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Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

CF 142: Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

Today we’re going to talk about Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

But first, here’s that sweet sweet bumper music

Subscribe button

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

und. 

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

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

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #142

Now if you missed last week’s episode , we talked about the update from the authors on The Lancet low back series and we talked about movement disorders and whether or not they translate into pain. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

Kids still in school. I called it early. I’m giving most of the schools about 4-6 weeks before they decide the numbers are too high. I do not want to be a pessimist. I just don’t see how they’ll keep it under control. I drove by my daughter’s junior high at lunch and they had 100-200 kids out on the playground playing basketball. Right up on each other. Lol. 

I know they’re outside. I know. We’ll see. I know the University of Alabama just reported 1200 positives at the campus. Notre Dame, University of North Carolina. I just see it as a start. 

My son told me a kid in his math class turned up positive so that got him all up in a wrinkle. I told him he’s got a better chance of getting it riding in a car with someone to eat or gathering up in dorm rooms than getting it in a big huge classroom. It’ll hold 300 kids but there’s around 50 or 60 in there all wearing masks and distanced. Minimal risk. 

Then I had a patient in here just last week, I treated her on a Tuesday. No temp, no symptoms at all….she goes home. The next day she feels a little funky. Her husband had the Rona a couple of weeks ago if I remember right. Anyway, she’s on high alert because of her husband so she goes and gets tested and she’s positive. The day after we had her in the clinic. 

Now, she was masked the whole time and my time with her was less than 3-5 minutes, she had no symptoms at the time so the risk, to my knowledge, while certainly not ideal, in the long run is probably minimal. 

Had that happened 3-4 weeks ago, I’d probably have been down at the place getting the tests and all that good stuff. Had Jake had a positive kid in his big ol math class a month ago, they’d probably be doing something more than just saying, hey this happened. Y’all wear a mask. 

Things ahve changed slightly in the past month I believe. I think more and more, we’re seeing we can live with this and it’s not the end of the world like some thought it’d be back in March and April. We still see cases going down but they’re still higher than they were in the first wave. Yet deaths aren’t. They’ve leveled and dropped as well. Which is all great news. 

I’m a nerd so I watch interviews with experts on vaccines and epidemilology and all that stuff done through the Journal of the American Medical Association. One of the experts said that’s it’s just not in the virus’s best interest to kill us off. It’s in its best interest to become more transmissible but less deadly so it can spread easier but not kill us…..so it can survive. Basically. 

That’s an interesting way to look at it. Then, yesterday, the CDC comes out and says that only 6% of deaths are due strictly to COVID. Well now hell. Doesn’t that give fuel to the fire for the science hating conspiracy nut cases? More ammo to confuse other dummies into their way of thinking but the truth is, it changed nothing. It just meant that 94% of COVID deaths have an average of 2.6 co-morbidities. 

Well, no durr Sherlock. That’s one of the few things we’ve all actually known this whole time. The CDC just was finally able to quantify it. That’s all. I’m still overweight. I’m still more at risk than John Workout over there drinking his fruit smoothie after his 6 mile run. No change whatsoever but day-um if the nut cases didn’t jump all over that one. 

Watching science haters just explode and reveal themselves on Facebook over the last 6 months has been such a disappointment. Especially the ones that you respected as doctorate level caregivers. 

Now look, I’ll admit something, in the very beginning, when nobody knew what the hell, how many would die and this and that, I got caught up in some of it. A whole bunch of us did. As more information comes to light, as we learn more about it, as we experience life with it, the danger is still there but, education has lessened any fear that might have been there in the beginning. 

Now, it’s just life and we have to keep living. We have to try to send kids to school. Let’s see what happens. We have to go to work. I’ve been working full time for basically 6 months following guidelines and so far so good. Can you imagine what business would look like if I just took off for months? Nope. Can’t do it. 

And isn’t there something to be said about government over reach on some of this stuff? How can they shut down bars yet allow people to gather up in a church? How can some bars stay open with music and bands but they’re able to stay open because you can buy a hamburger. Yet other bars are closed because they don’t sell a hamburger? How does any of it make sense? It’s a stack of hooey balls. 

I’m a Christian, I want people to want to go to church. So don’t get the wrong idea there. It’s a valid comparison. You can group up in church but not in a bar. It’s silly. 

We’ll know more about the back to school thing in jsut a few weeks. 

Alright, I’m rambling, let’s get to it. 

Item #1

The first article here is called “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores. A Randomized Clinical Trial” by Okereke et. al(Okereke O 2020). and published in JAMA on August 4, 2020. Hot tamale, hot tamale….

Why They Did It

The authors wanted to know if long-term supplementation with vitamin D3 prevent depression in the general adult population? What’s your guess? D3 is a bit of a wonder kid, right?

How They Did It

  • 18353 men and women aged 50 years or older 
  • Randomized clinical trial 
  • Randomized testing happened from November 2011 through March 2014
  • Randomized treatment ended on December 31, 2017
  • Randomization was D3 or placebo

Wrap It Up

“Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median follow-up of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This second one here is called “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures” by Lilly et. al(Lilly D 2020). published in Global Spine Journal in July of 2020. Is it hot in here? I need some air!

Why They Did It

To compare the utilization of conservative treatments in patients with lumbar intervertebral disc herniations who were successfully managed nonoperatively versus patients who failed conservative therapies and elected to undergo surgery (microdiscectomy).

How They Did It

  • Clinical records from adult patients with an initial herniated lumbar disc between 2007 and 2017 were selected from a large insurance database.
  • Patients were divided into 2 cohorts: patients treated successfully with nonoperative therapies and patients that failed conservative management and opted for microdiscectomy surgery.
  • Nonoperative treatments utilized by the 2 groups were collected over a 2-year surveillance window.
  • “Utilization” was defined by cost billed to patients, prescriptions written, and number of units disbursed.

What They Found

  • 277 941 patients with lumbar intervertebral disc herniations were included.
  • Of these, 269 713 (97.0%) were successfully managed with nonoperative treatments,
  • 8228 (3.0%) failed maximal nonoperative therapy (MNT) and underwent a lumbar microdiscectomy.
  • failures occurred more frequently in males (3.7%), and patients with a history of lumbar epidural steroid injections (4.5%) or preoperative opioid use (3.6%).
  • A cost analysis indicated that patients who failed nonoperative treatments billed for nearly double ($1718/patient) compared to patients who were successfully treated ($906/patient).

Wrap It Up

“Our results suggest that the majority of patients are successfully managed nonoperatively. However, in the subset of patients that fail conservative management, male sex and prior opioid use appear to be independent predictors of treatment failure.”

Item #3

The last one is called “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study” by Brouwer et. al (Brouwer B 2020) . and published in Regional Anesthesia and Pain Medicine in August of 2020….only the freshest for you fresh people. 

Why They Did It

They did this one in an effort to understand multidisciplinary approaches to solving chronic pain. 

How They Did It

  • 11,214 patients suffering from chronic pain
  • The pain was analyzed using relevant Initiative on Methods, Measurement, and Pain assessment in Clinical Trials Instruments. 
  • Most patients were female

What They Found

  • The mean age was 55.6 years old
  • Severe pain was reported by 71.9%
  • Psychological and quality of life values deteriorated when pain severity increased
  • About 36% of them showed severe signs of depression or anxiety
  • 39% had high pain catastrophizing
  • Of all patients, 17.8% reported high values for pain severity, catastrophizing and anxiety or depression 

Wrap It Up

“Based on baseline biopsychosocial values, this study shows the complexity of patients referred to pain centers. Pain management with a biopsychosocial approach in an integrated multidisciplinary setting is indispensable. Above all, adjusted education on chronic pain and attention to its biopsychosocial aspects are deemed necessary.”

It becomes more and more clear that if all you’re doing is adjusting and sending them on their way, you’re wrong. 

If you’re adjusting and doing some exericises and sending chronic pain on its way, you’re partly wrong. 

If you’re adjusting when appropriate, if you’re prescribing patients exercises and teaching them how to self manage at home, addressing yellow flags and building confidence while you encourage addressing the cognitive aspect of chronic pain…..well….now you’re starting to get it. You’re becoming someone that can make a realy difference in your patients’ lives. 

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

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

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Brouwer B, W. S., Jacobs C, Overdijk M, (2020). “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study.” Reg Anesth Pain Med.

Lilly D, D. M., Eldridge C, (2020). “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures.” Global Spine J.

Okereke O, R. C., Mschoulon D, (2020). “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores A Randomized Clinical Trial.” JAMA 324(5): 471-480.

Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches

CF 117: Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches

Today we’re going to talk about manipulation with and without myofascial release added and we’ll cover a cool paper on vitamin D3 and headaches. Good stuff today in regard to smarts being handed out for free. 

But first, here’s that sweet sweet bumper music

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

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

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

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

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #117

Now if you missed last week’s episode , we talked about the safety for chiropractic care in kiddos and we talked a little about an excellent article by Jan Hartvigsen called “What Is Chiropractic’. Definitely some food for thought. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Let’s talk about ebbs and flows, shall we? Here’s the thing; our practices ebb and flow. If someone tells you their practice looks like a business chart where it’s only up and to the right, they’re all hat and no cattle if you catch my drift. 

I told you all in the 10 Keys To Success episode recently that last year, I saw an average of 73.4 new patients every month last year. But in February of this year……I haven’t gotten the exact numbers as of the recording here but I believe it’s only somewhere around 30. 

Now, many of you would be jumping with joy to have 30 new patients in a month and I apologize if my displeasure is a put-off. It’s not meant that way. You must admit that if you love having 25 in a month, only having 8 or so is disappointing. Agreed?

So please keep the discussion in context. Now, what happened? Did I take a piss on someone’s dog and everyone found out? Of course not. I may do that to a cat but never a dog!!! Lol. 

Here’s what I think. I took four working days to go on vacation. Then, snow and ice messed with about another 2 and a half days or so. Essentially, I lost about 6 working days in February. Partly because of me. Partly not because of me. 

Then, for a hybrid insurance practice like mine, we have to battle with the fact that insurance plans reset in January. So, January and February are typically slower months to begin with. We basically took an already slower month and they made it worse by missing a little over a week of it. 

That’s a recipe for disaster. Dammit. I haven’t been in an amazing place since my dad’s health went south back in November but February was just a good way to put the cherry on the top. 

Here’s the deal though. Is it time to cash in the chips, throw my hands in the air, and say screw this. I’m out!!!????

Of course not. I’ve been around the game long enough to understand practice, understand life, and understand that I’m sitting on a cash cow of a practice and we just had a crap month. This too shall pass. 

Yes, I’m going to feel it in a couple of months. But that too will be short-lived. For example, I’m typing this on a Wednesday in the first week of March and for this week, we already have 11 new patients on the books and I expect more. Plus the re-exams are up there too. 

So, my practice is starting to level off again and get back to what I’m used to seeing. Hell yes, it’s stressful when numbers aren’t where you want them. Hell yes, it’s easy to get in the dumps and I do get in the dumps. But you can’t even imagine how productive I’ve been with the extra free time. Organizing marketing campaigns with our marketing manager, social media and website content, and basically TCB – taking care of business, man!!!

The marketers say don’t wait until it’s slow and then bust your butt marketing. Market like that year round. Yeah, I like that and it sounds great but that’s really fairytale land crap when you’re busting your butt like we did last year. There was no time. Literally. 

When people say they don’t have time, to me, that means it wasn’t a priority because we make time for the things that are priorities. Except when you literally do not have the time. And we didn’t. 

Now we do and we’re on it. I’ll keep you updated with how we proceed. I absolutely expect this coronavirus freak out to affect all of us. If people aren’t going to Las Vegas or Seattle, you can damn sure bet they don’t go to our offices as well. But, it’ll pass. 

You’ll stop seeing it on the news so much, deductibles will get met, and practices will fill up. At least…..mine will. Lol. And if you’re making good use of any extra time and being a marketer of what you do rather than a do-er of what you do, then yours will fill up too. 

If you’re playing video games at work on your computer, I can almost guarantee yours will not fill up. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with a paper called “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial” by Boff et al (Boff TA 2019)and published in Physiotherapy in Nov. of 2019 that’s only 3 months ago and it’s……Hot

Why They Did It

They wanted to investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone in individuals with chronic non-specific low back pain. 

How They Did It

  • It was a randomized controlled trial
  • There was a 3-month follow up. 
  • 72 patients between 18 and 50 years old participated
  • They were placed in two different groups
  1. Spinal manipulation
  2. Spinal manipulation + myofascial release
  • They were treated twice a week for three weeks
  • Assessments were performed at baseline, three weeks post-treatment, and at three months after treatment. 

What They Found

  • No significant differences were found between the two groups for pain intensity and disability 
  • They found an overall significant difference between-groups for CNLBP disability, though this effect was not clinically important and was not sustained at follow-up. Stay tuned for my thoughts on this please…..

Wrap It Up

They concluded, “We demonstrated that spinal manipulation combined with the myofascial release was not more effective compared to spinal manipulation alone for patients with chronic non-specific low back pain.”

OK, fair enough. Nothing was found. But, what about that treatment frequency? 2x/week for 3 weeks…..only four visits in 2 weeks. We ARE talking about chronic pain guys and gals. 

What about 3x/week for 3 weeks for starters? Some of these people will never get out of pain completely and we’re trying to reduce the frequency and reduce the intensity. 

Basically, I absolutely buy into the fact they didn’t see a lot of difference. But I also don’t think they gave it very long. What do you think? Shoot me an email at dr.williams@chiropracticforward.com and let me know or jump into our private Facebook group and start a discussion. 

Item #2

This one is called “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial”  by Ghorbani, et. al(Ghorbani Z 2020). and published in Neurological Sciences in January of 2020 – Dammitt – I burned myself. The heat and all…

Why They Did It

Due to the anti-inflammatory effects of vitamin D3, they aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro and anti-inflammatory markers in migraineurs.

How They Did It

  • It was a placebo-controlled, double-blind study
  • It included 80 episodic migraineurs who randomly assigned into two equal groups to receive either daily dose of vitamin D3 2000 IU (50 μg) or placebo for 12 weeks.
  • At baseline and after the trial, headache characteristics were determined using diaries and serum levels of interleukin (IL)-10, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (Cox-2) were assessed via ELISA method

What They Found

At the end of trial, analysis revealed that vitamin D3 supplemented group experienced significantly lower headache days per month

reduced attacks duration

less severe headaches

and lower analgesics use per month

This was all when compared to the placebo

Wrap It Up

The authors concluded, “Based on the results of this study, we found that 2000 IU (50 μg)/day vitamin D3 supplementation for 12 weeks could improve headache characteristics and might reduce neuro-inflammation in episodic migraine.”

If all of you tell me that you get 100% of your headaches patients completely headache free, I’m going to raise my eyebrow at you in the skeptical posture and deep deep deep down inside, I’m going to think you’re full of horse hockey. Plain and simple. 

This paper can give us some insight into other avenues to explore. I’m not saying go put all of your headache patients on Vitamin D3 but, if you have some that are not responding, it makes sense to read through this paper and decide for yourself about recommending it. Or, alternatively, collaborate with their primary on the matter. 

That’s it for this week. I’m outties, Hope you enjoyed the show. I humbly ask you, if you know a colleague that would enjoy this material every week, please share the show with them. There’s only one way we make a difference in the chiropractic profession and that is through your help. 

Thanks in advance!

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography

  • Boff TA, P. F., Ben AJ, Bosmans J, (2019). “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial.” Pysiotherapy 107: 71-80.
  • Ghorbani Z, T. M., Rafiee P, (2020). “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial.” Neuro Sciences.

American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.

But first, here’s that sweet sweet bumper music


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

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

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

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

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #111

Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class. 

That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site. 

Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor. 

I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor. 

Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through. 

Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting. 

Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice. 

Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.

I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.

So then you start life and you’re building a business and there’s never time to go then either. 

Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!

But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?

You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk. 

So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games. 

What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?

Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..

Not a research paper but more of an article in their publication but has plenty to do with chiropractic. 

They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse. 

Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide. 

They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex. 

They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL. 

In fact, I got one word, two syllables….day-um. 

One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”

Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago. 

In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.

They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography. 

After crunching all of the numbers and outcomes here’s what they came up with:

Specifically, service members who received nonpharmacologic therapies were

  • 8% less likely to experience new-onset alcohol and/or drug use disorders;
  • 12% less likely to experience suicidal ideation;
  • 17% less likely to experience a self-inflicted injury, including attempted suicide;
  • 18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
  • 35% less likely to accidentally poison themselves with the same types of drugs.

The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.

In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.

“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”

Despite these limits, the authors expressed confidence in their research methods and findings.

“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”

I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears. 

Item #2

I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017. 

The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.

The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols. 

So let’s motor through this like poop through a goose, shall we?

  1. Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
  2. Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
  3. Nitrate –  The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
  4. Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
  5. Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts

Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well. 

There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.

Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?

Store

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

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.

Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.