Veterans

Steps Per Day And Dementia & Vets And Chiropractic

CF 248: Steps Per Day And Dementia & Vets And Chiropractic Today we’re going to talk about Steps Per Day And Dementia & Vets And Chiropractic But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.    We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #248 Now if you missed last week’s episode, we were joined by the one and only, my friend, Dr. Jay Greenstein and man…..what a great episode. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

First, hey, I’m hiring. I need an asscoiate. Seriously, if you go to work for a franchise people, honest talk here…..you have a cap in salary. You will adjust all day every day and on the weekends. You will work your butt straight off and you’ll never get paid more.  At a private practice, like mine for example, you’re not going to have a cap. Once your prove yourself and you’re helping build the clinic, you will get paid without a cap.

You get paid for the work and effort you put in. If you want to work your tail straight off and not get paid what you’re worth, I’m not the right call for you.  If you want to work but get mentored by an ortho and forensics diplomate, play a part in this podcast, and set yourself apart from the parts of the profession you don’t like….oh….and get paid for your efforts with a potential buyout down the road, then I am exactly the guy you want to speak with.  If you think Amarillo is a great place to live and raise a family, which it absolutely is, send me an email at creekstonecare@gmail.com I want to meet you. Doesn’t matter when you hear this episode.

I’m always looking for top talent and I know if you’re listening to this podcast then you are indeed top talent. Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. 

When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. Second, we just got back from Vegas. I try take at least one short trip every quarter. Sometimes more. Sometimes less but we have to get out of the clinic.  Certainly after you’ve built and you’re on the way. It’s the only way you stay sane. I’m not telling you to close down the clinic and go to Europe for a month as a solo doc. Just a long weekend here and there. It’ll keep you likable. We saw Motley Crue, Def Leppard, Poison, and Joan Jett and it was a great. Just what we needed. I have to admit that I’m still on a bit of a buzz from having Jay Greenstein join me on the show last week. What a freaking gem that guy is. Don’t miss that episode. For any reason. I think that’ll be quite enough of rambling from me. Let’s get it started

Item #1

The first one is called “Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK” by del Pozo Cruz, et. al. (del Pozo Cruz B 2022) and published in JAMA on September 6, 2022. Pow! Hottern’ a firecracker!

Why They Did It

The authors wanted to find out if there is a dose-response association of daily step count and intensity with incidence of all-cause dementia among adults living in the UK?

How They Did It

  • UK Biobank prospective population-based cohort study with 6.9 years of follow-up. 
  • A total of 78,430 of 103,684 eligible adults aged 40 to 79 years with valid wrist accelerometer data were included. 
  • Registry-based dementia was ascertained through October 2021.

What They Found

  • This cohort study of adults assessed with wrist-worn accelerometers found that accruing more steps per day was associated with steady declines in dementia incidence risk, up to 9800 steps per day, beyond which the benefits upturned. 
  • The dose associated with 50% of maximal observed benefit was 3800 steps per day, and steps at higher intensity (cadence) were associated with lower incidence risk.

Wrap It Up

The findings in this study suggest that accumulating more steps per day just under the popular threshold of 10 000 steps per day and performing steps at higher intensity may be associated with lower risk of dementia onset. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called “Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial” by Hays et. al. (Ron D Hays 2022) and published in Pain Medicine on January 21 of 2022. Shazzaaammm! It’s sizzlin’ hot.  And I want to make note of the authors on this paper. They are among some of my very favorite researchers in our profession. There are lots of them but in particular Rober Vining, Ian Coulter, Katherine Polhman (former guest) and Christine Goertz (also a former guest) Yay for these folks. They are working for you every day. 

Why They Did It

This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 

  1. Worst pain intensity from a numerical pain rating 0–10 scale, 
  2. 24-item Roland-Morris Disability Questionnaire (RMDQ); and 
  3. Global improvement (modified visual analog scale).

How They Did It

  • It was a pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC).
  • Three military treatment facilities
  • 750 active-duty military personnel with low back pain
  • Linear mixed effects regression models estimated the treatment group differences. 
  • Coefficient of repeatability to estimate significant individual change.

What They Found

The researchers found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the Roland-Morris Questionnaire score. 

Wrap It Up

Findings from this pre-planned secondary analysis demonstrate that chiropractic care impacts health-related quality of life beyond pain and pain-related disability.  Further, comparable findings were found between the 24-item Roland-Morris Questionnaire and the PROMIS®-29 v1.0 briefer scales. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

del Pozo Cruz B, A. M., Naismith SL, Stamatakis E, (2022). “Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK.” JAMA Neurology.

Ron D Hays, P., Zacariah K Shannon, DC, MS, Cynthia R Long, PhD, Karen L Spritzer, BA, Robert D Vining, DC, DHSc, Ian D Coulter, PhD, Katherine A Pohlman, DC, MS, PhD, Joan A Walter, PA, JD, Christine M Goertz, DC, PhD, (2022). “Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial.” Pain Med 23(9): 1550-1559.    

Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain

CF 243: Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain Today we’re going to talk about Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #243 Now if you missed last week’s episode, we talked about effectiveness Of the Neck Exercise For Disc Herniation and Supine vs. Prone MRIs. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We have been flying all over the place this year. Honestly, I’m making up for lost time during the pandemic. 3 trips already to Florida this year for Kevin Christie’s MCM Mastermind group and another in November to meet the crew in Key Largo. Pumped about that one! As a part of the Forensics diplomate, I go to Chicago every October so we’ll be up there in a couple of months.  Not to mention trips to Texas Chiropractic Association functions. There are at least two a year for that. One in June and one in February or March.  Now, with my VoiceOver career going little bananas, I have a vo conference that I just go back from in Dallas and one in Atlanta in March.  And then anything we want to do that is not work-related. Like, go to Vegas on September 8th to see Motley Crue, Def Leppard, Poison, and Joan Jett. Can I get a hell yes from my fellow 80’s kids? Plus, I want to start visiting some of the practices of the docs in the MCM Mastermind. I’m interested in seeing what they do to make them so efficient and so successful. I can always learn from others. 

This brings up a point; have any of you considered identifying you colleagues that are highly productive and very successful and asked them if you can go and hang out and visit for a day or two just to see what they do that you could possibly implement in your own clinic? We can sit in a mastermind and exchange ideas and processes but at the end of the day, it’s when you see it all in action that it sticks and effects change in how you practice and how you manage your patients. 

So, I want to start fitting in some trips when I can find some space. Right now, I’m not sure where the heck I can make it fit to be honest. But, it is an investment in my company and in my clinic so I’m going to see if I can make it happen, regardless.  I’ll keep you updated. Getting a mentor is key folks. Even if the mentor come in the shape and form of several of your colleagues. 

Item #1 This first one is called “Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data” by Davis, et. al. (Davis BA 2022) and published in Journal of Chiropractic Medicine in June of 2022, Kapow!! That’s got some heat on it. 

Why They Did It The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care.

How They Did It

  • There were 217 individuals who met the inclusion criteria. 
  • We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. 
  • We included those who received chiropractic management from January 1, 2010, to December 31, 2018. 
  • Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). 
  • The minimum clinically important difference (MCID) was set at 30% change from baseline.

What They Found

  • The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction.
  • The mean score change for Back Bournemouth Questionnaire was 14.7 points, representing a 35.9% reduction. 
  • The percentage of participants reaching the minimum clinically important difference for the NRS was 57% and for the Back Bournemouth Questionnaire was 59%, with 41% of the sample reaching the minimum clinically important difference for both the NRS and Back Bournemouth Questionnaire.

Wrap It Up

This retrospective review revealed clinically and statistically significant improvement in NRS and Back Bournemouth Questionnaire scores for this sample of older male U.S. veterans treated with chiropractic management for chronic low back pain. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

This last one is great and is called, “Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims” by Anderson, et. al. (Anderson BR 2021) and published in Journal Of Manipulative And Physicological Therapeutics on November 1, 2021, and it’s just hot enough!

Why They Did It The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

How They Did It

  • They performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. 
  • The 3 care patterns analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. 
  • The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. 
  • They considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. 
  • Modified-Poisson regression modeling was used to determine relative risk of escalated care.
  • There were 83 025 claims that were categorized into 10 372 unique patient first episodes. 

Wrap It Up

  • For claims associated with initial episodes of back pain, initial spinal manipulative therapy was associated with an approximately 30% decrease in the risk of imaging studies, injection procedures, or back surgery compared with no spinal manipulative therapy. 
  • The risk of imaging studies, injection procedures, or back surgery in episodes in the delayed spinal manipulative therapy group was higher than those without spinal manipulative therapy.

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

Anderson BR, M. S. (2021). “Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims.” J Man Manip Ther 44(9): P683-689.  

Davis BA, D. A., Golley DJ, Chicoine DR (2022). “Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data.” J Chiropr Med 21(2): 77-82.    

NSAIDS And GI Events & Chronic Pain In The VA System

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

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

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #181 Now if you missed last week’s episode, we talked about Sitting on your butt and what that’ll get you and we talked about catastrophizing MRI results. Both for the practitioner as well as the patient. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. New Orleans was great. We stayed a little longer than we normally do but it was good. They acted like it’s been a bit of a ghost town down there since COVID came along. Restaurants were still closed and some of the ones open were understaffed. The door guy at our hotel was trying to hire our Uber driver today on the way to the airport. Life is getting there but it is most definitely not back to normal and business as usual just yet. We’ll get there though.  Priorities. Let’s talk briefly about if. Here’s some honest talk about what ‘I didn’t have the time” really truly means. This is actually a blog I just wrote for my personal website but it’ll work for you as a chiropractor and business owner as well.  We all seem to be short on time, don’t we? Emails, notifications, pings, bells, chimes, and phone calls just to name a few. It seems that we are always on call and expected to respond.  That goes for our actual jobs but it goes for our personal lives too. Social media alerts alone are enough to make a person lose it.  So when someone says, “You know, I just didn’t have the time,” you want to believe them. Because it makes sense. Life has just gotten very busy and more complicated than it has ever been before. Weren’t computers and technology supposed to make our lives easier? But then you remember that people still make time to go to the movies. They make time to go out to eat. They make time go to the park with their kid. At least they should be! When it comes to observing my own kids, they make time for friends, sitting around on their phones, or lounging and watching TV. Time is available. It may be in short supply for some of us, but it is most definitely available. I heard a saying once that went like this, “Saying that you didn’t have time to do something is just a less abrasive way of saying that it wasn’t a priority.” That hit me between the eyes.  Because it’s so very true. I’ve seen this in my kids’ and acquaintances’ actions and I’ve seen it in my own actions. When I’m interested in something and when I really want it, I can typically make it happen. Because it’s a priority. It’s a focus and our focus goes where energy flows. Or something like that I’m sure came from Tony Robbins. When I want to get better at one of my hobbies, I obsess a little about it and I make the time for it. The point is, when it’s important, we make it a priority and we make the time. We get it done. Stop using a lack of time as an excuse to not get the things done you know need to be done. Maybe it’s marketing. Maybe it’s calling that one attorney you need to speak with but don’t really really want to speak with. Maybe it’s going to a Chamber of Commerce event. Maybe it’s writing that blog or starting that podcast you’ve wanted to start for a while.  Make it a priority. Make the time. Item #1 This first one is called “A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain” by Kikuchi et. al. [1] and published in Pain Medicine in May of 2021.  Hot stuff, coming up.  Why They Did It The authors say the reason for the paper is that the real-world burden of gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in Japanese patients with osteoarthritis (OA) and/or chronic low back pain (CLBP) remains unreported. How They Did It
  • Used the Japanese Medical Data Center database to retrospectively evaluate anonymized claims data of medical insurance beneficiaries employed by middle- to large-size Japanese companies who were prescribed NSAIDs for OA and/or CLBP between 2009 and 2018.
  • 180,371 patients were included in the analysis
  • 32.9% had OA
  • 53.8% had CLBP
  • 13.4% had both OA and CLBP
  • NSAIDs were administered as first-line analgesics to 161,152 (89.3%) of the patients in the sample
What They Found
  • The incidence of GI events was 9.97 per 10,000 person-years
  • The risk of developing GI events was high in elderly patients and patients with comorbidities and remained similar for patients receiving oral vs. topical NSAIDs
  • Longer treatment duration and consistent NSAID use increased the risk of GI events
Wrap It Up NSAID-associated GI toxicity imposes a significant health and economic burden on patients with OA and/or CLBP, irrespective of whether oral or topical NSAIDs are used. Well, that’s what it’s about isn’t it? It’s about getting people well without the use of drugs or surgery if possible. I’m not advocating never using medicine. Medicine is vital to our health and our lives but let’s don’t pretend they don’t have consequences. They do. Even the mild ones.  CHIROUP ADVERTISEMENT Item #2 Our last item today is called “Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study” by Leonard et. al. [2] and published in Pain Med on September 24, 2020 and that’s just hot enough! Why They Did It Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers’ and administrators’ perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. How They Did It
  • They conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments.
  • Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis.
  • They interviewed 49 participants from 25 facilities from April through September of 2017
What They Found
  • They identified three themes
  • First, the Veterans Health Administration’s integrated health care system is both an asset and a challenge for multimodal chronic pain care
  • Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment.
  • Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients.
Wrap It Up Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources. I know where we fit in. IF they’re using an evidence based, patient-centered chiropractor in the mix, their patients are getting off of the pharmaceuticals, they’re sleeping better, they’re not thinking of suicide as much, and they’re beginning to become a part of their lives again.  I see it all of the time because we see veterans straight from the VA. You’re getting it from he horse’s mouth. We make such a difference in these people’s lives. But we still battle that BS all of the time don’t we? No matter how good you try to be, you still have that jackass primary somewhere inside the system spoiling the water. Locker room poison. Just bashing chiropractors when they don’t have any experience themselves regarding the things they’re saying.  Keep trudging though. If we were wrong, we’d have been eliminated generations ago.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography 1. Shogo Kikuchi, M., PhD, Kanae Togo, PhD, Nozomi Ebata, Koichi Fujii, MD, PhD, MBA, Naohiro Yonemoto, PhD, Lucy Abraham, MSc, CPsychol, Takayuki Katsuno, MD, PhD,, A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain. Pain Med. 22(5): p. 1029-1038. 2. Chelsea Leonard, P., Roman Ayele, PhD, MPH, Amy Ladebue, BA, Marina McCreight, MPH, Charlotte Nolan, MPA, Friedhelm Sandbrink, MD, Joseph W Frank, MD, MPH,, Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. Pain Med, 2020. 22(5): p. 1167-1173.  

Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

CF 146: Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

Today we’re going to talk about the success of the VA in reducing prescription opioid use – psst, guess who has helped them do that? And we’ll talk about diagnosing and testing for stenosis.

But first, here’s that sweet sweet bumper music

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

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

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

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #146

Now if you missed last week’s episode , we talked about how even kids can hurt. We talked about manipulation for lumbar radiculopathy. And we talked about the lack of attention found on the chiropractic boards for biopsychosocial issues. 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. 

Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

 

On the personal end of things…..

To kick off on a cool note you’ll all appreciate, I have a patient that is a med school student that has had amazing results for a pretty significant and lingering disc injury. Your truly opened his eyes to the power of what an evidence-based chiropractor is capable of and it’s paid off for him and, the more of the younger docs that experience something like he has with chiropractic, the more accepted the evidence-based faction of our profession becomes. And the more accepted, the more referrals we get. 

That’s not the good news I wanted to share though. The good news is that he said in one of his classes last week, when they were talking about back pain, manipulation was recommended. In med school. Did you freaking A hear that? Med school is now teaching medical doctors that spinal manipulation isn’t only accepted…..but it’s reco-freaking-mended. 

Bam, Kapow, Zap, Snap, Whack!!

Super hero noises for cool stuff. Hell yeah. 

Moving on, now that school is up and rocking and people are in their normal routines once again, the growth I was talking about a week or two ago is showing to be sustainable at this time. 17 new patients last week tells me we may be slowly getting back to where we were before the Rona. Climbing out of the hole slowly but surely. 

I know all states are different. Here in Texas, as many of you may suspect, is challenging. We probably have A LOT more anti-maskers than many states out there have. We’ve been at work, live…in person since May 1st. Some chiros never took the 2 weeks to step back and see what was up. They just kept motoring through. And….I have to say it looks like they were the smart ones from what I’ve seen. 

I lost out on 2 weeks of work by shutting down completely. Not only that, but from April 1st or so, we were open but emergency only. Honestly…..how many emergencies do we have? We have some but they’re not going sustain my practice. So….I lost two weeks but only doing the emergency thing made me lose a lot of business as well. 

Then, we’re open to everyone and anyone basically on May 1st. Cool, but it took a good while before people started coming in. They knew we closed for a bit and didn’t always know we were back open. Plus, a ton of them were just scared. Understandably. 

So, as with everyone else that follows science, rules, and recommendations, we lost out. For sure. Since I’ve been back at it….again….May 1st, it seems that maybe we could have been safely going the whole time. I could look back and be upset that I followed the rules and that I’m a boy scout like that. But, I’m not going to be. Because how quickly we may forget; it was spooky. Nobody knew the mortality rate. Nobody knew what percentage end up in the hospital or what percentage gets put on a ventilator and how those percentages change from age group to age group. 

We didn’t know anything about it. When you get reports that the death rate is as high as 5% and then a separate paper says it lives on plastic as much as 3 days…..well hell. Please excuse me a sec while my anxiety goes through the roof. I mean, I want to be polite and excuse myself but yeah, the anxiety was going through the roof for myself as well as for the majority of us out there. Not the subluxation slaying spine whisperers of course but for us sciencers….yeah….we were concerned. 

Now we know so much more. We know when everyone in the clinic is masked, we lower our chances of transmission. Life is continuing. Anxiety is still somewhat up there. But life’s continuing as it all seems to work itself out.  The college kid cases are going up all the time. As expected because they’re kids and they’re knuckleheads. As long as they don’t take it home to vulnerable folks, then I don’t see it as harmful. It’s only helpful. 

My daughter has been going to in-person on-campus junior high with over 1,000 fellow knuckleheads. In the first six weeks there have been 2-3 teachers come down with it and about 4 kids. While that may seem a lot to some of you, I see it as a win so far. All of those people in one building together for 6 weeks and that’s all the spread we have? And let’s be fair, I know one of the teachers for sure got it from her husband who brought it home from work. 

To me, it means so far, they are not giving it back and forth to each other at the schools as long as they’re being careful and masking. So far. I really thought they’d all be closed down and go back to strictly online learning by now. I’m still pleasantly wrong. I’ll take it. 

Alright folks Enough Rona rambling. I don’t start talking about it becuase I love the topic. I’ll admit that I do find it all fascinating though. I really do. I’m a bit nerdy about stuff like that. 

Anyway, I talk about it every week because….damnit….that’s what’s going on. It’s the way it is. It’s in my personal happenings as it is in yours as well. So, I might as well talk about it and share with you my experiences, what I’m seeing in my practice, and how I’m muddling through this mess. It’ll either let you know you’re not alone or it’ll show you what you don’t want to do. I’m good either way. As long as you get some use out of it!

Item #1

This one comes from the Office of Public and Intergovernmental Affairs(2020) and is called “VA reduces prescription opioid use by 64% during past eight years.” It was published online on July 30, 2020…..yep…..pretty damn hot. 

This was an article that was basically announcing that t he VA has successfully reduced prescription opioid use in patients within the VA system by 64%. They went from more than 679.000 veterans in 2012 to 247,000 in 2020. 

Lancet Low Back Update & Movement Disorders Mean Pain

 

They say they achieve this dramatic reduction by safer amd more responsible use of opioids but also by treating chronic pain using alternative therapies and treatments. Guess who’s a big part of that? Chiropractors. Yep that’s right. And to be fair…acupuncturists as well. We are getting referrals from the VA for both chiropractic and acupuncture. 

They say, the “VA takes an interdisciplinary approach to care focused on a Veteran’s Whole Health by using non-pharmacological, complementary pain management treatments, self-care, skill building, and support to transition from a biomedical to a biopsychosocial model of pain care. “

How many times have you heard me screaming about the biopsychosocial aspect of chronic pain? A LOT….a lot…

If you follow the link in the article to their list of complementary pain management treatments, chiropractic and acupuncture are the first two listed. Good stuff people. Good stuff. 

They’re just not there yet but wouldn’t have been nice if the title was something like, “The VA system reduces opioids 64% by be smarter and by using chiropractic and acupuncture.” I’m not holding my breath for that day but it really should read just like that. Baby steps I suppose. Itty bitty, teensy weensy baby steps it seems. 

Next paper covers diagnostic tests for stenosis but…

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 one is called “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study” authored by Tomkins-Lane et. al(Tomkins-Lane C 2020). and published in European Spine Journal in June of 2020. Damn hot enough!

Why They Did It

The authors wanted to reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis

How They Did It

  • Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items
  • An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test.
  • Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine
  • Round 2: Meeting of 15 members of Taskforce defined final list of 10 items.
  • Round 3: Survey was distributed internationally, followed by Taskforce consensus.

What They Found

  • 432 clinicians from 28 different countries participated
  • Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty
  • The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. 
  • The diagnostic test selected most frequently as the first test was neurological examination.

Wrap It Up

“This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy.”

Related but on a separate note, the grocery cart sign hints you toward stenosis. If walking through a grocery store just kills the patient but they can lean over on the cart with their elbows and that alleviates the pain….or if sitting removes the complaint fairly quickly, you need to start sniffing up the stenosis tree. 

I am a big fan of Dr. Carmen Amendolia’s program which he was able to validate through research. It’s called the Boot Camp for Stenosis and it’s REALLY turned a very difficult condition to treat into a much more successful outcome for me personally. 

Basically, it’s just a lack of real estate in the canals and this program helps the patient understand the condition as well as self manage after a 2xweek for 6 week protocol. It’s well-thought out and very well done. And easy to do and understand. 

I highly recommend it. Your stenosis patients will thank you profusely.  

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

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About the Author & Host

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

Bibliography

  • (2020). “VA reduces prescription opioid use by 64% during past eight years.” VA US Dept Veterans Affairs.
  • Tomkins-Lane C, M. M., Wong A, (2020). “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study.” European Spine Journal 29: 2188-2197.