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CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

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

You have drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 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.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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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TuneIn

About the Author and Host:

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

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Today we’re going to talk about what I think is some good news that bodes very well for the chiropractic future, for chiropractic integration, chiropractic effectiveness, and playing well with others. We’ll discuss a paper on non-pharma ways of treating pain and then we’ll discuss an article showing how roadblocks are set up to keep Americans from following those recommendations.

Stick with us as we shake it all out, but first, here’s that bumper music

Integrating Chiropractors

Welcome to the podcast today, I am still pretty new to the podcast game so, in case you don’t know me just yet,…I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

You have gallivanted into Episode #46 and we are so glad you did.

DACO Program

Let’s talk a bit about the DACO program, I have gone through 30 hours live and have taken 12 hours online so far. That makes 42 of the 300 but hey, who’s counting right? The last one I took had to do with Cervical pain and neural tension. I’m man enough to admit that, while I have an A in the class, I missed a question on this one and here’s what I’m going to say…..STOP. Stop asking trick questions dammit.

Honestly, you can know the material cold but the way they ask some of the questions, there’s no telling what the hell the answer is. “Which statement makes the most clinical sound?” Fine…no problem. But, as you read through them, there is maybe one answer that is very thorough while the others are not technically incorrect but aren’t quite as comprehensive as the one answer. Then, yes…..the feared…..ALL OF THE ABOVE.

Uh huh….just ask the damn question and be fair about it. That’s all I’m saying. On one hand, one answer is most definitely more clinically sound than the others. On the other hand, all of them have some correct aspects. So, you’re bound to miss some here or there and, with only 5 questions, you miss one, you make an 80. An 80 is hard for me to swallow friends.

So….cut it out, people. Be fair in your questioning. Thank you very much

The material though, my goodness. I can’t even begin to tell you all how wonderful the material is. Of course, I like some of the classes more than others. The one on pain was not necessarily my favorite but I muddled through it and still know a ton more about pain than I did prior to. Pain is a difficult topic but they did an excellent job of lining it out for us.

Every class makes a difference. Without a doubt. Let me know if you need some guidance on getting started on your DACO. Which was the main thing for me….just getting started in the first place. It’s a bit confusing but once you get enrolled and get that first class under your belt, you’re good to go. Just email me at dr.williams@chiropracticforward.com

Sign up for our Chiropractic Forward Newsletter

If you haven’t yet, please go sign up for our Chiropractic Forward newsletter by going to chiropractic forward.com and it’ll pop up right there. You can’t miss it. It almost punches you right in the face. Help us keep pass along important stuff here by getting on that newsletter. Never any more than once per week. Promise.

Evidently, you and your colleagues are catching onto this here podcast. We appreciate it and we appreciate your continuing sharing it with you people. That’s the only way to grow.

Front Desk Woes

So far, we still have the front desk staff in place. So that’s been amazing to not be obsessing about. It is really hard to find the right person with the right qualities to fill that spot. I’m not spouting fake numbers when I tell you that we see an average of about 60 new patients per month by myself.

No associate. I had a colleague recently tell me they don’t think they could do that by their self. I have to admit, I didn’t realize it was an impressive amount. Lol. I was glad to hear it though. Here’s my deal though, I don’t hold onto them. I see them, get them better, and will have them again in a year or so when they re-injure something.

I have about 40 or so visits booked per day and that’s pretty manageable when you have great staff. I still work from 8-1 on Fridays too. The majority of my time is spent on new patients trying to figure them out. After we have a direction with a patient, however, we have a team of people that really help take the workload off of me other than the actual adjusting.

And, in case anyone is wondering out there, I adjust manually, Diversified with some drops here and there. Very little activator. Some muscle work when appropriate but there’s not a lot of fluff in a visit once we are rocking and rolling with a case.

I tell them that I can really drag this visit out and make it last a lot longer than it takes if they want me to but most are ready to get in and out and back to work. And that works well for us too.

Getting back on track

Anyway, back to the original point: it’s hard to find someone that is not intimidated by the insurance demands, new patients, existing patients, etc…but excited about chiropractic effectiveness….looking them in the eyes all day every day all day.

Plus, a third of the building is massage, day spa services so, the right person is key. They get intimidated and leave. Lol. I suppose it’s a good problem to have. But, so far so good with the new one!

As I’ve said before, I will certainly keep you updated.

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.

Let’s get into the papers

Let’s kick off the discussion today with one from McGregor, et. al. 2014 called “Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey.” It was published in BMC Complementary and Alternative Medicine[1].

In the background section of the abstract, the authors’ discuss how healthcare has increased in complexity and there has developed a need for interprofessional collaboration. Amen, brothers and sisters.

It goes on to talk about how different factions within the chiropractic profession are contrary to each other and how one faction holding unorthodox practice beliefs and behaviors may compromise interprofessional relations going forward.

We can have all of the research on our side but when you have one faction of the profession spouting chiropractic effectiveness for everything under the sun, well, the credibility of the profession as a whole really suffers.

The purpose of this paper was, “to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions.”

How do you go about figuring this stuff out? Luckily, there are far more intelligent people out there in the world. They took a stratified random sample of 740 Canadian chiropractors and surveyed them in an attempt to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guides.

What they found

Out of 740 questionnaires, 503 came back.

Less than 18.8% of the chiropractors were in the faction considered to be unorthodox in the perceptions of the conditions they treat.

They also state that prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use, and vaccinations were strongly associated with unorthodox group membership.

The conclusions reached here were as quoted, “Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices.”

Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral.”

Basically, what they’re saying is that, in Canada at least, there are 20% of you chiropractors walking around saying your nerve doctors, that you fix everything under the sun, and you’re releasing the innate and turning on the power. This isn’t chiropractic effectiveness. This is belief. Not research-based findings.

That 20 % is REALLY putting 80% of us that have busted our butts and learned the latest science and research….you’re putting us at risk of staying right where we’ve always been rather than expanding, integrating, and being the experts in what we do.

We are masters at what we do but there are 20% out there keeping anyone that matters from taking the rest of us seriously. When we are talking about legitimate chiropractic effectiveness, that 20% has taken away our credibility.

Parento’s principle proves to be a real thing once again. 20% of chiropractors do all of the work in discrediting the other 80% of the profession.

Next paper

Let’s go to the next paper before I lose my mind.

This one is called Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care[2]. It was published in June of 2018 in Explore: The Journal of Science and Healing and was written by Heather Tick MD along with a team of other medical doctor/PhDs.

Dr. Tick is a specialist in pain management in Seattle Washington. She even has her own website and blog. All that good stuff. You can check it out at heathertickmd.com if you are so inclined.

A little more about her: She co-founded and directed one of the first inter-disciplinary pain centers in Toronto from 1991 – 2008 and has been involved in research with the University of Waterloo at the Department of Kinesiology, the Canadian Memorial Chiropractic College (CMCC), the University of Washington, and the University of Arizona.

She served as the Director of the Integrative Pain Clinic at the University of Arizona in the Department of Family and Community Medicine until Dec 2011, when the University of Arizona Health Plan recruited her to start the integrative medicine pain clinic for Medicaid patients.

Dr. Tick currently serves at the forefront of research and teaching as a Clinical Associate Professor at the University of Washington in the departments of Family Medicine and Anesthesia & Pain Medicine and is also the first holder of the prestigious Gunn-Locke Endowed Professorship of Integrative Pain Medicine at the University of Washington.

In this paper, Dr. Tick starts by saying “Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths.”

I like that opening quote. I like it a lot, folks. She’s saying that the medical way of managing pain isn’t working and throwing more pills at it is a downward spiral. And I agree as I’m sure you do as well.

She goes on saying, “There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.

“Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability.”

Conclusion

The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.

Here’s what I hate to do: I hate quoting an abstract word for word. It’s usually dry and well….boring. But, what she says here is so spot-on, quoting it was the best way to get it across in an equal manner. Meaning that I couldn’t say it better myself. Chiropractic effectiveness is becoming undeniable at this point.

She nails it:

  1. It’s not working
  2. We need non-pharma options that are backed by evidence
  3. There are barriers set up to prevent non-pharma options from being utilized
  4. There is ignorance in regards to non-pharma options and that needs to be addressed through education
  5. Continued research is needed

Further down into the paper, the authors mention in one spot that chiropractic care is 60-70% less likely to be reimbursed. Is that accurate? We are typically covered by most insurance plans no?

When they are saying that there are barriers set up to prevent complementary options, this may fit her rhetoric or point but I just haven’t experienced it being that much less likely to have coverage.

They cite a paper by James Whedon, Et. al. where they found, for New Hampshire[3], there was 60%-70% less reimbursement. I wonder if that is consistent throughout the US or if it’s isolated to New Hampshire?

That’s a great question and if one of you out there in podcast listening land knows the answer, please email me at dr.williams@chiropracticforward.com and fill me in. I’m curious and I’m pretty sure the rest of us out there are too.

Under their Evidence-Based Non-pharm Therapies for Acute Pain, they point out that non-pharma therapists have shown effective in acute pain with opioid paring in the hospital setting as a result of their use and the therapies mentioned in the paper are acupuncture, chiropractic, osteopathic manipulative therapy, massage, physical therapy, relaxation, and cognitive behavioral therapy.

The authors also site spinal manipulative therapy as being effective for chronic pain including migraines, cervicogenic headache, neck pain, low back, hip pain, patellofemoral syndrome, and on and on. Of course, we chiropractors know this stuff but it’s great to see it in black and white and as part of a paper written exclusively by MDs and PhDs.

This is a long paper with a lot of excellent information. I highly encourage your checking it out. Just go to our show notes for links and citations.

Wrap it up

A great takeaway from this paper is this quote, “In general, the costs of evidence-based nonpharmacologic options are nominal compared to medical costs of treating chronic pain with risk mitigation and greater potential for engaging patients in ongoing self-care.”

This is exactly why we are discussing chiropractic effectiveness at length these days. It is paramount for the future of our patients as well as for the the chiropractic future for people to get this message.

Last Paper

The last paper I want to talk about is by our very own Dr. Christine Goertz, DC, Ph.D. with Steven George, PT, Ph.D. as her side-kick and is published in JAMA. It’s called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change[4]” and published on October 5 of this year so, just this month. Brand new.

Dr. Goertz begins by relating low back pain with the obvious opioid crisis and goes into last year’s recommendation that you’ve heard here a million times.

The recommendations from the American College of Physicians for low back pain which recommended spinal manipulative therapy as a first-line therapy for chronic and acute low back pain.

We will talk about it in upcoming episodes but Dr. Goertz also mentions the new Gallup-Palmer Poll where they found that 78% of US adults prefer to use non-pharma options for back and neck pain.

In the article, she cites a paper by Heyward, et. al[5].  called “Coverage of Nonpharmacologic treatment for low back pain among US public and private insurers” that found coverage of some therapies (like chiropractic) was available in most health plans but that there are significant barriers to patient access identified.

Barriers such as visit limits, prior authorization requirements, and high out-of-pocket expenses. And that payment policies targeted toward coordination of pharmacological and nonpharmacological care were virtually nonexistent.

She says pretty clearly the following: In regards to most health plans surveyed, they did not have policies in place that:

  1. emphasize the use of nonpharmacological treatments at the forefront of the patient experience
  2. provide meaningful levels of coverage for care professionals who focus on guideline-adherent nondrug therapies like spinal manipulation, exercise, massage, acupuncture, and cognitive behavioral therapy
  3. us financial incentives that favor the use of nonpharmacological options over commonly prescribed pharmaceuticals, including opioids

Wrap it up

She also calls out healthcare executives quite effectively I thought by saying, “Relative to stigma, Heyward et al found that health care executives did not believe expanded coverage of nonpharmacological treatments is supported by the existing literature.

As outlined in the ACP guideline referenced earlier, in many cases nonpharmacological treatments offer equal benefit or even improved benefit, with lower risk, than commonly used pharmaceutical options.”

And by suggesting that future coverage policies should be based on unbiased reviews of the evidence appropriately balancing risk with benefit rather than prior dogma or biases.

Lastly, Dr. Goertz discusses cost-effectiveness and the need for future payment policies to decrease patient out-of-pocket expenses to strongly encourage earlier us of evidence-based non-harms options.

The Heyward paper demonstrated how trips to PTs or DCs are usually 6-12 visits with an out-of-pocket of $150-$720 or more. She then showed how Lin et. al. showed the median cost of a 30-day  supply of preferred generic opioid by commercial insurers is $10.

How does that add up for the Joe Blow citizen on the street?

It doesn’t.

I love how they sum it up by saying, “Restricting access to opioids without addressing the underlying problem of chronic care management for low back pain is unlikely to positively affect the opioid crisis. Well-conceived guidelines that encourage the use of evidence-based, nonpharmacological treatment options exist and must be enabled by changes in public health policies that better guide care delivery and reimbursement.”

Boom, Snap, kapow, Shazam…

Honestly, where would we be without Dr. Goertz? We’d still be moving the direction we’re moving in because of the opioid issue but she has done some amazing work that is putting us on the fast track where we hope to go rather than on the snail’s pace.

This week, I want you to go forward understanding that It’s happening folks. we are now able to cite papers in JAMA that are pro-chiropractic. Pro-complementary health care. Anti-pharma. This is big stuff. We are in the right place at the right time. And, it was in part, the failure of many in the medical kingdom that put us here. Integrating Chiropractors

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 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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About the author:

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

Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care – Explore: The Journal of Science and Healing

https://www.ncbi.nlm.nih.gov/pubmed/28304182?dopt=Abstract

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey | BMC Complementary and Alternative Medicine | Full Text

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2705853

Bibliography

1. McGregor M, Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Comp Altern Med, 2014. 14(51).

2. Tick H, Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care. Explore J Science Healing, 2018. 14(3): p. 177-211.

3. Whedon JM, e.a., Insurance Reimbursement for Complementary Healthcare Services. J Altern Complement Med, 2017. 23(4): p. 264-267.

4. C, G., Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Chang. JAMA, 2018. 1(6).

5. Heyward J, Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA, 2018. 1(6).

CF 020: Chiropractic Evolution or Extinction?

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 030: Integrating Chiropractors – What’s It Going To Take?

 

 

 

CF 030: Integrating Chiropractors – What’s It Going To Take?

Episode #30

Integrating Chiropractors – What’s It Going To TakeIntegrating Chiropractors

Today we’re going to talk about what the medical field may be looking for when integrating chiropractors into their referral network. We’ll also talk about a recent article discussing The Lancet papers and whether or not the Chiropractic profession needs to take more care…..or care at all for that matter. 

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.  

Before we get started, it was brought to my attention by Dr. Ryan Doss out in Lubbock, TX that our Chiropractic Froward episodes in iTunes only go back to Episode 18 or 19 right now. This is a new development that I’m not sure exactly how to fix or what to do about it at this time but, I am trying to figure it out. For now, though, you can go to our website at www.chiropracticforward.com and have access to all of the directly right there. All of them in one place.  

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 and it’s just nice of you and helps me notify when a new episode is up and ready for you. 

I’m always offering myself up for speaking opportunities or to be a guest on YOUR podcast or at your seminar.  Just send me an email at dr.williams@chiropracticforward.com and we will connect.

I have to tell you that I have recently joined the Facebook group called Forward Thinking Chiropractic Alliance led by Dr. Bobby Maybee who also hosts the Forward Thinking Chiropractic Podcast and I have been a member of the Evidence-Based Chiropractic group over there on Facebook for a while now. That one is led by Dr. Marc Broussard and has several highly respected admins. 

First, I host the Chiropractic Forward podcast and Bobby Maybee hosts the Forward Thinking Chiropractic podcast. Those sound similar right? And….to be fair…in regards to focusing on researched information and draggin’ chiropractic further into the evidence-based realm, we are very similar. OF course, we have different deliveries and Forward Thinking Chiropractic Alliance has been around longer than we have. Integrating chiropractors is a common topic. 

When I was trying to figure out what to name my podcast, I somehow came up with Chiropractic Forward. I Googled it and nothing showed up for Chiropractic Forward and I was so excited and ran with it. It wasn’t until a few months later that I stumbled on Forward Thinking Chiropractic and thought, well hell…. But, though there are similarities in the names, I do my thing and Bobby and his crew do theirs and they are very successful and good at what they are doing. In the end, I hope we are both extremely healthy for chiropractors everywhere a podcast can be heard. 

There is also Dr. Jeff Langmaid known as the Evidence-Based Chiropractor. Jeff has built an amazing brand talking about many of the things we talk about here and he does a great job with it. He’s a great speaker. Clear, concise, and easy to understand. 

So, outside of myself and the Chiropractic Forward Podcast, I hope you will give Dr. Bobby Maybee and the Forward Thinking Chiropractic Podcast a listen as well as Dr. Jeff Langmaid and the Evidence-based Chiropractor Podcast. They are excellent resources for further learning and understanding on all of this stuff. Again, integrating chiropractors is a common topic and you know I love that topic!

The Facebook groups I mentioned are simply priceless when it comes to being an evidence-based chiropractor.

I’ve found myself from time to time feeling a little uncomfortable and surrounded by ideas and philosophies within our profession that I just never got behind or could support. I’ve had to sit through countless speeches that made my eyes roll with disbelief. The Evidence-Based Chiropractic group and the Forward Thinking Chiropractic Alliance groups on Facebook are groups that fit me like a glove. As I said, integrating chiropractors is a topic I’m on board with. I’m not super active in there but really do enjoy reading the threads, opinions, and yes….even some light arguing here and there. But, these groups are very educational and an absolute must if you are evidence-based. 

We have a Chiropractic Forward group as well on Facebook but it’s new and just now getting going. I’d love to invite you all over there to join up with us as well as like our Facebook page itself and maybe even check us out on Twitter at chiro_forward. 

Hey, I’m doing my part to get the word out. You can rest assured on that. 

Enough social media talk, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have collapsed into Episode #30. I can’t believe I started this journey 30 weeks ago. It’s crazy to think. I really can’t tell you how much I have enjoyed it so far. I suppose it takes some amount of hubris to think anyone would care about what you have to say but, in the end, don’t you just have to go where you’re led? That’s what I’m doing and I’m glad you’re coming along with me each week.

We have talked a lot in previous episodes about integrating chiropractors. Whether that means integrating chiropractors into a hospital setting, bringing medical services into your clinic, or some sort of co-treatment/referral sort of set up between the chiropractor and other medical professionals. Regardless, integrating chiropractors is the next step for our profession. 

On that note, let’s start with the article about The Lancet papers on low back pain. This was in Chiropractic & Manual Therapies and Published June 25, 2018. Brand new stuff here folks. This was written by Simon French, et. al. and titled “Low back pain: a major global problem for which the chiropractic profession needs to take more care(French S 2018).” 

The abstract on this article introduces the series of papers published in The Lancet back in March of 2018 which provided the global community with a comprehensive description of low back pain, treatment recommendations based on research, and low back pain going forward from where we are currently. 

They go on to mention what we have been saying over and over here on the podcast. And that is that chiropractic is poised to step in and run the show for non-complicated low back pain. But, according to the authors and according to the Chiropractic Forward podcast, many chiropractors make statements and do things that aren’t supported by robust, contemporary evidence. 

We went through the Lancet papers here on the podcast and you can listen to them by going back to episodes 16, 17, and 18. I encourage you to do so. There really is some excellent information from a multidisciplinary panel of low back pain experts around the world. 

The authors of the Lancet papers, if you follow them on Twitter, have said repeatedly that they don’t want this paper to be profession specific. Meaning, they don’t want to come right out and say, “Hey folks, chiropractors should be the first referral or, we recommend PTs take any and all low back pain patients first and then deal them out where needed for more treatment.” 

I think that’s probably smart on their part but, as a chiropractic advocate, I have no problem throwing our hat in the ring and saying that research has proven several times over that spinal manipulation is superior to the mobilization that PTs perform AND less expensive. If chiropractors are less expensive and more effective, then why in the Hell WOULDN’T we be the first referral for these low back pain patients? Integrating chiropractors makes more sense now than ever before.

This paper goes on to mention that there has been a shift in thinking on low back pain in recent years from the traditional medical approach to a more patient-centered, evidence-based, non-pharma approach putting chiropractors right where they always should have been. 

They also talk about how The Lancet papers say that imaging needs to be reduced significantly. Wouldn’t you agree that may be a challenge for the way many chiropractors practice? You know who you are out there! They also discuss how evidence doesn’t support ongoing passive chiropractic care. This will also be an obstacle for many in my profession. In addition, they state that many chiropractors implement therapy modalities that simply have little to zero good evidence supporting them. 

French says chiropractors are in the right placed but not enough of us are actively involved in research and our research output is small when compared to other healthcare professions. Integrating chiropractors into the medical field will require more research production from our profession that we currently see. 

He also says that the chiropractic profession needs to be more integrated to be a major player if we are to be able to fulfill the role The Lancet papers put us in. And I agree wholeheartedly. If you check out episode #20 called Chiropractic Evolution or Extinction, you’ll hear a robust discussion on this. 

CF 020: Chiropractic Evolution or Extinction?

 

French’s conclusion highlights the reason the Chiropractic Forward podcast exists. It puts a spotlight right on the purpose if you listen close enough. 

He wraps up the article by saying the following: “Our low back pain “call to action” for the chiropractic profession is to get our house in order. In our opinion, nothing is more relevant to chiropractors than people with low back pain, and the evidence clearly shows that we can do a better job for the millions of people who experience this potentially debilitating condition every year. Chiropractors in clinical practice need to provide higher quality care in line with recommendations from evidence-based clinical practice guidelines.

The chiropractic profession is perfectly placed to be a major player in providing a part of the solution to the global challenge of low back pain. But the profession has been shut out of this role in most countries around the world due to, amongst many other things, internal political conflict, a lack of political will, and a minority of chiropractors who provide non-evidence-based approaches. The profession needs to invest heavily to support chiropractors who wish to undertake high-quality research directed at solving this major global problem.”

Amen amen amen. I’ve always wished I knew more about running my own research projects. It’s just not something we were taught. I’m looking at maybe searching out a mentor to help me get my own projects going…..maybe just case reports but something…. and get them published. Although the idea of generating my own research projects makes me want to punch myself in the nose, I know it’s important towards integrating chiropractors.

OK, let’s shift gears a bit. If we are poised and ready for integrating chiropractors and we start following evidence-based protocols, that’s all fine and dandy and moving in the right direction. However, what if there are already perceptions out there in the medical field we’ll be needing to change? I said what it? I meant, of course, there are negative perceptions of us that will have to be battled. It’s a fact. 

Here is a paper from June 22, 2018, by Stacie Salsbury, et. al. called “Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team(Salsbury S).” It would have been more fun if Salsbury would have just titled it “Stop, collaborate and listen if you want to be a good chiropractic physician….. but……she didn’t. We’re obviously not dealing with a Vanilla Ice fan here. It’s probably a good thing that, so far, I’m not responsible for naming research papers. 

Anyway, this paper wanted to explore the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting. 

How They Did It

  • It was a qualitative analysis of a multi-phase, organizational case study
  • It was designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team
  • It was a 62-bed rehabilitation specialty hospital
  • Participants were patients, families, community members, and professional staff of administrative, medical, nursing, and therapy departments. 
  • Data collection was from audiotaped, individual interviews and profession-specific focus groups 
  • 60 participants were interviewed in June 2015
  • 48 were staff members, 6 were patients, 4 were family members, and 2 were community members. 
  • The analysis process helped them produce a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings. 

What They Found

  • The central domain was Patient-Centeredness, meaning the practitioner would be respectful, responsive, and inclusive of the patient’s values, preferences, and needs. This was mentioned in all interviews and linked to all other themes. Of course, I may interject my own opinion here if you don’t mind. Isn’t the lack of patient-centered care the MAIN gripe when it comes to medical doctors too?!? That’s not just a chiropractic issue. 
  • The Professional qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Again, something desired of all practitioners regardless of discipline I would think. 
  • Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence
  • Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting.
  • Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

Wrap It Up

Salsbury ended the article with this conclusion, “Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.”

Now when you go a little deeper than the abstract you’ll see statements that hint at the fact that, when it comes to chiropractors there is fragmentation, disconnection, boundary skirmishes, and a general failure to communicate. 

In addition, the primary care providers and medical specialists have recognized the ability of some chiropractors to treat some musculoskeletal stuff in some patients but that’s about it right now. Couple that with the fact that most in the medical kingdom report just not knowing much about chiropractic or its treatments. 

Some medical providers express concern about the safety of spinal manipulation and have voiced skepticism over the efficacy of our protocols. Let’s be fair, I have my own concerns and am skeptical of some of their protocols as well so that swings both ways friends. But for evidence-based chiropractors, integrating chiropractors into the field makes perfect sense.

When talking to orthopedic surgeons that had particularly negative attitudes toward chiropractors, they typically cited something a patient told them or would cite aspects of the fringe element of the chiropractic community that allowed the surgeons to question the ethics of some chiropractors, to comment on the inadequacy of educational training, and comment on the sparse scientific basis of chiropractic treatments. 

To all of this, I say…..what the hell rock have these people been living under? Sure question the ethics of some. I question the ethics of A LOT of chiropractors if I’m being honest. I could be a wealthy man right now myself but I wouldn’t be able to sleep knowing I’m taking advantage of people. But, what about laminectomies? What about the fact that outcomes have never improved for lumbar fusion but they incidence of performing fusions has gone sky high. Where are the ethics on that? The epidural shots have shot through the roof without any improved outcomes and proof of zero long-term benefits. Where are the ethics?

If you question our education, know what you’re talking about first. That’s all I’m saying. The admission scale is low admittedly. There are philosophy courses I could do without. There are a few technique classes I think are worthless but, overall, the education of chiropractors is outstanding. Are physical therapists getting the same basic science courses the medical doctors are getting? Is that happening? From a quick search of the Physical Therapist curriculum, it appears that it is not so what on Earth are these people even talking about?

The other comment was the sparse body of research. Let’s just say that I’ve been blogging on chiropractic research since 2009 every single week without repeating research papers. The body of research is absolutely there. They’re just ignorant of it. It’s that simple. And where is the research for some of the garbage they utilize? 

I’m in no way saying chiropractors don’t need to step up. They most certainly do in a big way if integrating chiropractors si to become a reality. I hope the evidence-based guys and gals are starting to find more places they feel comfortable out there in social media and starting to find more of a voice within the profession. I truly believe there are many many more evidence-based chiros than there are others. Let’s be honest here. If you want to fit into healthcare, you damn well better do it based on solid research and evidence backing your profession and protocols. 

If I went through this paper from top to bottom, we’d be here for hours, I would have a red face from defending chiropractic, my blood pressure would be sky high, and my vernacular would probably devolve into meaningless gibberish at some point. So I’m going to leave it there. I gave you some highlights, I have it cited in the show notes. Go and read it and email me your thoughts. I’d love to hear them. 

This week, I want you to go forward with some things a poster in the Evidence-based chiropractic group on facebook the other day that I thought had value when it comes to what we’re talking about. She said:

Chiropractic is not a religion. 

A medical doctor should be able to understand the language coming out of your mouth, if they do not, they need to be able to find it cited in a medical textbook. 

I think chiropractic has a long way to go. It does indeed. But, not as far as we had to go 5 years ago. We still have too many people out there on the fringe. We still have far too many practices that are about numbers instead of being patient-centered. Don’t you think that when your business is patient-centered, your patients know that and the money takes care of itself? 

On the other hand, if you are trying to get 50 visits out of a patient, some will go for it, but many more will be turned off by it and will not return. Not only that but for many patients, you will have ruined the entire profession in their eyes based on your act of hitting numbers rather than making sure you’re doing what is best for the patient. That’s just being as honest as I know how to be. I know some won’t like that much but it’s a fact. 

I can’t tell you how many patients I have gotten from a guy that made patients sign contracts for treatment and when treatment didn’t work, he wouldn’t allow them out of the contract. How in the hell does that fit into healthcare folks? It certainly not patient-centered in any shape form or fashion and you’re fooling yourself if you think otherwise. You will never see us integrating chiropractors into the medical profession with junk like that. 

I told you that I can’t tell you how many patients we got from this guy’s poor ethics but, the bigger question is, “How many patents did he ruin on the idea of chiropractic so now they’re out there thinking they have to suffer in pain when all they had to do was visit a chiropractor better equipped with a high standard of ethics?”

THAT is the real question. 

We have to improve, yes. But, for us to integrate properly, the medical kingdom has to improve as well in regards to musculoskeletal complaints, proper recommendations and treatments, and in their perception and understanding of chiropractic and what we can do for these patients. It’s not all one-sided in my mind. 

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. Integrating chiropractors makes perfect sense here.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of 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.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you heard on integrating chiropractors, be sure to check out www.chiropracticforward.com. We want to ask you to share us with your network and help us build this podcast into the #1 Chiropractic podcast in the world. More people need to hear about integrating chiropractors!

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

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

 

 

 

French S (2018). “Low back pain: a major global problem for which the chiropractic profession needs to take more care.” Chiropr Man Therap 26(28).

Salsbury S “Be good, communicate, and collaborate a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team.” Chiropr Man Therap 26(29).

Today’s topic was integrating chiropractors, integrating chiropractors, and integrating chiropractors. : )

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

Episode #29

Is Chiropractic Integration Healthy For The Profession?

Today we have a very special guest and we’re going to be talking about chiropractic integration into a medical based case management or medical team. This one may irritate the holy heck out of the straight chiropractors that preach being separate and distinct but I think evidence-based practitioners will find some good stuff here. 

But first, here’s that bumper music

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

Before we get started, 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 and it’s just nice of you. 

Also, I’m alway offering myself up for speaking opportunities or to be a guest on YOUR podcast.  Just send me an email at dr.williams@chiropracticforward.com and we will connect. I always appreciate hearing from my brothers and sisters out there in the profession. 

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. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have tip toed ninja style into Episode #29

But first, my week …..I have to say that we started off slow at the start of this Summer season but, now that everyone is settling into the heat, it’s starting to get busy busy and that’s nothing but good good. What are the most effective means you’ve found to get your message out to your communities? Email me and I may just share you suggestions in future episodes. 

This week, I want to welcome a friend of mine and a brother in arms in our battle for Chiropractic here in Texas to come and speak with me about chiropractic integration. He has been involved deeply on the state level leadership for years at this point and has held several posts including the biggest one. Yes, he is currently the big cheese, the head honcho, the el jefe of the Texas Chiropractic Association. Until June of 2019, he will sit as the President of the TCA and we’re honored to have him with us on the Chiropractic Forward Podcast today. 

– I want to welcome Dr. Devin Pettiet of Tomball, TX. Dr. Pettiet, thanks for being here and letting us pick your brain a little today. 

  • When I was coming up with this week’s topic, chiropractic integration, I really couldn’t think of anyone better than you to talk about chiropractic integration with. I know you pretty darn well but our listeners probably do not. Tell us a little bit about your practice. 
  • What originally got you involved in service to your profession? Was there a single incident or experience that flipped a switch in you?

I don’t want to speak for you but, for myself, I’m certainly on the evidence-based aspect of the chiropractic spectrum here. We would like for our thoughts and opinions to be separate from the TCA’s stance on different matters and we should state from the start that our thoughts and opinions are our own and not representative of the TCA. At the same time though, we are the kind of people that want to go to bat for everyone practicing as long as they are within the scope mandated by the State of Texas. 

Now, How do you feel we chiropractors can start making headways into the medical field as spine specialists and….keeping the straights in mind….is it healthy for our profession to seek those avenues for ourselves? Is chiropractic integration a good idea basically?

We know it’s not a lack of research validating our profession but, with your years in practice and with your years of service in the TCA, what things come to mind as the biggest obstacles to chiropractic care fully integrating into medical referral programs or treatment protocols?

Over the years, have you seen any changes in the opinions of chiropractors from those in the medical community or in the way you interact with them?

Let’s go over a couple of papers and you just play Troy Aikman to my Joe Buck and provide commentary wherever you see fit. 

This one is from February 2018 and is called, “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” It was written by S Salsbury, et. al. and I see Dr. Goertz listed as an author as well. She has really been a star for the chiropractic profession(Salsbury S 2018). 

Why They Did It

The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic working in private sector health care settings in the United States.

How They Did It

  • The authors did an online, cross-sectional survey. 
  • They were looking for chiropractors already working in integrated health care facilities 
  • They collected demographic details, facility details, and the characteristics of the practice
  • Using descriptive statistics, they analyzed all of the data they collected. 
  • The response rate was 76% which is odd because my email open rate when I email for TCA stuff is like 10%….
  • Most respondents were male with the mean years of experience being 21 years. 

What They Found

  • Doctors of Chiropractic working in hospitals were 40%
  • Multispecialty offices = 21%
  • Ambulatory clinics = 16%
  • Other health care settings = 21%
  • 68% were employees and received a salary
  • Most DCs used the same health record as the medical staff and worked in teh same clinical setting. 
  • Over 60% reported co-management of patients with medical professionals. 
  • In many clinics, the DCs were exclusive providers of spinal manipulation (43%) but most of the clinics saw the DCs receiving and making referrals to the primary, the PT, or to pain and ortho docs. 

Wrap It Up

The authors concluded by saying, “Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.”

Here’s another by Paskowski et. al.(Paskowski I 2011) Called “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.”

There were 518 patients and they developed a Spine Care Pathway protocol for their treatment. These patients underwent chiropractic care and physical therapy. 

What They Found

Those that went to a Doctor of Chiropractic treated for about 5.2 visits costing an average of $302.

The pain was 6.2 on intake and 1.9 on exit. 

95% that saw a chiropractic rated their care as excellent. 

Then there’s this one from the Ontario Ministry of Health-commissioned report called The Manga Report which was a comprehensive review of all of the published literature on low back pain(Manga P 1993). 

Some of the things this government-commissioned study had to say are just outstanding. 

  • There was an overwhelming amount of evidence showing the effectiveness of chiropractic in regards to the treatment of low back pain and complaint.
  • They found that it is more cost-effective than traditional medical treatment and management
  • Found that many of the traditional medical therapies used in low back pain are considered questionable invalidity and, although some are very safe, some can lead to other problems being suffered by the patient.
  • They showed that chiropractic is clearly more cost-effective and that there would be highly significant savings if more low back pain management were controlled by chiropractors rather than the medical physicians.
  • The study stated that chiropractic services should be fully insured.
  • The study stated that services should be fully integrated into the overall healthcare system due to the high cost of low back pain and the cost-effectiveness and physical effectiveness of chiropractic.
  • They also stated that a good case could be made for making chiropractors the entry point into the healthcare system for musculoskeletal complaints that presented to hospitals.

They concluded the paper by saying, “Chiropractic should be the treatment of choice for low back pain, even excluding traditional medical care altogether.”

There are a ton of reasons for chiropractic integration into medical protocols that, if we tried to cover them all, we’d be sitting here for a very long time. The point here is that, when you consider these studies, when you consider the low back series in The Lancet that we covered in episodes 16, 17, and 18, when you read the recommendations from the American College of Physicians for acute and chronic low back pain, and you see the recent article in JAMA from Dr. Goertz on Vets and low back pain that we covered in episode 

Dr. Pettiet, where do you see everything going on this??

How do we do our part to ensure chiropractic integration of our profession and move from the fringe toward the center?

Can we do that while still maintaining our identity as chiropractors?

Is the TCA doing anything that we can talk about publicly toward chiropractic integration?

This week, I want you to go forward understanding that you have been and are doing the best thing there is out there for headaches, neck pain, and back pain. There is no other profession with the juice behind them that we have. Be smart, be responsible, and we may just be able to not just have our foot in the door, but to actually knock it down and burst in like a superhero. 

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.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of 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.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic podcast in the world. 

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. 

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

CF 020: Chiropractic Evolution or Extinction?

 

 

Bibliography

Manga P, e. a. (1993). “THE MANGA REPORT: THE EFFECTIVENESS AND COST-EFFECTIVENESS OF CHIROPRACTIC MANAGEMENT OF LOW BACK-PAIN.” Funded by the Ontario Ministry of Health.

Paskowski I, e. a. (2011). “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.” J Manipulative Physiol Ther. 34(2): 98-106.

Salsbury S (2018). “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” J Manipulative Physiol Ther 41(2): 149-155.