Physical and Psychological Pain & Disc Herniations And Pain

CF 262: Physical Pain and Psychological Pain & Disc Herniations And Pain


Today we’re going to talk about physical and psychological aspects of pain and we’ll talk about low back pain after disc herniations


But first, heres that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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

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

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

  You have found yourself smack dab in the middle of Episode 262   Now if you missed last week’s episode, we talked about The Stroke Issue – New Information. This is one of the biggest issues we as chiropractors face so I hope you’ll give it a listen. I think it’s vital.  Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Alright, New Year is upon us folks. Time to re-focus. Re-energize. Tap into a fresh energy. Energy that may have waned a bit. We got this!   I have to say though, I’m not a resolutions guy. I don’t wait until the beginning of a New Year to decide on what I want to make better for the next year. Hell with that. I consider that stuff pretty much every week.  

Diet – I work on my diet almost every single meal of every single day. I believe I’m just genetically going to always be a bit bigger. But at least I can eat as healthy as possible. It’s not all what’s on the outside but the inside as well. We know this. Just confirming it for you.   Business – if you’re a frequent listener, you know I’m not goal setting once per year. It’s every week. I’m figuring, tweaking, testing, and trying to identify new business acquisition opportunities.  

So that’s a good spot to talk about the Fall. Listeners know I’ve had like a COVID numbers type of Fall for some reason. Who the hell knows why I’ve been slower but it’s a fact. If my normal is 185-200 appointments per week, this Fall averaged probably about 135-140 per week. That’s around 200 visits less per month. Day-um. One word – two syllables.  

I have a big machine to keep running here people. So that stings and while nobody is broke or starving, I’m not taking home what I’m accumstomed to taking home and it makes your Ol’ Uncle Jeffro more than fussy faced. Since September, I’ve had this perpetual scowl on my face.   Makes me want to punt bunnies. But, what I like about a New Year is some re-freshed vigor and determination.   Part of that is my work with Darcy Sullivan with Propel. I know well that Google SEO is one of the biggest drivers of new patients.

My search results have continually dropped despite writing new and original content for my blog each and every single week. That’s where Darcy rides in on her big huge powerful white horse and hopefully serves as my secret weapon to save the day!!   We’re still early in the process but as I mentioned a week or so ago, we did two phone sessions to get very clear on the direction and wants and needs. That was really helpful.  

After that, her team wrote articles and pages for my current site and sent it over to approve. Holy schnikies, folks. This was like 40 pages of content. I read through it all and made my edits in the Google doc so it updates on their end as well. It was a lot but very important for the messaging part of what we do and what we put out there. It helps with what we want to be known for, basically.   Then last week I assigned access to my Google Business Page, my website, and some other Google platform that the name escapes me at the moment. So Darcy and team will start uploading all of the changes and tweaking all of that stuff this week.   Still a process. A 6-month process. But we’re on the path and I’ll keep you updated.   Alright, good talk, folks. Let’s get on with the research shall we??          

Item #1   The first on today is called, “Data-driven pathway analysis of physical and psychological factors in low back pain” by Bernard X.W.Liew and published in Journal of Science Direct on 15 November 2022.Dayum. That’s hot.   Why They Did It   To understand the physical, activity, pain and psychological pathways contributing to low back pain (LBP) -related disability, and if these differ between subgroups.   How They Did It  

  • Data came from the baseline observations (n = 3849) of the “GLA:D Back” intervention program for long-lasting non-specific LBP. 15 variables comprising demographic, pain, psychological, physical, activity, and disability characteristics were measured.
  • Clustering was used for subgrouping, Bayesian networks (BN) was used for structural learning, and structural equation model (SEM) was used for statistical inference.

  What They Found  

  • Two clinical subgroups were identified with those in subgroup 1 having worse symptoms than those in subgroup 2.


  • Psychological factor was directly associated with disability in both subgroups.


  • For subgroup 1, psychological factor was most strongly associated with disability (β=0.363). Physical factors were directly associated with disability (β=-0.077), and indirectly via psychology.


  • For subgroup 2, pain was most strongly associated with disability (β=0.408). Psychological factor was a common predictor of physical factors (β=0.078), pain (β=0.518), activity (=−0.101), and disability (β=0.382).


Wrap It Up  

The importance of psychological factor in both subgroups suggests their importance for treatment. Physical, pain, and psychological factors interact, albeit differently in different clinical subgroups, to contribute to disability, confirming the need for biopsychosocial management of LBP.   Before getting to the next one,   Next thing, go to 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 cant live without those products, send me an email and Ill 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 & 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. and the discount code is HOTSTUFF. Go do it.  


Item #2   Our last one this week is called, “Prevalence of Long-term Low Back Pain After Symptomatic Lumbar Disc Herniation” by Taylor Wong and published in the National Library of Medicine on November 10, 2022. Hot potato!  

Why They Did It

They did it to determine the prevalence of chronic LBP after LDH, understand the relationship between LDH and chronic LBP, and investigate the relationship between radiological findings and postoperative pain outcomes.  

How They Did It

They performed a literature review on the PubMed database via a combination medical subject heading and keyword-based approach for long-term LBP outcomes in LDH patients.  

What They Found

15 studies (2019 patients) evaluated surgical and/or nonoperative outcomes of LDH patients. Regardless of surgical or nonoperative management, 46.2% of LDH patients experienced some degree of LBP long-term (range 2-27 years) as compared to a point prevalence of LBP in the general population of only 11.9%.  

Wrap It Up

LDH patients are more likely to experience long-term LBP compared to the general population (46.2% vs. 11.9%). Additionally, understanding the relationship between radiological findings and pain outcomes remains a major challenge as the presence of radiological changes and the degree of LBP do not always correlate. Therefore, higher quality studies are needed to better understand the relationship between radiological findings and pain outcomes.  

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      

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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.   When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.   It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.   And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!  
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….   That’s Chiropractic!  
Contact Send us an email at dr dot williams at 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.  
Social Media Links  
Chiropractic Forward Podcast Facebook GROUP  
Player FM Link  
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      
Bernard X.W. Liew, J. H., Marco Scutari, Alice Kongsted, (2023). “Data-driven network analysis identified subgroup-specific low back pain pathways: a cross-sectional GLA:D Back study.” J Clinical Epidemiology 153(66-77).  
Wong T, P. A., Golub D, Kirnaz S, Goldberg JL, Sommer F, Schmidt FA, Nangunoori R, Hussain I, Härtl R, (2022). “Prevalence of Long-Term Low Back Pain After Symptomatic Lumbar Disc Herniation.” World Neurosurg 22: 01571-01576.  

Leave a Reply

Your email address will not be published. Required fields are marked *