make a big, big difference in the lives of our low back pain patients. Without a doubt.

For this week’s next step, go register with The Lancet and get this paper for free! You just have to register. That’s it.

We hope you enjoyed this week’s paper called “Low back pain a call to action.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

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

 

Other episodes you may enjoy:

CF 003: Great News: Chiropractic Outpaces Muscle Relaxants

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

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

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

CF 017: Pt. 2 – Review of The Lancet Article on Treatment of Low Back Pain

 

 

References:

Paper 1 – “What low back pain is and why we need to pay attention: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext

Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext

Paper 3 – “Low back pain: a call for action”: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Hergert, you are a great resource here since you’re in the middle of the two professions. What is your experience on this?
Tyce: The carriers will come right out and tell you they don’t think they have to play by this rule.

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

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

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

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

There is also a possible violation when doctors of Chiropractic are denied inclusion into a plan or group purely based on the profession. For example, it is my understanding that FirstCare won’t cover Chiropractic. Is that a violation? I suppose I could offer an opinion if I were a lawyer. I’m not sure why exactly other providers are allowed coverage while chiropractors are left out in the cold. Here is a great example though that I’m aware of here locally. there is a local insurance network that will remained un-named that charges $200 per year for chiropractors to be included for coverage however, medical professionals pay nothing to be included. Could that be a violation of the nondiscrimination law? I would say it smells a little fishy.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition, policies that discriminate against chiropractic or chiropractors run in violation of Section 2706 of PPACA. It comes full circle.
I know you have something good to say here Tyce…
Tyce: The beautiful thing we get to see in our office, since we have both medicine and chiropractic working together, is the end of the story…people getting off the mind altering drugs, healing, and getting their lives back. All we do is follow these simple guidelines.

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

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

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

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

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

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

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

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

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

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

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

 

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

CF 012: Proven Means To Treat Neck Pain

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

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

 

 

 

 

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

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

 

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice

This weeks’s entry is going to be a little long and it’s definitly more geared to chiropractic practitioners rather than patients or potential patients. Unless you are a patient that is just a little bent toward practice protocols and I just don’t know very many of those types of patients. I can see where a patient may be interested in this week’s edition if they feel they have received poor treatment in the past I suppose but most patients likely won’t be interested this week.

Welcome to episode #5. We’re on a roll folks. We’re going to have more fun than walking on hot coals today.

Have you ever been in practice, especially in the early years, wondering if you’re doing things right? I mean, they taught you how to diagnose. The taught you how to evaluate and adjust. But what about all of the gaps in between? Did you get it all and, if you got it, did it stick? Did you retain it? We all have questions about certain issues. If you aren’t always learning and asking yourselves questions, then I would suggest that you do. I believe that’s how we grow.

In this episode we are going to try to help answer some age-old questions that many chiropractors get out of school not necessarily knowing the answers to. We are going to cover recommendations on how often, what, why, and how for your practices. It should be interesting for most of you. That’s my hope anyway. So buckle up.

Many of us in the chiropractic profession tend to wonder around on our own islands for years without any sort of mentorship or guidance. If I’m being honest, and I am, I was that way myself until about 11 or so years ago when I decided to start paying attention. In fact, there are still times I find myself researching the latest standards of practice and guidelines to make sure that I am not an outlier in my profession without even realizing that I’m an outlier. Healthcare tends to change so quickly that it is a scenario I would assume occurs more often than we think.

This sort of information can admittedly be monotonous and can make your eyes bleed if you allow. Some LOVE to dive into long text and technical terms but I’m guessing most do not. That is why I am offering it in different forms.

Different people communicate in different ways. Some prefer email. Some prefer texts. I like videos while others prefer blogs. Podcasts, Reddit, etc… It’s all a part of communicating in the best, most effective way possible. With this in mind, I offer you this information in blog form, on YouTube in a video, and in Podcast form in the hopes that you guys and gals out there can digest it and maybe even RECEIVE it rather than just simply take note of it, before moving on to something else.

The impetus for this week’s information comes from a blog I read that was recently published on the American Chiropractic Association’s blog. You can find this at www.ACAtoday.org/blog. The blog was posted December 28, 2017. It was titled “Research Review: Clinical Practice Guideline: Chiropractic Care for Low Back Pain,” and was submitted by Dr. Shawn Thistle(1). Dr. Thistle is the founder of RRS Education which is a continuing education company providing weekly research reviews. Much like we do right here on my blog, on YouTube, or as part of the Chiropractic Forward Podcast.

I have used Dr. Thistle’s article here as the template and simply “overdubbed” and commented on it as I went through it.

In this article, Dr. Thistle reviews a research paper called “Clinical Practice Guideline: Chiropractic Care for Low Back Pain,” The lead author and researcher for the paper was Dr. Gary Globe who has a Masters in Business, a Doctor of Chiropractic, and a PhD.  The paper was published in the Journal of Manipulative & Physiological Therapeutics in Volume 30, Issue 1, in 2016(2).

Basically, we are doing a review of a review. You may wonder why this is even necessary to do on my part. I feel it’s necessary because I believe my calling is to take more difficult or more boring concepts, terms, and ideas and to then strip them down into a very understandable and more palatable form. A transfer of information, if you will. Hopefully I can get that information distributed to folks that need it. If we just left it at this blog, it is my assumption that the people that really need the information may not get it. In other words the people that read the American Chiropractic Association’s blog probably have already familiarized themselves with much of this information. However, people that do not read their blog likely do not keep up with Chiropractic research either. If they’re not involved, then they’re just not involved usually. They may be outliers in the profession because they have likely never been exposed to this sort of evidence-based information.

I’m hoping that’s where I come into the picture.

First, why would chiropractors be interested in guidelines of any sort? I would share with you that a frustrating part of our profession for me personally is that there seems to be no standardization that is widely followed or respected by chiropractors as a population. Some practitioners in Chiropractic may think that’s a great thing and that that’s what is unique about Chiropractic. I am of the thought that it’s a good thing when you go to a practitioner of any style and you can feel comfortable knowing there are professional standards of care being followed by your caregiver. It’s when practitioners have not educated themselves or have not at least been somewhat in tune to what’s going on in their profession that they may start to be considered outliers and can run the risk of getting themselves into some sort of trouble professionally. Nobody wants that.

Let’s be clear; following guidelines don’t mean that the practitioner has no autonomy or that there is no professional decision-making going on. They are just that: guidelines. General guidelines that not only help your decision-making process, but also give you something to refer to should there be any questions down the road about your treatment plans or protocols. I call that “standing on solid ground.”

When you have so many webinar and seminar folks trying to scare chiropractors into buying their courses and marketing to them by triggering the fear of either being sued or jailed if they don’t buy, well….standing on solid ground is always a bit liberating.

Be honest here, how does it look when one chiropractor tells the patient they need to be seen 55 times this year and this happens just one or two weeks before a doctor with the second opinion says the standards of practice require 18 visits over the next 2 months or so for the same issue? Of course, that reflects poorly on the first chiropractor but wouldn’t you agree that it also reflects poorly on Chiropractic in general?

I am in no way saying that there are not conditions requiring 55 visits so don’t send me any hate email. I’m simply using a generalized example here. I’ve always felt that treatment should have a start, it should have a finish, it should be responsible and smart recommendations, and upon completion should enter the maintenance phase. If we aren’t giving good recommendations, Then we simply are not doing our job. But it’s also my opinion that if you’re not staying on top of research and current standards of practice, then that also means you’re not doing your job.

Now that we talked about standards of practice and guidelines, let’s dive into this research and guideline summary.

Why They Did It

Everyone should know by now that low back pain is the leading cause of disability around the world. Research has continued to show over and over that chiropractors are highly effective when it comes to low back pain. Even traditional chiropractic haters, at this point, mostly concede the fact. The goal of this research project seems to be focused on providing some sort of standardization and guideline protocol for an easier and smoother transition into an integrated setting in the medical world. The project focused on nonspecific low back pain.

How They Did It

The authors underwent a comprehensive search of the literature. They found 270 relevant articles. After screening the 270 articles, only 18 where accepted for the paper. Of those 18, sixteen of the papers were accepted as high-quality.

Here’s where we get into the thick of it. They break their points down into the following categories: general considerations, informed consent, severity and duration of conditions, examination procedures for lower back pain, treatment frequency and duration, initial course of care for low back disorders, re-evaluation and re-examination, benefit vs. risk, contraindications and cautions, and chronic pain management for spinal disorders.

Let’s dive into those sections a little further point by point and try to make some sense of it all.

General Considerations. 

  • If a patient gets chiropractic treatment in the acute pain phase, they usually have full recovery of the complaint. Even though they may have full recovery, recurrence of the pain can be common.
  • If not treated properly in the beginning, it could turn chronic with increased disability.
  • Practitioners, at all times, should be mindful of red flags and yellow flags. In case you don’t know, yellow flags are usually associated with chronic pain or disability. Some examples may be negative coping strategies, poor self efficacy beliefs, fear of avoidance behavior, and distress. That’s according to Dynamic Chiropractic, Nov. 30, 2002, Vol. 20, Issue 25 by Craig Liebenson, DC. Patients with high yellow flag scores should not be labeled with an injured back. For example, telling the patient they have a ruptured disc may not be the best idea. Your treatment should reduce dependency on medication and encourage active treatment rather than passive treatment and should include self-treatment protocols(3).
  • The authors of this paper feel that the goal of chiropractic should be improving the patients’ functional capacity as well as educating them to accept responsibility for their own health.

Informed Consent: Chiropractors often get into trouble because they lack a proper informed consent procedure.

  • Basically, informed consent is communication between your office and a patient that results in the patient giving you authorization for treatment.
  • An informed consent should include a clear explanation of the diagnosis, of your examination, and what you propose to do as far as treatment. This should include treatment options and possible risks involved.
  • If the person appears to be of sound mind to perform an informed consent, you have satisfied recommendations, assuming they have no further questions.

Examination Procedures for Low Back Pain:

  • While there is no limit to what the examination includes, there should at minimum be a health history, an examination that includes range of motion, orthopedic tests, and/or neurological testing, and further diagnostics when indicated. These may include lab tests or imaging.
  • This report says that range of motion should not be used to determine a person’s functional status but can be used as part of the exam to assess regional mobility.
  • As part of the exam process, they don’t recommend routine imaging for diagnostic tests in cases of nonspecific low back pain.
  • With that being said, if serious pathology is suspected or if someone is having neurological issues associated with it, then of course further diagnostics would be appropriate.
  • While the authors are not proponents of regular imaging, MRIs are indicated when the low back complaint is associated with symptoms of stenosis or radiculopathy.
  • Another condition in which a practitioner may consider getting imaging would be when the patient has not responded to a reasonable, responsible short-term conservative protocol or if you have reason to suspect something else is going on such as spondylolisthesis.

Severity & Duration of Conditions: this is a really simple section that can cause confusion by those that have just never had the information or have forgotten it.

  • An acute complaint refers to something that has been experienced for less than six weeks (1.5 months).
  • A subacute symptom has lasted between six and 12 week (1.5 months to just under 3 months).
  • A chronic condition is something that has lasted 12 weeks minimum (3 months).
  • A recurrence means the return of the symptom that is suspected to be similar to their original complaint.

Treatment Frequency & Duration:

  • The authors indicate that most patients respond to your care but that the treatment frequency and duration may change depending on the patient themselves. They may have other issues including red and yellow flags that extend, or alter in some way, the duration or the frequency of treatment. Again, the practitioner must always be mindful of the red and yellow flags.
  • The paper suggests that the effectiveness of care should be evaluated both subjectively and objectively during or after each course of care. In our office we use the Functional Rating Index (FRI) every single day upon the patient’s arrival. We also use outcome assessment questionnaires fairly often. We use them for a baseline during the initial treatment, again at each re-examination, and then again upon the conclusion of the treatment schedule. In addition to that, our patients are asked to rate their pain on the Visual Analog Scale (VAS) for each complaint at each visit. It takes seconds. Yes, it’s subjective and can have a wide variance from day to day for the same person but, when you are keeping these types of records, you are standing on more solid ground if anything about you or your treatment ever comes into question. Not to mention, it’s just better for the patient to be kept track of in this manner.
  • Here is a quasi-answer to a big question. The question I’m referring to is, “How often should I see someone?” Well, the full answer is not in this paper but there are hints at it. The researchers here suggest that a therapeutic trial of chiropractic is usually between 6 and 12 visits that takes anywhere from 2 to 4 weeks to complete. That seems to be about the average. For further insight into generally accepted treatment protocols, you may try looking at the Council on Chiropractic Guidelines & Practice Parameters (CCGPP) guidelines(4).

Initial Course of Care for Low Back Disorders

  • The best evidence of efficacy is in High Velocity/Low Amplitude manipulation and in mobilization. 
  • A good starting point in care is passive physiotherapy like electric stim, cold laser, ultrasound, etc for pain. Additionally a practitioner should attempt to educate the patient about their complaint and set in place recommendations for self-management of the complaint.
  • As the authors state, physiotherapy shouldn’t be used individually or isolated as the lone means of treatment. As I tell my patients, “There is a mountain of evidence for manipulation/mobilization, for certain physiotherapies, and for exercise/rehab but the best evidence show the greatest effectiveness comes from the three being combined and integrated into a treatment protocol that is reasonable and makes sense.” How it is used will come down to practitioner judgement and patient preference.
  • The authors here state that they cannot recommend the use of lumbar supports like bracing, taping, or orthoses because the research just isn’t there to support it at this time.
  • Active care, otherwise known as exercise/rehab, should become a bigger and bigger part of all chiropractic clinical protocols. I often will try to relate this to patients in a way that make sense in the medical world. When appropriate I may say something like, “What happens on the day after someone has a knee replacement, appendectomy, or a C-section? They have them up walking, which may seem counterproductive to do so soon after a surgery. In fact, for low back pain, a common recommendation used to be to go home, get in bed, and wait it out. But, they realized that movement is healing. Part of the healing is getting the joints moving properly through manipulation and joint mobilization but that’s just part of it. Another big aspect of it is exercise/rehab; both here in the office and at home.” Chiropractic practitoners need to stress it.
  • The more you explain why you want them performing exercise/rehab and the more you stress that exercise/rehab is part of the protocol from the very start, the less resistance you tend to run into later down the road.

Re-examination & Re-evaluation

  • After your initial recommendations are fulfilled, then what? You need to determine whether any further treatment is indicated and why it’s indicated. What was the patient’s response to your care?
  • If you threw everything in your office including the kitchen sink at someone for 2-4 weeks for 6-12 visits and saw little to no improvement, do you think any further treatment is likely to bring about positive change? Not very likely. It’s times like these that I swallow my pride and, in the best interest of the patient and my reputation, I find them a referral to a reputable practitioner that may be better-suited to address the complaint. I wouldn’t want a family member of mine treated any differently so I don’t treat patients any differently.
  • On the other hand, if the patient’s complaint is resolved, you should perform a final exam and outcome assessment questionnaire, make sure the patient is adequately educated on your recommendations going forward (exercise, maintenance care, etc.), and then release the patient from the active care protocol.

Benefit vs. Risk

  • The authors state that chiropractic care is remarkably safe and effective. Certainly when compared to our medical counterparts. Even though we all know this already, it never hurts to re-state the obvious. I hope you don’t mind.
  • The paper says that serious adverse reactions to chiropractic care tend to only happen to the tune of 1 in 1 million patient visits when referring to treatment for low back pain.
  • The authors went a little further by saying that, while adverse reactions were very rare, other more mild-moderate events were noticed like muscle soreness or stiffness. We see this in my office here and there as well. If they have never been to a chiropractor and then get sore after the first one or two visits, one could compare that to going to the gym after laying off for an extended time. You are doing something new and something different with the body. It makes sense for people to get a little sore sometimes.

Contraindications & Cautions: have you always been completely aware and knowledgeable on what constitutes a hard contraindication to chiropractic care? The authors try to help us all out here so listen up. This is a biggie. Since I feel the importance of knowing these are paramount to your longevity in practice, I am going to quote these conditions directly from the source(1) for accuracy. Don’t be caught having treated these conditions. 

  • General Conditions: severe osteoporosis, multiple myeloma, osteomyelitis, local primary bone tumors where osseous integrity is questionable, local metastatic bone tumors, Paget’s disease.
  • Neurological Conditions: progressive or sudden neurological deficit (including cauda equina syndrome) or spinal cord tumors demonstrating neurological compromise (care may be appropriate after specialist investigation and clearance)
  • Inflammatory Conditions: rheumatoid arthritis in active systemic stage (or locally in the presence of inflammation or atlantoaxial instability), inflammatory phase of ankylosing spondylitis or psoriatic arthritis, or Reiter’s syndrome (reactive arthritis).
  • Bleeding Disorders: congenital or acquired, unstable aortic aneurysm, etc.
  • Other: structural instability, inadequate physical exam, or inadequate SMT training/skills

Chronic Pain Management for Spinal Disorders:

These conditions can no longer be referred to as “acute” or “uncomplicated” as they are beyond 3 months in duration at the point of being labeled “chronic” and other factors must be considered in a robust treatment protocol. Some complications may include:

  • Work environment, including ergonomics
  • Work requirements
  • Comorbidities. Some may wonder, “What the heck is that?!?” Well, that is when you have two or more other conditions occurring in addition to the initial diagnosis. Low back pain in addition to arthritis and diabetes is an example. Low back pain in addition to obesity and depression could be another.
  • The history of the condition’s prior treatments
  • Lifestyle factors including bad habits
  • Other psychological factors which may include depression, anxiety, etc….

Whew….that was a lot, right?

With such an amount of information to wade through, I would say, that Dr. Thistle did a great job of reviewing this paper for the American Chiropractic Association’s blog and I hope, in turn, that I have been able to bring even more clarity and maybe even relate it to my personal practice and your practice in a way that really drives home the need for more regulation and practice standards in our profession.

As the internet and the “Age of Information” has brought the world together, I believe the days of being a lone wolf and/or being an outlier may be numbered. When they say that ignorance is not a defense, that especially rings true now that information is at our very fingertips at all times of the day no matter where we may be.

You may agree with me that this is a good thing. You may disagree and think I’m off my rocker for wanting some standards in the profession. Chiropractic practitioners differ from one to the other. That’s OK. Differences in opinions is American to the core. Usually what triumphs is reason and, if you find these guidelines or those of the CCGPP to be reasonable guides, I hope you will consider giving them more thought and maybe even implement them into your regular treatment protocols.

Regardless of how you go about practicing, I’m a firm believer that we chiropractors can absolutely change the world when it comes to the treatment of non-complicated neuromusculoskeletal conditions of the body. Not just low back pain either, but the whole shibang. As I said last week, if we were wrong in what we do as a profession, we would have been wiped off the face of the Earth years ago. Lord knows they tried and keep trying.

We are still here because we are naturally right but, we give our detractors ammunition for the battle when we are not holding ourselves and our profession to certain reasonable and responsible standards.

I hope you will stop by our websites and get involved with what we are doing. chiropracticforward.com is our podcast site. We have years of research-based blogs available right now at amarillochiropractor.com/blog as well. Not to mention our YouTube channel which can be found by searching Creek Stone Integrated Care Jeff Williams in a YouTube search. Find Chiropractic Forward on Facebook as well as Twitter which is @Chiro_Forward. Subscribe, share, and do all the things that help us grow and spread our message.

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

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

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or if you have any suggestions for future episodes.

From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward podcast, this is Dr. Jeff Williams saying upward, onward, & forward.

  1. https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/315/Research-Review-Clinical-Practice-Guideline-Chiropractic-Care-for-Low-Back-Pain
  2. https://www.ncbi.nlm.nih.gov/pubmed/26804581
  3. https://www.dynamicchiropractic.com/mpacms/dc/article.php?id=15493
  4. https://clinicalcompass.org

CF 004: And Instantly, Treatment of Back Pain Changes Due To Increase In Opioid-Related Deaths

This week we’re going to discuss some attacks on the profession in the not-so-distant past, we’ll talk about the current state of the opioid epidemic, and we’ll talk about why right now is such a good time for what is going on with Chiropractic research.

Before we get to the meat of the subject this week, I want to say that I hope you all had a Merry Christmas and a Happy New Year. My family brought it in sitting on the couch drinking decaf coffee. It was very uneventful but pleasant. I used to be a traveling musician in what seems like a former life now and…if you’d have told me 10 years ago that I’d be bringing in the new year sitting on the couch drinking coffee, I would have laughed at you in a dismissive way and probably had given you a look that you would not have taken as being positive. But, jobs and kids and family have a way of forcing the needed changes and that’s OK with me. It’s all a part of life and you better believe I’m living it.

Here’s wishing you all a happy and prosperous 2018.

Now, back to our regularly scheduled programming. This week, we’re going to have more fun that Chinese algebra. Just sit back and watch. I tell you the truth.

Seriously though, this is the place where we talk about some pretty cool stuff going on in the Chiropractic field that is based on research and evidence. How cool is that? When you can just sit back and let all the super smart guys and gals validate everything you do? What a blessing. Of course, we chiropractors have always known we were right about how to go about treating our patients. Think about it. Think about the generations of attacks this profession has endured through the years from extremely powerful people in the legislative and in the healthcare world. The American Medical Association. I’m not sure it gets more powerful than that. Heck, they even lost an anti-trust case in the Supreme Court when chiropractors sued them. In short, chiropractors proved in Federal Court that the American Medical Association did the following or encouraged their members in the following manner:

  • They encouraged ethical complaints against doctors of chiropractic;
  • They opposed chiropractic inroads in health insurance;
  • They Opposed chiropractic inroads in workmen’s compensation;
  • They opposed chiropractic inroads into labor unions;
  • They opposed chiropractic inroads into hospitals; and
  • They attempted to contain chiropractic schools.
  • They conducted nationwide conferences on chiropractic;
  • They distributed publications critical of chiropractic;
  • They assisted others in preparation of anti-chiropractic literature;
  • They warned medical doctors and their underlings that professional association between medical physicians and chiropractors was unethical; and
  • They discouraged colleges, universities and faculty from cooperating with chiropractic schools.

If you hear all of this ridiculousness and you say to yourself, “There’s no way that’s true,” then please do us both a big favor and Google the term Wilk vs. AMA and that should tell you all you need to know about the matter.

Anyway, to my original point, if we weren’t right, we would have been destroyed years ago by the machine. I want you to listen to me here. Let me say it again, if we chiropractors were not right, we would have been wiped off the map years ago. It certainly wasn’t from a lack of effort on the part of the powers that be.

The best part about the blogs and podcasts and videos I share every week is that most everything we talk about has its roots in research. How do you generate facts? I’d argue it’s through research. I hear it all the time: “I believe in chiropractics.” My response is pretty simple. We’re not a church. You don’t have to believe. We have mountains of research. The problem is, few people know about it.

I don’t like the fact that our national debt and deficit is what it is. But, they’re just facts and we have to learn to live with it. Well, the medical field is starting to learn to live with some new facts. In fact, they’re getting smacked down like a red-headed step kid by these facts!

Facts like this…the opioid crisis cost the US economy $504 billion dollars in 2015 according to an article from Reuters this year written by Lucia Mutikani and Ginger Gibson. There authors of the article were relaying information taken from the White House Council of Economic Advisers (CEA).

There is no reason to expect this number to improve any time soon either. If indicators are correct, as numbers become more available for 2016 and 2017, you’ll see this amount explode.

The opioid crisis has reached the point that President Trump was forced to declare it a public health emergency.

The article goes on to discuss the fact that there was a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015. The wide range in dollar amounts is to take into account the fact that there are several different models but, I think you get the idea. It’s incredibly significant.

“The crisis has worsened, especially in terms of overdose deaths which have doubled in the past ten years,” the CEA said. Wow. And, if I’m correct, yo u can compare the crisis to a fire. While it may have taken 10 years to double (which is bad), I believe the rate of expansion of the problem has increased exponentially.

The article wraps up by citing the U.S. Centers for Disease Control and Prevention as saying more than 100 Americans die daily from related overdoses. On top of that, new information is out that opioid-related deaths have now surpassed breast cancer. I love that the NFL does the pink uniforms during October which is Breast Cancer Awareness Month but I’m wondering if now we’ll start seeing a specific color and more awareness for the Opioid Addiction Awareness Month or something of that nature. It’s bad, y’all.

https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0

How bad is it? It’s so bad that a recent article in The Guardian says that overall life expectancy in the US has declined for the second year in a row as a result of the opioid crisis. Can you imagine? It’s the first time in 50 years that the US life expectancy has gone down for 2 years in a row. The last time was the year of our Lord, nineteen hundred and sixty-three!

The article in The Guardian was written by Jessica Glenza and was published on December 21, 2017. In the article, she shares that there were 63,600 opioid-related deaths in 2016 which was an increase of 21% from the 2015. These numbers came from the National Center for Health Statistics.

As I hinted in the beginning of this blog, early indications for 2017 aren’t looking very bright. Robert Anderson of the National Center for Health Statistics says of 2017, “It doesn’t look any better.” Anderson goes on to say, “We haven’t seen more than two years in a row in declining life expectancy since the Spanish flu100 years ago,” said Anderson. “We would be entering that sort of territory, which is extremely concerning.”

There are guesstimates that this crisis is going to take a good 10-20 years to turn around now that multiple generations are already hooked.

https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis

Realizing that the first phase of the opioid crisis was started by physicians over-prescribing these opioids, the American Medical Association and the American College of Physicians have really stepped up in a way that I would believe most alternative caregivers would describe as rather unexpected considering the history of these organizations. They have consistently and constantly attacked – verbally, in the courts, and legislatively – just about any and all alternative healthcare protocols up to this point in history.

However, in new recommendations put out in February of 2017, the American College of Physicians have now started recommending Chiropractic, Massage, and/or Acupuncture as first-line treatment for acute and chronic low back pain before even taking an over-the-counter anti-inflammatory such as Aspirin, Tylenol, or Ibuprofen.

Quickly thereafter (2 months), the American Medical Association published an article in its journal called Journal of the American Medical Association (JAMA) in support of the updated recommendations made by the American College of Physicians.

I would say they need to go ahead and expand it to the entire musculoskeletal system but acute and chronic low back pain is a good starting point I suppose.

In the end, it is my firm belief that patients are entitled to the best treatments that do the least harm. There is nothing out there safer and more effective than chiropractic, massage, and/or acupuncture.

Through the years, I have carried with me a wonderful quote by Dr. Lee Green, a Professor of Family Medicine at the University of Michigan. He said, ”Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.”

Doesn’t it?

Just another reason to call a chiropractor TODAY!

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

https://www.amarillochiropractor.com/evidence-backed-reason-add-chiropractic/

I want you to be sure you know all about our blog and our YouTube channel. Currently, we have these entities set up under Creek Stone Integrated Care. Now, with the building of the Chiropractic Forward podcast site, how’s that going to change and how’s that going to look? I haven’t figured that part out just yet but know this, you can get your fix on all things chiropractically researched by going to amarillochiropractor.com and clicking on the blog button. Or, you can visit our youtube channel by searching Creek Stone Integrated Care in the YouTube search

Be looking for our upcoming website at chiropracticforward.com. It is not ready but it will be soon enough. It’s closer every week. I don’t know if you know this but I am all over social media in a whole bunch of areas. For a list of links, see the show notes and we’ll see you somewhere in that list I hope.

Thank you for listening. You know, sharing is caring and that’s how we get to more and more ears. If you like what you hear and you know other chiropractors or medical field professionals…..or even potential chiropractic patients….make sure you share our podcast with them. Together we can make a difference and help people get off of medication, get out of pain, and get healthier overall.

I’m Dr. Jeff Williams from the Chiropractic Forward Flight deck saying upward, onward, and forward .