VITALISM

Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

CF 163: Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts.  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. 

You have found yourself smack dab in the middle of Episode #163 Now if you missed last week’s episode , we had Dr. Bobby Maybee of the Forward Thinking Chiropractic Alliance and the Chiropractic Success Academy. It was Part Two of a two-part interview that I think you’ll all get plenty of excellent insight and inspiration from. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had the second Moderna vaccine shot on January 20th and all’s well. My experience is that, if you remember, I had zero symptoms with the first shot. Not even a sore arm. Nothing at all.  With this second one, I had a pretty sore arm. It felt like when I got the flu shot. Just a sore arm. It was red for a couple of days too. It was honestly about two days and that was it. I may have been hyperfocused on whether I was having symptoms or not but was maybe a touch tired that day.

I got the shot at 2:30 in the afternoon and then went back to work until 6pm so….I may have been a touch draggy but like I said, that could have just been me being hyperfocused. It wasn’t anything very noticeable.  My wife felt a little crummy for one day. Then she was back at it.  Overall, not a bad deal. They say the full protection is approximately 2 weeks after shot #2 so we’re looking pretty good and, outside of the first two weeks we took off in late March of 2020, I haven’t had to take any days off due to illness and if it all works out, I won’t have to in the future. As a result of COVID anyway.  As I’ve said here, I don’t think it’s unreasonable at all to wait to get yours until you’ve seen how everyone else reacts to it.

I really don’t. I’m not a ‘get your shot instantly’ type of guy. Especially if you have associates that will pick up your slack should you get COVID and be out sick. But when you’re a solo doc like me, the business depends on your presence. I can’t get sick and be out for 2-4 weeks. Some folks are out much longer than that. For me, there’s nothing that makes more sense than getting the vaccine as quickly as possible.  In addition, I have a wife that is 100% over this mess and is ready to go traveling. So, happy wife – happy life in full effect.  Also, I have a local surgeon running advertisements all over TV and it makes me want to punt baby bunnies into the stratosphere.  He says in thw commercial that we all deserve to live without pain and then he goes into his campaign in support of back and neck surgery. Who am I to try to keep someone from marketing their business?

But day-um. One word, two syllables. Day-um. 

Years ago it was illegal to run an ad for hard liquor. You don’t see any cigarette commercials do you?  Now, I’m not saying surgery is equal to cigarette smoking and hard liquor but I know several that have done worse through one surgery they they would ever do from a life of smoking and drinking.  I see that commercial come on TV and I start talking to the TV. I have a strongly worded conversation with the TV every time. It’s because I know that there’s little to no support for spinal surgeries in the research and there’s not better outcomes from them either. The problem is that the common, every day patient does not know that. 

They see the damn white coat and lose their damn minds and just say, “OK.” A pharma commercial could say that you butt could fall out of you walking across a room if you take this medicine and people would still line up for it.  You tell them we’re going to get you moving and exercise and they think you’re dangerous or crazy. It’s a conundrum.  Alright, let’s get to the good stuff shall we?

Item #1

This first item is called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. al(Whedon JM 2020)….there’s that Whedon name again. It was published in Pain Medicine in December of 2020 and that a lot hot

Why They Did It

Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.

How They Did It

  • The total number of subjects was 101,221.
  • It was a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain.
  • We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).

What They Found

Overall, between 1.55 and 2.03 times more non-recipients filled an opioid prescription, as compared with recipients.  Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. CHIROUP ADVERTISEMENT

Item #2

Alright, I’m going after vitalists a bit here today in item #1. I came across a script and I just can’t ignore this stuff anymore. If we’re not willing to call it out, then we are complicit. And I refuse to be that. In fact, if you have any of these scripts you’ve been given from vitalist gurus, please email them to me at dr.williams@chiropracticforward.com I would love to read them on future podcasts and discuss my disdain for the tom foolery within. 

This script is to be used when a patient hasn’t been in for a while. It’s basically used to scare the holy hell out them and force them back to your office because…..you know…..they depend on you to keep them healthy and there are no other means of keeping one healthy outside of the removal of the magical subluxation.  So, here is the script: Dear Patient I have been thinking about you! (with an exclamation mark because, you know….bilking and scaring people is super exciting and all). I realized I have not seen you in a while.

So, I reviewed your file and looked at your last x-ray.  I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.  This means that your nerve is unable to alert you to a problem that is potentially developing…. That’s not emotionally manipulative at all now, is it? It would be like cutting the wire to your fire alarm when your house is on fire!!! OMG!! Cutting….it sounds so awful!! 

The alarm can’t warn you of the fire in time to get out of the house, Holy s-word!!! That must mean I’m going to burn the hell up then. I better call this knucklehead’s office and be seen before I look like a crispy curly fry!! Gimme a damn break. I can’t believe professionals are sending out garbage like this.  It continues; Another sign of spinal degeneration is the loss of flexibility. You lose files without being aware of it. You begin to turn with your shoulders instead of using your neck.

You lift with your back instead of bending your knees. You should have enough flex to enjoy your life. This means you should be able to get out of bed in the morning without feeling stiff or sore. It means you can do the things you enjoy in life. You should be flexible enough to exercise and enjoy your hobbies and leisure time including sitting down to watch your favorite TV programs without being stiff when you get back up. 

The most serious effect of spinal degeneration is loss of vitality. Oh that sounds horrible. Not vitality!!  You should feel healthy!! Yes, you should but you can do that by making yourself move and exercise and eat better while getting a good amount of sleep. You don’t need a chiropractor to feel healthy.   You should have a sense of wellness and energy. You should be able to get out of bed ready to go. You don’t feel this way when your systems do not function properly. You feel that something is just not right but you can’t quite put your finger on it.

You feel stressed and tense. Yeah….like 100% of every other American on this planet.  Last paragraph of the garbage. 

I have set aside the next month for you as “Welcome back to Chiropractic month.” Damn, that’s so nice. They set aside a whole month for me. Sweet bastards. 

Do yourself a favor and call our office to schedule a visit. I will perform a ‘back to chiropractic adjustment and exam including x-rays if needed at no cost.’ Way to value you treatment, doc!! This visit has a normal valued of up to $175 and is yours absolutely FREE during the next month. It’s my way of encouraging you to get back on track and avoid the consequences of spinal degeneration. Please bring the enclosed ‘back to chiropractic’ coupon with you when you come to the office. I look forward to seeing you again soon! Now, if you can read through that without throwing up, congratulations. You have a stomach of iron.

Secondly, if you ever hear a vitalist claim they do not use scare tactics to take advantage of their patients, they’re simply not being honest. In essence, that’s exactly what the subluxation theory is in the first place. IT’s a scare tactic. The silent killer, right? You’ll get sick, you’ll be unhealthy. You’ll develop degeneration. Not because of the consequences of normal freaking aging but because you had all those subluxations all up in ya. 

Talking about the person and using the word ‘you’ is a sales tactic. They use the word ‘you’ or its variants 39 times in that mess of a sales letter.  Can I say that I’m not sure I’ve gotten a birthday card from my family MD much less a scare tactic-laden sales letter.  We can do better than this folks.

Crap like this make us all look like fools. Not to mention what it makes the ones sending their crap out look like. They look like bozo the clown in full makeup, y’all.  “I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.”

Come on man. Spinal degeneration is a normal part of aging. You quit building bone and then you start to regress over the years. This is natural. Stop making patients believe they have to depend on you. It’s not right and if the state boards have any teeth on this kind of garbage, they should start using it. That’s if chiropractic is ever going to step its game up.  We are better than this. When you and your heart and your business are built on things like, honestly, ethics, character, education, and love……you could never in your life send out something like that.  When you are built on selfishness, low-character, deceitfulness, and an anything to get ahead, then you’re more than happy to send it out and you won’t think twice when they come in because you scared them and then you scare them into treating every other week for the next year with upfront payment, blah blah blah. How do these types of practitioners live with themselves?  The absolute worst are the ones that claim it’s a God thing.

If they don’t come in and get their regular adjustment, they can’t allow God to express his true power in their body’s? Oh….is that right? The dude we Christians claim created the world and man in his own image……the dude controlling everything on Earth and beyond…..that dude needs a chiropractor to adjust their patients all of the time because he didn’t make quite perfect enough. The hell you say.

Remember, I’m a Christian. I can make fun. The hypocrisy in this type of practitioner is about as low as it gets for me.  All of these practitioners have big houses. No doubt. But at what cost personally and to our profession?  We’re better than that. Stop it dammit. Stop it now

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 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.

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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 Whedon JM, T. A., Kazal L, Bezdijian S, (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  

Chiropractic Misinformation, Patients Need Movement & Love

CF 157: Chiropractic Misinformation, Patients Need Movement & Love

Today we’re going to talk about misinformation on the part of chiropractors during the COVID pandemic, we’ll talk about three papers covering pain and how patients need a little love while they also need movement and physical activity. 

But first, here’s that sweet sweet bumper music

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 #157. The first episode to kick off our 4th year in the podcasting business. To be 100% honest, it doesn’t seem like I’ve been doing this for that long. It’s crazy to think about. 

Now if you missed last week’s episode , we talked about our Top Ten episodes over the previous 3 years. It was our 3rd Year Anniversary episode. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had a pretty decent weekend. Still just staying in and being smart. We drove around and looked at lights with the kiddos. More just to get outta the damn house and do something different. The wifey, myself, and the two kiddos are about ready to give each other the People’s Elbow from time to time. People are all like….COVID is a time we get to slow down and reconnect with our families. 

I’m all like, I’d like to connect with some of them. Physically. With my hands and tinged with some level of aggression. Lol. It’s hard as a parent to watch your kids waste away into boredom and just allow it to happen. I’m a big believer in doing things. Creating things. Being busy on some level. I believe an idle mind is a dangerous thing. So, I’m the parent telling them to get the hell up and make something of themselves. Maybe it’s me or maybe it’s my generation. Generation X is a generation of do-ers I believe. 

Either way, they get tired of me urging them to do, to make, or just to freaking be. Be something! No, you can’t lie on your bed reading fictional books all day long. Maybe for an hour or so at night before bed instead of the xbox. That’s a good time to read don’t you think? Not for hours smack dab in the middle of the day. 

I’m a big believer in art of all forms. So they get pushed to play the guitar, the piano, draw something, paint something. Write a story or a poem. Freaking create something. ANYTHING! Just don’t lay or sit around like a lump on a log all day. I won’t have it. I won’t create lazy bums to put out into the world. I just won’t. Yeah, it probably sucks to be my kid. I know. I admit it. My daughter is a 7th grader and I’ve already got her learning the discus. Pumping my own tires for a second here, I won state here in Texas in the discus and went to state in the shot put so I love re-visiting those days by coaching others. My son had no interest but Joss….she’s in and she’s doing great! My son, I’ve got him on the guitar and piano and he’s doing great too. All I ask for is activity and some progress. That’s all. 

It actually snowed in Amarillo this weekend. Yes, we get snow somewhat regularly in my part of TX. We’re in the northern plains of Texas. We are flat and there are really no trees unless someone planted them. But we do have the nation’s second largest canyon called Palo Duro canyon and it’s awesome! If you’re ever close to Amarillo, you gotta check it out. Well worth it.

I’m typing this up on Monday morning 12/14. I saw on the news this morning that the first healthcare workers are getting the vaccine today. That’s pretty dang exciting. I already called my doctor buddies here in town and told them that when they feel it’s appropriate for us to have one, my wife and I would love to be on their list. I know a lot of folks are freaky about the vaccine and here’s my deal; by the time it’s my turn, any adverse events will already be well-known. They started in the UK las week. Adverse events are pretty much sorted out in about 8 weeks. 

I’m tired of it. I’m over it. I’ve said it before here but, if I get the Rona, I have to shutter my clinic for 2-4 weeks. I can’t afford that. Well, technically, I can afford it but it would drain resources that don’t need to be drained if I just try to stay smart and healthy. So why wouldn’t I do everything I can? Besides that, I’m ready to get back to my life. Traveling, building things, and moving forward instead of this stagnate state we’ve all been in for 8 or more months. The vaccine is the first real step out of it. 

I am so over other chiropractors out there. One of the vitalists I talked about and was ashamed of in Episode 153 called Some Chiropractors Could Be Better…..well that Flat-Earther has been on his Facebook railing against the vaccines and acting like he is an epidemiologist and trained in the safety and efficacy of vaccines. 

He wasn’t. I went through chiropractic school. Other than chiro philosophy, no real education on vaccines was had and certainly not enough to pretend to be an authority on them. One way or another. For or against them. So why the hell are so many wading out into those waters? Just stay the hell out of the discussion. It’s so dumb. It really is. 

Can  you imagine telling a young mother their baby doesn’t need the measles vaccine because your magical powers of subluxation slaying will protect them by boosting their immune system? And then the baby actually gets measles?

Why in the hell would you want to put yourself or that mother and baby in that position. Just shut up. Back off. Stay in your lane, pal. You’re not that cool. Same goes for COVID. Do you really want to be in the position of telling your patient they really shouldn’t take that vaccine because you’re a spine whisperer and detecting subluxations protects from viruses if they’ll just come to see you every week for the rest of their lives? First you create dependency on YOU. That’s not right and it’s damn sure not evidence-based. Good for the ol’ wallet though isn’t it?

Second, you weren’t trained on it. So back off. 

Third, can you imagine that patient getting it anyway and, God forbid, dying from it. What if that patient mentioned to their family members that they weren’t getting the vaccine because Dr. Jackhole told them they didn’t need it and shouldn’t take it. Would the family have a legal claim against you? My opinion is hell yes they do and you should be calling your malpractice carrier to see how to handle it. 

The point being. Just remove all of that by keeping your mouth closed and staying out of vaccine discussions. It’s completely appropriate to say that getting it is an individual choice and they should talk to their doctor about the risks vs. the benefits and take it from there. Because that really is what they should be doing. 

This vitalist and others like him are going to get more people killed because they love themselves on a level that leads them to believe they have all of the answers. They don’t. In fact, when they’re recording selfie videos of themselves walking around their offices or sitting and driving in their cars, they look insane. Crazy-eyed insane people. 

Enough of that. I made my point. Some of you listen enough or we’re friends on Facebook so you know that I’m an artist of sorts. Guitar singer songwriter, charcoal drawing and portraits and sculpting. I’ve been sculpting a race horse lately and I did the bridle and saddle this weekend. Looking back on it, I may rather take a swift kick in the cajones then repeat that. Geez. Straps, buckles, loops, cuss words. But, it’s shining up finally. If you want to follow some of my artistic escapades on Facebook, go like and follow River Horse Art. It’s fun. If nothing else, I’m keeping life interesting at the very least.

Another thing totally unrelated to chiropractic is Hot chocolate bombs. Here’s a tip from your Ol’ Uncle Jeffro. Be damned careful what you put on FB during the holidays people. My wife Meg and daughter Bitsy… her real name is Joss….they were making these things and I shared it in FB just to brag on them a bit. They were just making them for family and friends and they are pretty cool.I’m on Weight Watchers…down 33 pounds now…and so I can’t indulge but I did share one with my wife and they are absolutely sinful, people. Holy cow. They’ll make your hair stand up. 

Anyway, now it’s an overnight success business sort of thing. Geez. She has orders for about $300 worth of these things and a guy that may order around $1500 worth of them for his business connections and marketing purposes. What in the holy chocolate hell? So now I have a factory in my kitchen with two bumblebees buzzing all over it. 

In business, you have probably heard me mention that we have been down since the second spike hit. Down quite a bit. I used to gripe that my new norm was 145 a week rather than my pre-COVID average of about 190 per week. Well, turns out it could get worse. We’ve been averaging about 125 a week since the second spike came on BUT…..but….this week is starting off right with 41 and four new patients today. Fingers crossed. 

I told you we did a radio run and, believe it or not, people are starting to tell me they’ve been hearing our ads. Which is encouraging. It’s still too early for me to share what we’ve done and it that’s why this week is better. I’m not sure the powers at play just yet. I’m going to keep monitoring it and will let you know.

Enough, let’s get to the research, shall we?

Item #1

This first one is new and it goes with one of my talking points in the intro section. It’s called “Misinformation, chiropractic, and the COVID-19 pandemic” by Iben Axen, et. al. and published in Chiropractic & Manual Therapies in November of 2020. Hopping jalapeños that’s hot!

Why They Did It

Before we get to why they did it, I think we all know. Yes, we know. If fact, look, I knew people were crazy before COVID. There are just crazy people out there in the world. That’s a given. But I had no idea how many truly crazy and impressionable people there really are until this pandemic. Holy huge balls of insanity, people. I have seen the most disappointing stuff coming from people. Not just chiropractors but definitely some chiropractor as well. No doubt. They crazier than bed bugs. Crazier than a craphouse rat. 

They begin by saying, “During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements.

We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.”

Despite this grave situation, some chiropractors have advocated a misbelief that spinal manipulative therapy (SMT) or “adjustments” can boost immunity and thus should be offered as a preventive measure for viral infections. The World Federation of Chiropractic (WFC) noted this development on March 17th 2020 and refuted this in a public statement: “… .there is no credible scientific evidence to support this notion and to suggest otherwise is potentially dangerous to public health” . Nevertheless, some chiropractors continue promoting misinformation on social media putting the chiropractic profession at odds with scientific evidence.

The chiropractor (and I use that term loosely) I discussed is 100% one of these people. Geez, he’s embarrassing. But he takes videos of his huge pool and big backyard he got from seemingly bilking the holy crap out of impressionable patients and young dumb chiropractors but whatever.… 

Anyway…they say that the estimate is that 20% of the chiropractic profession has the vitalist, faith-based, philosophy, I’m going to pop this and protect you from virus approach to taking advantage of patients. I mean….going about their business. 

They say, “Misinformation about adjustments and immunity taints public understanding of viral prevention, undermines the coordinated efforts of health authorities, and has become a cause for concern among researchers and public health authorities”

Wrap It Up

Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.

CHIROUP ADVERTISEMENT

Item #2

This one is called “Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis” by Guzman-Pavon, et. al. (Guzman-Pavon MJ 2020) and published in Pain Medicine on October 4, of 2020. Sizzlin’ succotash! It’s hot!

Why They Did It

Remember, this is a systematic review and meta-analysis and those are at the top of the research pyramid. They’re mostly reliable. 

They say, “Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points.”

How They Did It

  • A systematic search was conducted in Pubmed, Web of Science, and Scopus.
  • Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included
  • 24 randomized controlled trials were included

Wrap It Up

Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.

Let me just tell you that physical exercise programs are absolutely effective. Not just in the physical sense but in the biopsychosocial aspect as well. When people are gradually moving more and gradually building their confidence in movement and their abilities, the brain, or the centralized part of the pain experience is affected in for the positive which brings the pain level down overall. It’s just fascinating but in short, moving means more than just physical activity when we’re talking about pain. 

Item #3

Item #3 here is called “Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain” by Shiri, et. al (Shiri R 2020) and published in Pain Medicine on November 11, 2020. Which makes hotter than a habanero. And that’s real hot. 

Why They Did It

To estimate the effects of excess body mass and leisure time physical activity on the incidence and persistence of chronic pain.

How They Did It

A prospective cohort study.

three cohorts of employees of the City of Helsinki (18,562 observations) and defined incident chronic pain as having pain in any part of the body for more than three months at follow-up in participants without chronic pain at baseline. This was a great sample size. 

Persistent chronic pain was defined as having pain for more than three months at both baseline and follow-up

Wrap It Up

As if we didn’t know this already, they say, “Obesity not only increases the risk of developing chronic pain, but also increases the risk of persistent pain, while leisure time physical activity reduces the risk of developing chronic pain.”

Now consider the obesity issue in America today. 

Item #4

And finally, our last one is called “Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain” by Penn et. al. (Penn T 2020) and published in Pain Medicine on April 24, 2020 which is hot enough because it just came out in the November 2020 issue. It’s not steaming but it is indeed very hot. 

Why They Did It

For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Just for the record here, Dr. Stuart McGill and his mustache would call total BS on the idea that nonspecific back pain exists. He’s say you just aren’t looking hard enough. 

Anyway, they go on to say, “Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP.”

And honestly, these are things I haven’t considered before and I think it’s interesting as hell. 

How They Did It

Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function.

What They Found

  • Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity and physical function. 
  • Greater chronic pain stigma was associated with greater perceived injustice, which in turn was associated with greater movement-evoked pain severity. 

Wrap It Up

“These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.”

So, today’s take-aways…..

  • Be a science driven healthcare leader and practitioner. Don’t be crazy because you look insane and you make everyone else in your profession appear to be insane as well. That’s just rude as hell. Especially when you’re proving Parento’s Law by just 20% of you making the rest of us look like crazy people. We don’t appreciate it. Stop it now, dammit. 
  • Love your patients and if you worry about the outcomes, you won’t have to worry about the income
  • And get them moving. 

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. 

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 & Vlogger

Bibliography

  • Guzman-Pavon MJ, C.-R. I., Martinez-Vizcaino V, (2020). “Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis.” Pain Med 21(11): 2986-2996.
  • Penn T, O. D., Aroke E, (2020). “Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain.” Pain Med 21(11): 3161-3171.
  • Shiri R, L. T., RAhkonen O, Leino-Arjas P, (2020). “Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain.” Pan Med 21(11): 3092-3101.

Giving, Maintenance Care, Dry Needling, and Vitalism

CF 132: Giving, Maintenance Care, Dry Needling, and Vitalism Today we’re going to talk about Giving, Maintenance Care, Dry Needling, and Vitalism

 

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 #132

Now if you missed last week’s episode , we talked about 5 principles to change clinical practice. There was some great information in that one all based on a recent paper that came out. 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…..

One foot in front of the other. I’ve been thinking a lot lately. I know this concept but I don’t do it intentionally. Still….I definitely do it. I give away stuff and help others when I like them, their product, or service. I promote them without expecting anything in return. Because I don’t expect anything in return. I do it because of the reasons stated. 

Then, what happens is that through giving to others, things come back around and are given to you. That’s the way it works. Again, I don’t give to get something back.  To me, that’s just not how it works. You have to give because you have a giving heart. Not a greedy heart just giving to get. 

I talk about people that I believe in and things that I use because I like them and I think they’d be useful to you. I talk about other people’s stuff more than I talk about my own stuff. I have some awesome evidence based patient education brochures and posters on our website but I talk more about Forward Thinking Chiropractic Alliance than you hear me talk about my stuff. 

If you’re evidence-based, I firmly believe you need to be a part of the FTCA. It’s that simple. We had Kevin Christie with Modern Chiropractic Marketing Podcast on a couple weeks ago. He does it right. That’s why he was on. I believe in Dr. Christie, I like Dr. Christie, and I support him. 

ChiroUp, not only do I really like the co-owners personally, but I don’t know what I ever did without the product. Honestly, I have no idea. I was less than before I had ChiroUp in my office. 

It’s why you always hear me speak about the diplomate/fellowship through the international academy of neuromusculoskeletal medicine. I’m not sure I’ve ever professionally believed in anything more than the education you get through them. 

It’s why I talk often about involvement with the Texas Chiropractic Association. It’s because I hope you’ll see the value in being active and involved in your own associations. Doing so was one of the key gamechangers in my professional life. You can count on that. 

Same goes for philanthropy. If you’re not giving back to your local non-profits monthly, you really should consider doing so. It’s easy and it’s fun. We’ve made it a cornerstone of my personal business. 

This isn’t a ‘oh look at me and how awesome I am’ thing here. It’s just an honest conversation about something I was thinking the other day. Does any of this come back to benefit me financially? I don’t know. I really don’t have a clue. And honestly, I don’t care. Once again, that’s not why we give. We give because we have a giver’s heart. Not only do I like and believe in the people and the products or the causes, but I also think that our listeners will find value in it. If I’m providing you value, then you know you’ll get the best, most valuable information through this podcast. 

So, maybe, even if others aren’t necessarily talking us up or pumping our tires, it still comes back, huh? Either way, there’s nothing better than giving. At least for me. I came across a quote that made some sense recently. Pablo Picasso said that the meaning of life is to find your gift. The purpose of life is to give it away.” That’s a giver’s heart. Exactly what I’m talking about. Seems like it worked out for Pablo. 

I think about give vs. take and I think of people that are takers. Taking money from patients when they don’t need the treatment. But a doctor scared them into a ton of extra visits because it’s good for stats and the bottom line. That’s a taker. 

Being in a position to help but deciding to never do anything to help anyone unless it benefits them personally or financially. That’s a taker. 

Just being in the world to see what you can get out of it instead of what you can contribute. That’s a taker. What can you do to make your space better? How can you spread a little love and kindness? 

Just some random thoughts today. Hope it meant something to you. 

Item #1

Let’s get started with this one called “The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial” by andreas Eklund et al(Eklund A 2020) and published in Chirorpactic and Manual Therapies in April 2020. Hot cakes coming up, hot cakes people. 

Why They Did It

Eklund has shown in two previous papers the benefit of treating preventatively but thae benefit varied across psychological subgroups. 

The aims of this study were to investigate 

  1. pain trajectories around treatments, 
  2. recurrence of new episodes of LBP, and 
  3. length of consecutive pain-free periods and total number of pain-free weeks, for all study participants as well as for each psychological subgroup.

How They Did It

A secondary analysis of data from a randomized controlled trial of patients seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with low back pain that limited activity. 

What They Found

  • Patients receiving maintenance care had flat pain trajectories around each new treatment period and reported fewer days with pain compared to patients receiving the control intervention. 
  • The entire effect was attributed to the dysfunctional subgroup who reported fewer days with activity limiting pain within each new LBP episode as well as longer total pain-free periods between episodes with a difference of 9.8 weeks compared to the control group. 
  • There were no differences in the time to/risk of a new episode of LBP in either of the subgroups.

Wrap It Up

Data support the use of MC in a stratified care model targeting dysfunctional patients for MC. For a carefully selected group of patients with recurrent and persistent LBP the clinical course becomes more stable and the number of pain-free weeks between episodes increases when receiving MC.

Item #2

Item 2 is called ‘Dry needling for spine related disorders: a scoping review’ by Funk et. al(Funk MF 2020). published in Chiropractic and Manual Therapies  in May of 2020…..bringin’ the heat people! Bringing the heat!

Why They Did It

The depth and breadth of research on dry needling (DN) has not been evaluated specifically for symptomatic spine related disorders (SRD) from myofascial trigger points (TrP), disc, nerve and articular structures not due to serious pathologies. Current literature appears to support dry needling for treatment of trigger points. Goals of this review include identifying research published on dry needling treatment for spine related disorders, sites of treatment and outcomes studied.

How They Did It

A scoping review was conducted following Levac et al.’s five part methodological framework to determine the current state of the literature regarding dry needling for patients with spine related disorders.

That sound fine and freaking dandy but what the hell is a scoping review vs. a systematic review? Well, I did the work for you and here’s what we have. Within the framework of research methods, a well- done scoping review is considered at a higher level than a straightforward review of literature or an integrative review, but not as in depth as a Cochrane or Johanna Briggs model systematic review

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.

Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. 

And now we’ve both learned something so that’s awesome. 

Wrap It Up

Back to the paper here; I’m not even going to get into the meat and taters here on this paper because you’ll zone off and might even tune out. I have it cited in the show notes if you really want to find it and dive in. Getting straight to the conclusion, the authors say, “For spine related disorders, dry needling was primarily applied to myofascial structures for pain or TrP diagnoses. Many outcomes were improved regardless of diagnosis or treatment parameters. Most studies applied just one treatment which may not reflect common clinical practice. Further research is warranted to determine optimal treatment duration and frequency. Most studies looked at dry needling as the sole intervention. It is unclear whether dry needling alone or in addition to other treatment procedures would provide superior outcomes.”

We covered a paper on dry needling last year that suggested it had little use. It appears it does indeed have some use. They just don’t know how to best use it yet. If that makes sense.

Item #3

Our last one today is called ‘Vitalism in contemporary chiropractic:a help or a hinderance?” by J. Keith Simpson and Kenneth J. Young(Simpson J 2020) and published in Chiropractic and Manual Therapies June 11, 2020. See the sizzle on that stacks of steaming sizzlers.  

Why They Did It

Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today.

Discussion

Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors.

They say that despite the obstacle of vitalism, chiropractic has made extraordinary inroads into the health care system worldwide. Having emerged from the pre-scientific health care era in the United States of America (USA) in the early twentieth century it now has a global footprint with representation in approximately 100 countries. It is the third largest regulated primary contact health care profession in the western world

Conclusion

Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care.

Y’all know by now how I feel about it. When you have someone following current research, updating their procedures and thought process as the knowledge base expands, and taking care of their patients and running their businesses in an ethical way with the highest of morals and love, then you’re my kind of person. I respect you and I’m proud of you. Most of our listeners are that kind of practitioner. 

If you’re scaring people into a bunch of visits based on stuff research says is no big deal, if you’re convincing people they depend on seeing you consistently, if you’re engaging in vaccine discussions when you’ve read a book or two but never been proper educated to do so, when you’re stats and your profits come before the true needs of the patient, then I don’t respect you and I wonder how you sleep at night with the knowledge of how you are screwing and stealing from patients coming to you for your help weighing heavily on your conscience. They come to you for your help. Not to buy you a big house. Not to be lied to. Not to have false, fake, or outdated ideas shoved up their poop shoot and to be taken advantage of. 

Stop it dammit. It’s gross and you give everyone that truly works their asses off a bad name. You’re the reason someone that gets a diplomate or some other significant continueing education ro certification…..you’re the reason they still get laughed at behind their backs. You should be ashamed of what you do to yourselves, your colleagues, and your profession. 

I’m really not a bitchy guy. I’m a fun-loving ‘let’s have a beer’ kind of guy. But very few things grind my geears worse than this stuff. Honestly. It’s the wrench in my gears, the salt in my wound if you will. I think about it and I start breaking out in hives and get all rashy. My eyes about roll out of my damn head onto the floor. 

I’ll be in a better mood next week. I hope. 

Alright, that’s it. Y’all be safe. 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. 

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

 

Bibliography

Eklund A, H. J., Jensen I, Leboeuf-Yde C, (2020). “The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial.” Chiropr Man Therap 28(19).

Funk MF, F.-D. A. (2020). “Dry needling for spine related disorders: a scoping review.” Chiropr Man Therap 28(23).

Simpson J, Y. K. (2020). “Vitalism in contemporary chiropractic: a help or a hinderance?” Chiropr Man Therap 28(35).