CF 225: Pain And COVID & Images Can Mislead Today we’re going to talk about Pain and COVID & how in the hands of the wrong practitioner, Imaging Can Mislead 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.   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. 
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  • 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 #225 Now if you missed last week’s episode , we talked about The Complexity & Treatment of Chronic Pain. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. What a damn day folks. What a way to start a Monday. I get to work and have a message to remove the permissions on my page for one of the folks I have helping me with my ad campaign on Facebook.  Turns out he got hacked. Which means everyone he has permission with on social media got hacked as well! Including me. Unreal. So I showed up on a Monday going one direction with a ton of focuse. Next thing you know, I’m headed in teh complete opposite direction afraid I’m going to lose every bit of everything that makes up my professional online presence.  Including my Chiropractic Forward page and Insta. My Creek Stone Integrated Medical, my voice over page, my art page…..everything. I have a botu 22 pages for various things. Furniture building, bands I’ve been in, charity groups, etc.  So, that’s stressful as hell. For that very reason, I’m cutting it short and getting straight to the research. I’ll let you all know how it turns out next week.  Before the research though,  I have a gift for you!  I’m going to turn you on to a system I recently came acros that can result in your getting tons of PI cases from attorneys.  Getting these referrals can be done because it’s how I built my practice in the early days.  Paul Samakow, a veteran personal injury attorney, put this system together.  An attorney telling your how to talk to attorneys – he knows what attorneys want to hear – inviting them to lunch isn’t effective marketing these days.  His system, is delivered to you in both written and video form, and really hits the mark.  Over 25 concepts on how you can not only get attorneys to refer to you, but endear yourself to them. Samakow’s system costs $997 and he guarantees satisfaction or your money back. Which is always a big deal. That guarantee makes a difference for me. You should check it out. Even if you only get one case, you’ve made at least 4 or 5 times the investment. Trust me, I get, on average, about $2500-$3500 per settled case minimum. Lots of time much more than that.  Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs Item #1 The first one this week is called, “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study” by D’Souza et. al. (Ryan S D’Souza 2022) and published in Pain Medicine in 2022 holy smokes it’s hot.  Why They Did It Pain is an often overlooked and underappreciated manifestation during the COVID-19 pandemic. Several permutations of pain should be considered, including: 1) acute pain related to viral infection, 2) exacerbation of preexisting chronic pain, and 3) new-onset pain from post-COVID syndrome. Preexisting chronic pain may worsen, potentially because of lack of health care access, worsening of psychological well-being, unavailability of medications, and other stressors A unique category includes patients without any history of chronic pain who developed persistent pain after recovery from COVID-19 infection [1]. This fits within a syndrome known as “post–acute COVID-19 syndrome” which describes patients who experience persistent symptoms beyond 4 weeks after the onset of COVID-19 symptoms  I have been seeing this A LOT!  Patients who suffer from pain may not be well informed and may turn to publicly available sources for their information needs, especially during the pandemic when in-person health care was less accessible [2]. With the omnipresence of social media and popular broadcast sites, these platforms should be considered vital in disseminating information on COVID-19 [3,4].  Thus, our objectives were 1) to view videos on the YouTube platform as a source of information on pain during the COVID-19 pandemic, 2) to report on their content on the location, type, and chronicity of pain symptoms, 3) to report the overall goal and target audience of the videos, and 4) to critically appraise video quality. Given the novelty of this topic, we hypothesized that the quality of videos would be low and there would be a paucity of videos published by professional societies.  Second, we compared video characteristics between low- and high-quality videos and hypothesized that lower-quality videos would more likely be produced by independent users. How They Did It
  • It was a cross-sectional study
  • They sampled videos on YouTube from March 2020 to March 2021 that had to do with COVID-related pain
  • The authors queried the YouTube platform (www.youtube.com) with the keywords “COVID-19 pain,” “chronic pain after COVID-19,” and “pain related to COVID-19” from March 11, 2020, to March 1, 2021, using the “relevance” filter. 
  • The authors restricted each search to the first 50 videos, yielding 150 videos screened.
Wrap It Up Our findings highlight that musculoskeletal/nociceptive pain in the back and extremities and visceral pain in the abdomen and chest are the most commonly reported pain types. Not surprisingly, the intended audience was patients, with an overall objective to educate on pain symptoms in most videos. This information is important, as it provides patients an explanation of the various pain generators in the body and the expected type of pain quality.  The general public may be unaware that COVID-19 infection, a disease primarily having pulmonary and cardiovascular manifestations, can actually cause painful symptoms, even in seemingly disparate areas such as the eyes or genitourinary system. However, only a minority of videos (15%) provided education on pain management. Thus, clinicians should consider focusing time on educating patients on treatment options, as publicly available sources are lacking in this component. Item #2 Thsi one is called “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations” by Brinjikji et. al.  (Brinjikji W 2015) and published in AJNR in 2015.  Why They Did It
  • They say in the abstract that degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. 
  • They sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.
How They Did It
  • We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. 
  • Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. 
What They Found
  • Thirty-three articles reporting imaging findings for 3,110 asymptomatic individuals met our study inclusion criteria. 
  • The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. 
  • Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. 
  • Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. 
  • The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.
Wrap It Up
  • Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. 
  • Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. 
  • These imaging findings must be interpreted in the context of the patient’s clinical condition.
Don’t see it on an. Image and immediately assume that’s the issue. Phantom Limb pain exists in chronic pain conditions so why can’t low back pain be a phantom back pain? Take a long hard look at the biopsychosocial part of things. If you cannot line up the cliinical patient with the image, don’t make a big deal out of the findings because it’s likely meaningless.  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
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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 (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 Brinjikji W, L. P., Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG (2015). “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR Am J Neuroradiol 36(4): 811-816.   Ryan S D’Souza, M., Anthony E Kilgore, Shawn D’Souza (2022). “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study,.” Pain Medicine 23(2): 229-233.    

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