CF 032: How Evidence-Based Chiropractic Can Help Save The Day - chiropracticforward CF 032: How Evidence-Based Chiropractic Can Help Save The Day - chiropracticforward

How Evidence-based Chiropractic Can Help Save The Day

Integrating Chiropractors

Today we’re going to talk about our blessing and our America’s curse, opioids. Why would I ever call opioids a blessing? We’ll get to that. Stick around for some updated info on how evidence-based chiropractic can save the day.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are really starting to pick up some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have Texas two-stepped your way into Episode #32

As I was wondering what the heck I was going to talk about this week, I started looking at having a guest. Well, he was unavailable for a few weeks so now what? 

I started to put some random research papers together for this week’s episode was trying to gather my thoughts on flow, order, and all that good stuff and then…..POOF….it was like divine intervention. In my email box came about 4 or 5 articles on updates having to do with the opioid crisis. ALL IN THE SAME DAY. Pretty much in the same hour if you can believe that!

I’m not one to poo poo blessings or to throw rocks at divine intervention so guess what? We’re going with opioids and the ways evidence-based chiropractic can help save the day by helping our patients avoid them. 

If you have followed the Chiropractic Forward Podcast for any amount of time, or have seen any TV news program, you’ll know that American, and the world, has a bit of an opioid crisis and chiropractic is in the driver’s seat of alternative interventions that have been proven effective in treating the conditions that opioids have been commonly prescribed for. 

I want to start with an article I received from my malpractice carrier and, since I use the largest of chiro malpractice carriers, I’m guessing you all got it too but, if you are like most chiros, just deleted it rather than reading the thing. It turns out that I’m a nerd and I read the thing. It was titled “Opioids Misuse and Addiction: How Chiropractic Can Help(Petrocco-Napuli K)” and written by Kristina Petrocco-Napuli and posted on a site called Clinical Risks on June 13, 2018.

The article started with a story about Megan who was mid 30’s and suffering pain chronic pain four years after being in a wreck. 

As we chiropractors are well-aware of…..evidence based chiropractic care was not offered to her as a viable option for treatment following her car wreck, of course not….right? I mean, the trauma is mechanical in nature so why recommend mechanical solutions? Let’s just go right to the historically ineffective, addictive chemical treatment instead, OK?

So, basically, Megan went through two pregnancies addicted to opioids. She had some success quitting them during different parts of the pregnancies but continued to return to opioids. 

She goes on to cite information from the American Academy of Pain Management that says 100 million Americans suffer from chronic pain. Think about that just a second. Last I remember hearing, there was somewhere around 320 million Americans? That’s about 1/3 of the nation suffering from some form of chronic pain. That’s terrible news but, I’d argue it’s actually great news for chiropractors. Evidence-based chiropractic

It’s like, if we see personal injury patients in our office, we really don’t want people to get in wrecks but, be honest….it’s good for business. It feels dirty just saying that. I know I don’t personally want to see them get hurt but I’m here to help if they need me and that’s how I go about that. Same thing if it’s icy outside. You don’t want people falling and hurting themselves but…….yeah…..it’s good for business. You get my drift. 

We don’t want 1/3 of the nation suffering chronic pain but that also means the opportunities open to evidence-based chiropractic are virtually limitless if we play our cards right.  

I can tell you that we have seen some referrals in my office from a few of the pain doctors in the region that are trying to wean patients off of opioids and can I tell you something? It ain’t pretty. Some are mad at the world. Some are fidgeting all over the place and can’t sit still. Good Lord I’m glad I don’t prescribe and am not getting hit up all of the time for these pain meds. That is a blessing all by itself, isn’t it?

I am an advocate of yours. If you want to practice with adjustment only. Go for it. If you want to integrate…go for it. If you want to further educate yourself, go for it. You should be able to practice and get reimbursed to the extent of your schooling and to the extent of your state’s scope. I’m all for that. 

There was a time I thought it might be cool to prescribe like they do out in New Mexico. Chiropractors over there can go through an extra two years of education and have the ability and right to prescribe some meds to their patients if they feel they need it. I’ve had chiropractors tell me, “That’s not chiropractic.” I get that. That is why it is called an Advanced Practitioner or something of that sort. I don’t recall off the top of my head the official title. Regardless, who am I to hold a brother or sister back that wants to further their education, further their rights, and further their capabilities. You did the work. You deserve the pay-off and I’m on your side. 

However, for me personally, I’m over that. Not only is research showing more and more that that sort of prescription and treatment basically has no more effect than chiropractic, and, on top of all of that research, I don’t want to have to deal with people looking for the meds. I got over that a long time ago. Evidence-based chiropractic

In this article, the author goes on to mention the role of chiropractic which she says are as follows. 

  • Public awareness: Build knowledge on how chiropractic can help with chronic pain as an alternative to medications. We’ve talked about this many times before here on the chiropractic forward podcast
  • Education: Inform other practitioners about chiropractic as a treatment option for patients. This will become increasingly important, given the recent focus on non-pharmacological care. Again, we have screamed this one from the rooftops.
  • Reduce misuse: Help patients locate drug drop boxes for opioid disposal, drug take-back programs, medication lock boxes and testing programs. THIS is one I have not considered. Not at all. I think it’s a great point. If you know how to commonly find these take-back programs and lock boxes, send us an email at dr.williams@chiropracticforward.com and we will be glad to share with others. Right now, without going to Google for more information, I’m assuming a call to your local hospital can probably get this mystery solved for your area. 

Evidence-based chiropractic providers better get off their rears and take action on these points if we’re going to take our place. 

Next, there was this article in the Journal of the American Medical Association titled “The burden of opioid-related mortality in the United States” by Tara Gomes, et. al(Gomes T) and published in JAMA in June of 2018.

Why They Did It

The authors wanted to answer the question, “What has been the burden of opioid-related deaths in the United States over a recent 15-year period?”

How They Did It

  • The study was a cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes from January 1, 2001- December 31, 2016. 
  • For the purposes of this study, opioid-related deaths were defined as those in which a prescription or illicit opioid contributed substantially to an individual’s cause of death as determined by death certificates. 

What They Found

Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42?245 deaths

Overall, opioid-related deaths resulted in 1?681?359 years of life in 2016

Wrap It Up

Premature death from opioids imposes an enormous and growing public health burden across the United States.

We covered a paper some time ago that mentioned the average age of death has actually decreased in America in the last two years because of opioids. 

Remember the uproar Americans were in when we lost a little over 58,000 soldiers in the Vietnam war? Yeah, another paper we reviewed recently estimates over 64,000 death to opioids just last year. See the issue? But chiropractors have been crazy all these years to offer a sensible, safe, and reasonable alternative for treating these people? Give me a freaking break with that stuff. Now, some chiropractors are crazy OK? It’s the fact but, evidence-based chiropractic care can fix this problem and I have zero doubts about it. 

I want to cover this next one briefly just to highlight how damn tone-deaf these people in the medical kingdom can sometimes be. This one is called “Prescription drug coverage for treatment of low back pain among US Medicaid, Medicare Advantage, and Commercial Insurers.” Written by Dora Lin, MHS and published in JAMA on June 22, 2018(Lin D) this article really highlights the issue we are dealing with in America. 

The question the authors looked to answer here was, “Among US insurers, what are the coverage policies for pharmacologic treatments for low back pain?”

How They Did It

  • A cross-sectional study of health plan documents from 15 Medicaid, 15 Medicare Advantage, and 20 commercial health plans in 2017 from 16 US states representing more than half the US population and 20 interviews with more than 43 senior medical and pharmacy health plan executives from representative plans.
  • Data analysis was conducted from April 2017 to January 2018.
  • Of the 62 products examined, 30 were prescription opioids and 32 were nonopioid analgesics, including 10 nonsteroidal anti-inflammatory drugs, 10 antidepressants, 6 muscle relaxants, 4 anticonvulsants, and 2 topical analgesics.

What They Found

Look who the hell cares what they found, OK? Here’s why NONE of it really matters. All they’re doing here is trying to figure out what drugs insurers carry and how to get drugs to people rather than what is effective, what the current guidelines recommend, what The Lancet papers had to say about opioids and nonopioids, what the American College of Physicians have to say is first-line treatment and what is last line treatment for low back pain. Evidence-based chiropractic

How about they do a little research having to do with….I don’t know…maybe doing away with opioids, and anticonvulsants for low back pain…doing away with steroid shots and surgery for non-complicated low back pain….and knocking down the barriers to patients seeking alternative care. Barriers noted and called out by the White House last year and barriers that were set up by CMS and insurance companies. 

How about we do something effective along those lines instead of wasting more time and paper folks? It could not be more exhausting. 

This week, I want you to go forward with comfort. Comfort in knowing that you are where you need to be and you’re there for the right reasons. You are helping people stay away from these drugs. You saving their lives in many cases whether they….or you….know it. We are saving lives folks. Good on you. Keep it up. Keep making a difference. Stay with evidence-based chiropractic care, be patient-centered rather than doctor driven or numbers driven and the money will take care of itself.

Key Takeaways

  1. Opioids haven’t gone away. Pill pushers haven’t gotten the message yet. The issues are still there and they’re real 
  2. Research doesn’t matter unless we educate the medical professionals around us and educate our patients so spend some extra time talking to your patients about the stuff we go through with you right here. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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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Bibliography

Gomes T (2018). “The Burden of Opioid-Related Mortality in the United States.” JAMA Network Open 1(2).

Lin D (2018). “Prescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial Insurers.” JAMA Network Open 1(2).

Petrocco-Napuli K. (2018). “Opioids Misuse and Addiction: How Chiropractic Can Help.” Clincal Risks  Retrieved June 13, 2018, from https://www.ncmic.com/learning-center/articles/risk-management/clinical-risks/opioids-misuse-and-addiction-how-chiropractic-can-help/.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 020: Chiropractic Evolution or Extinction?

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

evidence-based chiropractic

evidence-based chiropractic

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