CF 303: Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery Today we’re going to talk about Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery
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, 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.
I’m so glad you’re spending your time with us learning together.
Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com
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.
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You have found yourself smack dab in the middle of Episode #303
Now if you missed last week’s episode , we talked about
Spinal Manipulative Therapy And Bezodiazepines & Yanking Someone’s Head Off. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things….. Back at it. You remember when I told you last week that I think we’re on a turnaround after having been out sick and then the next week having to spend half a week in Chicago for the Forensics conference? I think the trend is continuing.
I’m looking at 46 appointments today. That’s including 3 new patient exams, 2 PI intakes, and 3 re-exams. So it’s going to be a busy one today. I’ll be glad when the day wraps up at 6:00 pm this evening. Thursday is looking a little light but it’s 8:30 on a Monday morning right now. We have plenty of time to fill that day out in the next few days.
We had our first cold blast of the year and guess who’s not happy about it? This guy. This guy that love the Summer and green things and birds chirping and shiny happy people out running around and enjoying the warm weather. This guy.
In fact, cold weather and Winter basically piss me off a bit if I’m being honest. It’s terrible. Everything goes dormant, the clocks change so it’s dark before I even get off of work, the cold wind and wet rain and ice and snow…..I’m getting triggered just to talk about it honestly.
So, the point is, it’s a mental battle for me on some very low level. It’s in the background for sure but it’s a battle for me. I hate it and yet, I have to learn to live with it every year and just get through it. Maybe I’m dramatic about it. Sure. But don’t we have our challenges that work our mental state? We’re all different so I’m sure yours is likely different than mine in lots of cases.
Another thing that has been working my mental state is the lack of a good billing company. I tried to have in-house billing for years. I lost almost a million dollars over the course of 3 years because I trusted too much. She didn’t steal. She just didn’t re-submit when denied so once timely filing passes, you’re outta luck. Well, we were outta luck a bunch it seems and by the time I found it, it was pretty far gone.
A lot of beer will get you past something like that.
They don’t share these things with you when you’re going through school but there are some soul-sucking parts to being a clinic owner. What would it be like to just show up and go to work and go home without the worry and the fret of the HR part….the billing and collecting part? What would that all be like??
I don’t know but I’m moving down the path of finding that out. I’m working on a potential partial buyout in the next 6 months. And ya know what? I’m not even nervous about it. Because the business end of it isn’t my special skill. Not my special talent. It gives me loss of enjoyment.
So as I go down that path, I’ll be updating you. It may be something you’ll be interested in as well in the coming years. Especially if you’re 50-something and getting long in the tooth.
We shall see. To be continued.
Item #1 Our first one this week is called,
“Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip” by Okie et. Al. and published in Journal of Bone Joint & Surgery on November 17, 2021.
Okike K, King RK, Merchant JC, Toney EA, Lee GY, Yoon HC. Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip. J Bone Joint Surg Am. 2021 Nov 17;103(22):2070-2079. doi: 10.2106/JBJS.20.02155. PMID: 34550909.
Why They Did It While recent reports have suggested that hip corticosteroid injections can hasten joint degeneration, there are few published data on the topic. The purpose of the present study was to evaluate for an association between corticosteroid injection and rapidly destructive hip disease (RDHD) and to determine the rate of, and risk factors for, occurrence.
How They Did It- This study was conducted in 2 parts. First, to assess for a potential association between hip corticosteroid injection and RDHD, a case-control analysis was performed.
- Patients who developed RDHD between 2013 and 2016 served as cases, whereas those who underwent total hip arthroplasty for diagnoses other than RDHD during the same period served as controls, and the exposure of interest was prior intra-articular hip corticosteroid injection.
- Second, in a retrospective cohort analysis, we analyzed all patients who received a fluoroscopically guided intra-articular hip corticosteroid injection at our institution from 2013 to 2016.
- The rate of post-injection RDHD was determined, and logistic regression was used to identify risk factors for occurrence.
What They Found- In the case-control analysis, hip corticosteroid injection was associated with the development of RDHD.
- There was evidence of a dose-response curve, with the risk of RDHD increasing with injection dosage as well as with the number of injections received.
- In the retrospective cohort analysis, the rate of post-injection RDHD was 5.4%.
- Cases of post-injection RDHD were diagnosed at an average of 5.1 months following injection and were characterized by rapidly progressive joint-space narrowing, osteolysis, and collapse of the femoral head.
Wrap It Up- This study documents an association between hip corticosteroid injection and RDHD.
- While the risk of RDHD following a single low-dose (≤40 mg) is low, the risk is higher following high-dose (≥80 mg) injection and multiple injections.
- These findings provide information that can be used to counsel patients about the risks associated with this common procedure.
- In addition, caution should be taken with intra-articular hip injections utilizing ≥80 mg of corticosteroid and multiple injections.
Before getting to the next one,
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.
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, “Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis” by Alshammari et. Al. and published in Cureus on July 13, 2023 and Damnit that’s sizzlin’ hot!
Why They Did It Degenerative disc disease and low back pain are common challenges that persist even after a discectomy. However, characterizations and quantifications of these illnesses from the patients’ perspective are insufficient. We aimed to perform a systematic review of the literature and meta-analysis to determine the frequency of chronic pain after spinal surgery.
How They Did It- They searched all of the common libraries of research to retrieve articles describing the frequency of persistent back pain, reoccurring disc herniation, and undergoing another operation following primary lumbar discectomy.
- They excluded articles that did not disclose the proportion of patients who experienced ongoing back or leg pain for over six months after the operation.
- They included 16 studies evaluating 85,643 patients.
What They Found The pooled prevalence of persistent pain was 14.97%
Wrap It Up With all advancements in technology and operation techniques, many patients (14.97%) still have failed back surgery syndrome. Appropriate preoperative communication and multidisciplinary and coordinated treatment strategies yielded the best results.
I would argue that it’s actually higher than that. In a book that I highly recommend called Back In Control by spinal surgeon Dr. David Hanscum, he cites research showing that when surgery is performed on a patient with chronic pain syndrome, that person is 60% more likely to develop chronic pain at the new site of injury….the site of surgery. That’s when everything goes perfectly.
I have a friend that is a neurosurgeon in our market and he regularly tells his patient that spinal surgery is about a 50/50 chance of success or failure. I haven’t asked him for research on that but I’m passing the info along as it was passed to me.
Take it or leave it.
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!
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!
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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 (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
