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CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

Today we’re going to talk about chiropractic prevalence, a new article in JAMA with some pretty terrible projections for opioid use and deaths, and new information on kiddos and the time they spend on screens. 

But first, here’s that bumper music

Chiropractic evidence-based productsIntegrating 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 collapsed into Episode #62

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Evidence-Based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. 

DACO

Let’s talk a bit about the DACO program. Man, this is how it goes with the DACO: just yesterday morning, I had a patient come in, mid-’60s and literally everything hurt. Restless leg syndrome was her main complaint but her GP just yesterday already started her on Vitamin D and iron supplements so she’s going in the right direction there. I have heard of acupuncture being good for it as well but have not seen any research on that so can’t make that claim. 

Anyhooo…literally everything hurt, couldn’t sit down and basically, a general overall look of being unwell for a lack of a better word. She just didn’t look healthy. I started asking her about bone scans and she’d never had one. Well, this guy just gets feelings and when I get a feeling, they get sent out. I sent her out for a bone scan. 

No kidding, that afternoon I sit down for a class. The next one up? Yep, diagnosing osteoporosis. Lol. Wouldn’t you know it? Anyway, had I had this class before the encounter with the new patient, I might not have sent her. I’m not sure.

But, it’s just funny how in tune with clinical practice the classes really are. Also, as a consequence of the class, I have a quick sheet made up that changes the way I deal with potential osteoporosis patients from here on out. Forever and ever amen. 

Personal Happenings

So far, not a lot of blowback on my recent episode covering my thoughts on faith-based practices. Sometimes I’m mouthy, right? I get it. Who the hell cares what I have to say? I don’t know who cares honestly. Lol. But, we’re growing and growing so at least some of you identify with my way of thinking.

I’m religious and I think that’s what makes me feel that I can be credible in critiquing certain things in regard to religion. I just have a hard time with management companies coaching their impressionable doctors how to use the bible to manipulate scared patients looking for answers. When I think about it, it makes my pee hot. 

Anyway, it turns out that you guys agree with me and that makes me like you even more. Before you know it, we’re all going to be besties and share milkshakes with two straws and all of that mumbo jumbo. 

I’m glad you’re here with me today as we dive into the information I have for you this week. Here we go. 

Item #1

I want to start with one that had some conclusions I found surprising and somewhat encouraging……sort of. This new paper from The Journal of Alternative and Complementary Medicine published January 18, 2019, and authored by Stephanie Taylor, Patricia Herman, Nell Marshall, and colleagues called “Use of Complementary and Integrated Health: A Retrospective Analysis of US Veterans with Chronic Musculoskeletal Pain Nationally[1].”

Due to time constraints on me, I didn’t go beyond the abstract here so….freaking sue me. I’ll have it cited in the show notes at chiropracticforward.com so you can go get it and dive in you over-over-achiever you with all that time sitting around. Must be nice pal. 

Why They Did It

The authors say that little is known regarding the use of complementary and integrative health therapies for chronic pain in the VA system which is the nation’s largest integrated healthcare system. We will get into chiropractic prevalence briefly.

In my experience, I can echo this paper’s sentiment that the VA is at the forefront of the movement away from opioids and toward alternative healthcare. 

They researched this paper over 2 years for the use of 9 types of alternative therapies that included meditation, yoga, acupuncture, chiropractic, guided imagery, biofeedback, tai chi, massage, and hypnosis. 

What they found

27% of younger veterans with chronic musculoskeletal pain use alternative healthcare

The most used for was meditation at 15%. I found that surprising. Meditation means slowing down, sitting still, relaxing, and all that good stuff. In this day and age, I just have a hard time seeing that as the most prevalent form of alternative healthcare. 

We all think we’re so busy and, for us chiropractors, a lot of us really ARE too busy to stop and meditate. I may just be taking my own personal experience here and assuming everyone else on the planet is like me and, of course, that’s not true. Still, meditation was the most prevalent in this study. 

Yoga was next at 7%. Again, I guess I haven’t realized how popular yoga is getting these days but, I know the VA is pushing it so that may be playing a part in it. 

Coming in in 3rd place we have acupuncture. Once again, it’s surprising to me but, the VA is directing the recommendations and, in the real world, outside of the VA, acupuncture does not out-pace chiropractic. I do believe the VA is seeing it’s use for PTSD and chronic pain though and is responding appropriately. 

Finally, here comes Chiropractic care coasting in in 4th place for chiropractic prevalence.

Ugh. We know outside the enclosed ecosystem of the VA, chiropractic care is not less prevalent than yoga, meditation, and acupuncture. But, being within the VA, we know that medical doctors, PA’s, and nurse practitioners are making these recommendations and referrals so we still clearly have a lot of work to do. We are still a world away from where we need to be in regard to chiropractic prevalence,

You know what else that means though right? There are incredible potential and opportunity. If the VA is an example of the rest of the allopathic world, we could say that even fewer than 5% of chronics get referred to us from the GPs and orthopedic surgeons. I think that’s fair because most of them are unaware of Dr. Christine Goertz’s work that was published in JAMA not long ago.

If you’re unfamiliar with that, go listen to Episode 25 of this podcast. In short, she showed how veterans with chiropractic care mixed in with their traditional care had better outcomes. That’s when we started seeing the referrals from the VA

Also, you’ll notice that all of the nine therapies tracked here were on the list of first-line therapies that came from the updated recommendations by the American College of Physicians in February of 2016[2]. 

I guess my point on the paper here is that the medical world, or at least the VA part of it, is paying attention to research regardless of whether it goes against their previously held biases. They are absolutely trying to reverse the opioid epidemic. And we have a lot of work to do to gain that trust and get those referrals. When they’re recommending meditation before chiropractic care for chronic pain, then there is a ton of room for us to shine. So go shine it up all you shiny happy people out there. 

Item #2

On to item numero dos, number 2 for our non-Spanish speaking population out there. This one is discouraging and…..well….awful if I’m being honest.

This one is from JAMA called “Prevention of Prescription Opioids Misuse and Projected Overdose Deaths in the United States” published on February 1, 2019, and authored by Quiushi Chen, Marc Larochelle, David Weaver, and colleagues[3].

Why They Did It

In JAMA, they always start with the question being answered here. The authors wanted to answer this one: “what is the projected effect of lowering incident non-medical prescription opioid use on the future trajectory of the opioid overdose crisis in the USA?

I’m just going to cut to the chase on it and leave a bunch of details out. Here’s why. I don’t want us getting bogged down in the details and methods and all that stuff.

I want you to be able to retain just a few numbers and not be distracted by the rest of the minutiae. You like that word? I know you do. Minutiae, You say that to the right fellow nerd and you may just get you a date, people.

It’s a powerful word so take it, use it, enjoy it. I swear I’m undiagnosed ADHD. I swear it. 

Anyway, here’s the deal, although we as a nation, as a world, now see the issues with opioids and are now trying to address the issue, It’s not getting better and it won’t get any better according to this paper. 

Check it out, according to this paper, the annual number of opioid overdose deaths is projected to increase from 33,100 in 2015…..then we know that 72,000 died in 2017….all the way up to 81,700 deaths projected 2025. 

They are projecting from 2016-2025 to lose a total of approximately 700,400 people to opioid deaths. They say about 80% of that will be due to illicit opioids. I don’t know how the hell they can tell that but that may be a little bit of, “yeah it’s happening but it’s not our fault,” BS going on there but who knows? In this paper, they’re assuming that the illegal use of opioids will increase from 61% in 2015 to 80% by 2025. I don’t know. Sounds like fuzzy math to me but I’m not a researcher. 

I think their numbers are fuzzy because we know 2015 saw about 36,000 die, but then 2016 saw around 63,000 die if I remember correctly. Then, 2017 saw 72,000 die. Are you seeing the graph there in your mind? It’s not only up and to the right on this deal, but its up and to the right like it’s climbing Mt. Everest. The numbers have harnesses fastened tightly and ropes and expert climbing guides and they’re going straight up the face like pros! 

These guys are guessing that by 2025, in 9 years, the deaths will only have increased a total of 9,000 per year, so….they’ll only increase an average of 1,000 deaths per year. Do you see why I think they’re crazy? The deaths increased by 9,000 just last year. Do you see what I’m saying? I’m not saying they’re wrong but….they’re wrong. Lol. 

They then say that across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3%-5.3%. 

Their quoted conclusion is, “This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.”

So what do we take from this exactly? Here’s my deal. On the surface at least it smells like a steaming pot of shoo shoo caca doody, 

Instead of recognizing the fact that unnecessary surgeries were many times the reason people got addicted in the first place, and that there are amazing opportunities outside the allopathic world to prevent those unnecessary and financially motivated surgeries, they say, “Hey look, a lot of this is done illegally and that’s just going to get worse and our part of this is really very small.

In fact, we can lower the prescriptions of opioids but it’s really not going to do a lot of good and, in fact, we think we should still be able to prescribe them as much as we are right now….blah blah blah poop coming out of the mouth and falling onto the floor with a splat. 

They are making guesses 9 years in the future what addict behaviors will be. I think that’s presumptuous and ultimately impossible. I just thought it was entertaining and that you all might enjoy this group trying to minimize responsibility or what role they can really play on decreasing opioid use.

I could totally be mischaracterizing this and they may have the best intentions in mind. While I trust my GP and I trust the friends of mine that are surgeons personally….I just don’t trust stuff like this. 

Obviously, I don’t agree with them but I’m a bumpkin chiro on the Texas Plains. I wouldn’t listen to me if I were them either. Lol. 

Item #3

OK, last item for this week and it’s something I’m admittedly fascinated with and I think that’s because I have a high schooler and a 5th grader and this stuff hits home any time I see it or read about it. 

This one was in JAMA too and called, “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” written by Sheri Madigan, Dillon Browne, Nicole Racine and colleagues[4] published January 28, 2019. 

Why They Did It

The main question they were trying to answer was this, “Is increased screen time associated with poor performance on children’s developmental screening tests?” Basically, does screen time have a direct effect on child development?

They had 2,441 kiddos in it. A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. 

What They Found

Their conclusion was, “The results of this study support the directional association between screen time and child development. Recommendations include encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.”

Yes, it’s easy to just hand them a device and hope they’re quiet long enough to get a nap in. Guilty as charged. Guilty as charged. 

But, turns out as we may have guessed if we really thought about it 8-9 years ago when all of this really started….this isn’t in their best interest in the long run. 

Chiropractic evidence-based productsIntegrating 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. 

Website

http://www.chiropracticforward.com

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About the Author & Host

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

 

Bibliography

1. Taylor S, H.P., Marshal N,, Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med, 2019. 25(1).

2. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

3. Chen Q, L.M., Weaver D,, Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Network Open, 2019. 2(2): p. e187621-e187621.

4. Madigan S, Association Between Screen Time and Children’s Performance on a Developmental Screening TestAssociation Between Screen Time and Child DevelopmentAssociation Between Screen Time and Child Development. JAMA Pediatrics, 2019.

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

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

CF 052: Chiropractic Forward Podcast Year One Review

 

 

 

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at dr.williams@chiropracticforward.com and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

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.

Website

http://www.chiropracticforward.com

Social Media Links

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YouTube

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iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

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About the Author & Host

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

 

Bibliography

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

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

 

 

CF 059: Don’t Be Dumb on Cervicogenic Headache

CF 059: Don’t Be Dumb on Cervicogenic Headache

Today we’re going to talk about headaches. More specifically, we’re going to talk about cervicogenic headaches. How can we recognize cervicogenic headache, and get better at diagnosing and treating cervicogenic headache?

But first, here’s that delicious 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 crashed into Episode #59 like a bull in a china cabinet. You know, I’ve been told before that I’m a little like a bull in a china cabinet. That what I don’t break I poo on. Was that more palatable than some of the other words I could have used? I certainly hope so because me saying it that way just doesn’t sound very Jeff-like but I try to keep it mostly high brow and not too profanity-laced. 

DACO

As always, let’s talk a bit about the DACO program. I decided I kind of dread the eLearning episodes. Although the information is excellent, I’m one of those that doesn’t want to miss a word in the notes. These can be somewhat complex topics and, I’m afraid that if I miss something, it’ll be important and I’ll have trouble making sense of it all when I re-visit it. 

That could be my undiagnosed anxiety issue at play. Who the hell knows but it’s a fact so that means that I have to transcribe the entire 20-40 minutes of video or I’m not happy with the final result of the class. There are notes on these classes. A worksheet that helps organize it all but, there is a lot on the videos that is not on the worksheet so transcribe I must and I’m starting to despise that process. 

It’s admittedly a quirk of mine and probably won’t be your experience on the deal if you give it a try. As a result, I have started combining the Communication Drills. So I’ll take an eLearning episode and then I’ll take a Communication Drill and basically alternate them to keep me from getting burned out and to keep me moving forward efficiently. I’m averaging 8 or so hours a week so we’re still clicking along like a tired locomotive. 

Recent classes have been Managing Migraine Headaches, Diagnosing Cervicogenic Headaches, A Neurological Approach to Scoliosis, and Thinking Laterally With The Disc Patient. 

Coming Up

I gotta tell you, you all really liked the episode we did with Dr. James Lehman, episode 55, and the one we did on what I despise about this profession, episode 56. We are up over 7,200 downloads and that’s pretty exciting Y’all. This little thing of ours is rocking and rolling and shows no signs of slowing down either. 

That’s because THE Dr. Christine Goertz is coming on the show in late February. Wow! That’s a biggie! I’m going to let you in on a little secret. You’d already know this if you were in our private Chiropractic Forward Group on Facebook. You would have even had the chance to suggest questions for me to ask her when she comes on the show. You should probably go ahead and become a member. 

Speaking of the episode where we talked about the magical disappearing osteophytes, I was a little worried if I’m being honest about that one. I hated being negative like that and I was a bit concerned some of you would have a problem with that. Oh contrare, I think I had more feedback on that one than any of our episodes. 

It appears you guys agree and there is indeed no room for that mystical hunk o junk in our great profession. Of course, there isn’t. We knew that. Sometimes you just have to blow off a little steam and be the old guy saying, “get off my lawn ya punks!”

That was episode 56 for me. “Get off my lawn and stop driving so fast in a 30 mph zone yeah steampunk loving jackasses! And quit looking at my daughter like that before I shoot you in the nose hole!” We’re in Texas and all. lol. 

Cervicogenic Headache

Alright, let’s tackle cervicogenic headache a bit here. The first thing I want to say here is that, prior to the DACO classes, I had assumed that cervicogenic headache had a much higher prevalence than it does in reality. In your clinic, it really doesn’t show up all that much compared to the other forms of headaches. 

Breaking that down a little, tension-type headaches are the most prevalent at 38% of cases, migraines are next at 10%, and cervicogenic headache brings up the rear-end of the group at about 4% of cases. 

If it only makes up 4% of cases, why the heck are we covering it this week you may ask. Well, let me answer that since you’re so damn inquisitive today. 

Because it still makes up your patient base, you need to be able to notice it, and it’s one of the forms we can be fairly effective in treating. 

The first thing we gotta do is rule out a pathological headache by testing 

  • Steady gait over a normal base
  • Normal vital signs
  • Normal Romberg’s test
  • Quick screen of cranial nerves looking for extra-ocular movements, nystagmus, symmetrical pupils with normal reaction to light, normal facial muscle tone, and things like that. 
  • And then a basic screen of tendon reflexes, motor power and pathological reflexes like Babinski’s and Hoffman reflexes

 

What Does It Look Like?

So, what does a cervicogenic headache typically look like? Well, the first thing is that it is technically a secondary headache which means it is the symptom of something else that’s going on. 

Cervicogenic headache is usually 

  • Unilateral, side-consistent pain referred from a source in the neck. In fact, many times, you can elicit the head pain by pressing on the facets of the C2/3 region. 
  • Usually, the pain starts in the upper cervical region and then spreads toward the front of the head, orbital region, temples, vertex, or ears.
  • The pain may also spread to the ipsilateral shoulder or arm
  • Also, the pain is precipitated or aggravated by special neck movements or sustained neck posture. 
  • It’s mostly in the adult population with females being four times more affected than men. 
  • Sufferers can have suboccipital neck pain, dizziness, and even lightheadedness 

Paper #1

Let’s look at this paper called “Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headaches” authored by G. Jull and published in 2007 in the International Headache Society[1]. 

They were testing musculoskeletal function in headache types like tension-type, migraine, and cervicogenic.

In all but one measure (kinesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache.

It doesn’t get much more sensitive and specific than that does it? 100% and 94%. Bam, you got a cervicogenic headache Patient Jones and I have pretty much zero doubt about that. Yes…that feels good to be that confident. 

Paper #2

This next paper is called “Upper cervical and upper thoracic manipulation vs. mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial[2].” It was authored by James Dunning, and what looks like about 30 others and published in BMC Musculoskeletal Disorders in 2016. 

In the beginning here the authors say that no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache. Thus the reason for the study. 

They had 110 participants here that were randomized to receive both cervical and thoracic manipulation or mobilization and exercise. 

What They Found

“Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.”

Time for superhero sound effects….Bam, snap, pow, shazam!

One of these days, I’m really going to incorporate sound effects into my efforts here but until then, you’re stuck with my ridiculous superhero effects. Lol. 

Paper #3

Moving on, this next paper is called “Dose-response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.” It was authored by M Haas, et. al. and published in the Journal of Manipulative and Physiological Therapeutics[3]. 

Why They Did It

To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor.

What They Found

There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits.

The authors concluded, “A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”

Paper #4

Roughly that same group led by M.  Haas, et. al. later published this one in 2018, just last year, called “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.” It was published in Spine Journal[4]. 

They were looking to settle in on the optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy. 

It was a two-site, open-open-table randomized controlled trial with 256 participants. 

What They Found

There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 treatments, days suffering from cervicogenic headache were reduced by half and about 3 more days per month than for the light-massage control group. 

And there you have it people, more information than you probably expected to get on Cervicogenic headache today. 

This week, I want you to go forward knowing more about cervicogenic headache than you did before you listened to this podcast. I want you to see it, test for it, recognize it, and fix it!

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.

Website

Home

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

 

Bibliography

1. Jull G, Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches. International Headache Society, 2007. 27(7).

2. J, D., Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord, 2016. 17(1): p. 1.

3. Haas M, Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther, 2013. 21(2): p. 113-24.

4. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

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

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

 

 

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

Today we’re going to talk about a great new paper coming to us from Internal Medicine Journal on Lumbar fusion surgery and it’s evidence or lack of. What’s the word on lumbar fusion surgery? We’ll tell you.

But first, here’s that silky smooth Chiropractic Forward 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 glided all fast and furiously into Episode #54 and we’re happy to have you here smokin tires and all. Kill the engine and take a chill pill, won’t you?

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedics program quickly. I’m sitting at around 76 of my online hours and I have to get 250 of those. Yes, if you were wondering, it is going by slowly here lately but I’m going to have a little time this week and weekend to put the pedal to the metal and get after it. 

Some classes from this past week were migraines, migraines in children, thoracolumbar junction difficulties, and chronically injured hamstrings. 

Spelling Issues

These courses come from a group in Australia and they really take the long road when it comes to spelling. Did you guys know that? The first thing that’s crazy about the Aussies is that they use esses instead of z’s. For example, recognize is spelled with an s rather than a “z”.

When you see the word orthopedic spelled orthopaedic, it’s because of them and the English. We take the shortcuts and say, hey, recognize has a z sound in it so let’s spell it with a z. Hey, orthopedic has an e sound in the middle of it so let’s drop the dumb a since we don’t need it and let’s just spell it orthopedic. 

Here’s another one. Behavior. These goofy people spell it behaviour. They snuck in au right there at the very end of the word like they thought they were going to get away with it or something. Uh uh. Nope. We Americans don’t need the u at the end so we just end it in or. Because we’re cool and ain’t nobody got time for that crap. 

The most annoying one is probably edema or estrogen. They start both of those words with an O. Who the hell would ever spell estrogen Oestrogen? Or edema spelled oedema? That’s absolutely uncalled for and I’d appreciate them re-evaluating their use of the English language in this manner. 

Absolute ridiculosity. 

I am currently designing some really cool stuff all based in research and current evidence that I think you will all be interested in. At least I hope you are because, from what I’ve seen in researching, it’s like nothing else out there. 

Go to chiropracticforward.com right now while you’re thinking about it, just under this week’s episode, you’ll see an area where you can sign up for the newsletter. It’s only once a week and it’ll help us tell you about what we’re working on when we get it ready to go live!!

Now, let’s get to the reason for the season here. 

The is titled “Lumbar Spine Fusion: What Is The Evidence(Harris I 2018)?” and it was written by Ian Harris, Adrian Traeger, Ralph Stanford, Christopher Maher, and Rachelle Buchbinder. I recognize at least two of these names from the low back pain series published in The Lancet earlier this year. 

If you have not been through those papers, please listen to episodes #16, 17, and 18 of this Chiropractic Forward podcast for all the info you need on that. 

Basically, in this paper, they say that lumbar spinal fusion is common and associated with high cost and a risk of serious adverse events. They state that they aim to summarize systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. 

Of important note is where they say that they found NO high-quality systematic reviews and the risk of bias of the randomized controlled trials they found was generally high. For something as serious as lumbar fusion surgery. Where they cut into the body, take two vertebrae that usually aren’t unstable on each other, and then drive screws into them and affix hardware to fuse them together forever and ever amen. 

No high-quality systematic reviews for lumbar fusion surgery and the RCTs out there generally carry a high risk of bias. Great. Duly noted. Awesome. Lumbar fusion surgery

They go on to say that the available evidence doesn’t support a clinical benefit from lumbar fusion surgery compared to non-operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

They say that surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome. That was based on a single trial. 

That was the high points of the abstract but let’s move in a little more and get on the micro level of this thing. 

This study takes info from Australia and, in the land down under, lumbar spine fusion is the fourth most costly surgical procedure, behind knee replacement, hip replacement, and C-sections. For a procedure with no high-quality systemic reviews. The first word that comes to mind for me here is, “Damn.”

The most common reasons used for lumbar spine fusion procedures would be intervertebral disc disease (which nearly everyone beyond 50-60yrs old has), degenerative scoliosis, and spinal canal stenosis. 

The main purpose here was to compare lumbar spinal fusion to non-operative means. Not to compare it to other surgical procedures. 

Conclusion

As part of the conclusion, the authors say, “The available evidence does not support the hypothesis that lumbar fusion surgery confers a clinical benefit compared to non‐operative alternatives for low back pain associated with degeneration. Similarly, the available evidence does not support the hypothesis that spine fusion confers a clinical benefit compared to non‐operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

Benefits of lumbar fusion surgery compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial).

Ideally, lumbar fusion surgery for spondylolisthesis, burst fractures, back pain or degenerative conditions (degenerative scoliosis, spinal stenosis, recurrent disc herniation or instability), should only be performed in the context of high-quality clinical trials until the true value for each of these conditions is established. 

Until better quality evidence is available, treatment will continue to be guided by expert clinical opinion based on evidence at high risk of bias. Patients contemplating lumbar fusion surgery should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.

When Surgery Is OK

Let’s transition from that to an excellent guideline called When Surgery is OK and this comes from the legendary Dr. Stu McGill. 

To keep this episode from getting too long and out of hand, let’s hit the highlights. This is a 3-page document so we’ll shorten it to the extent that makes sense while still squeezing the good stuff out of it. Use these thoughts and ideas when deciding if surgery is indicated. 

Stu says to try the virtual surgery game and consider surgery only when it fails. Meaning pretend you had surgery today and tomorrow is the first day of recovery. It is characterized by gentle movements and activities but mostly a forced day of rest. The days following a typical post-surgical progression involves restricted activity. If this helps, no surgery at this time. 

Consider surgery when neurological issues are substantial, such as loss of bowel and bladder control. Note: that does not include radiating symptoms like sciatica, peripheral numbness, atrophy, etc….

Consider surgery in cases of trauma. When structures are unstable and need to be stabilized. 

Consider surgery only when the pain has been unrelenting and severe for a substantial period of time. Pain can be a terrible and misleading reason to get surgery. 

Select the surgeon. Dr. McGill says everyone likes to state that they had the best surgeon. He has found that asking the nurses and physical therapists at the hospital which surgeon has the best results is a wise way to go. 

Discuss the pain with the surgeon. Ask what the pain generator is and if they can cut it out. IF there are several tissues involved, chances of success are getting worse. Also if there is damage at several levels. 

Clarify what the success rate is. What does success even mean in your case? Does that mean you survived or does it mean you did OK for a bit before relapsing into pain? You want long-term success to any and all other options available. 

Beware of new treatments. That one should really go without any further discussion. Don’t be a pioneer on the patient side of surgical procedures. 

Beware of disc replacement – Dr. McGill states in this paper that he has not seen a successful case as of the writing of the article. 

Always exhaust the conservative options – He says you may believe that since you tried physical therapy and it didn’t help that only surgery remains. It just may be that the exact therapy tried was not the right one for your specific condition. 

FREE MRI Review

Beware of institutes that offer to view medical images and, with no other information, advise patients on surgery. Pictures are not linked to pain. He argues that a thorough clinical assessment is absolutely essential. I want to butt in on this one. The laser institute and orthopedic surgeons are all over the commercials on TV with this one. 

I will take this time to admit because they’re doing these free MRI reviews, I’m offering the same in my region but here’s why. It’s evidently enticing or they would not offer it and I KNOW for a fact they have a higher-paid marketing department that has decided it is indeed effective. 

That’s one of the reasons I’m doing it but the real reason is because I know that the majority of these people, if they get a free MRI review at the osteopath or the laser spine institute, they’re very likely to be lined up for surgery whereas I, after a thorough exam, will be lining them up for conservative, non-invasive therapy and I can usually keep these people from surgery and useless shots. 

There’s a difference. My free MRI review is to prevent them from surgery. Their free MRI review, in my opinion, is to QUALIFY them for surgery. 

Wrap Up

In wrapping this article or paper up, Dr. McGill says the following, “Tissues in the back become irritated with repeated loading. Consider accidentally stuffing a toe or biting the lip repeatedly – eventually, the slightest touch causes pain. This is symptom magnification because the tissues are hypersensitized. Reduction of the hypersensitivity in the toe or lip only occurs following a substantial amount of time after the accidental stub or bite has stopped.”

Dr. McGill goes on to say, “For example, people with flexion bending intolerance of the spine may replicate this every time they rise from a chair. Correcting this movement fault, metaphorically taking the hits away, results in less sensitized tissues, an increased repertoire of pain-free tasks, and a return of motion. Motion returns once the pain goes away.”

Boom. Snap. Pow. Shazam. KaBAM!! Superhero abilities via the chiropractor and ZERO surgery. How clever. 

Opinion

I don’t care what your chiropractic practice looks like. OK….I lie. As long as it doesn’t make mine look hokey or bad, then I don’t care what your practice looks like. Some are geared toward getting people out of pain. Some are geared to some wellness protocol. Some are floundering because they don’t know where they belong or exactly what they’re trying to accomplish. 

I’ll admit that, at one point in time, I was one of them. 

But, one common thread through all sorts of practices is this, we keep people from surgery. Maybe not 100% of the time but we do a hell of a job with the tools we’ve been given and I love the direction that opioids and lumbar fusion surgery failures are pushing our profession. 

Sometimes even in spite of ourselves. 

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.

Website

Home

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

About the Author & Host

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

 

Bibliography

Harris I, T. A., Stanford R, (2018). “Lumbar spine fusion: what is the evidence?” Internal Med J.

 

 

CF 024: They Laughed When I Said I Could Still Help After Back Surgery

CF 020: Chiropractic Evolution or Extinction?

 

 

 

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. 

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

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 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART TWO)?

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (Part TWO)?

Today we’re going to continue our talk from last week on whether or not a disc herniations change as you sit up, stand up, or move around. We went over some pretty good research last week. This week, it’s time for the cherry on the top. 

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 scampered into Episode #48. I use scamper this week because, as my son was playing with his aunt and uncle’s dog named Rowdy down in Dallas last weekend, that was the way he described when the dog would take off after the tennis ball every time. Scamper. Great word that I plan on using more from here on out where appropriate. 

Diplomate of Chiropractic Orthopedists

The DACO this weekend down in Dallas. The class was with James Lehman. Dr. Lehman, in case you do not know, is with the University of Bridgeport Connecticut. His official title from their website is Associate Professor of Clinical Sciences, Health Sciences, College of Chiropractic. 

Dr. Lehman is also one of the main drivers of this DACO program. Through Univ. of Bridgeport Connecticut, he has teamed up with CDI out of Australia and their courses in neuromusculoskeletal online education. It is VERY well done. Very professional and very worthwhile. You can find that at https://cdi.edu.au

We talked a lot about some stuff that I want you to hear straight from him so we’ll do an interview with him very soon but the gist of it all is this: get certified in something other than simply having your doctor of chiropractic degree. 

FQHC

I’ve heard a couple of opinions. I’ve heard the Diplomate programs are worthless now and that people are moving away from them. But, I think that’s coming from people that don’t want to take the time or put in the effort. The real story is most likely that our system, for good or bad, is moving away from private practice and TOWARD integrating through the group offices and through the Federally Qualified Health Centers. 

There are chiropractors being reimbursed in the system up to $300 for a Medicaid visit and around $150 on the lower end. 

I have to thank Dr. Craig Benton once again for bringing this to my attention. Did you guys know that, given the right positioning, you could make that much per appointment from freaking Medicaid?

Here’s the deal though: you have to be a specialist. A Diplomate. So, is it really useless? I say it most certainly is not. 

Whiplash Section

Now the course, the course this weekend was on whiplash. I’ve been through Art Croft’s 4 part Advanced Certification on Whiplash Biomechanics and Traumatology so I can say with a lot of honesty that a good portion of the course was a refresher for me. 

But, I absolutely learned a solid amount of new stuff as well. Such as Axillary compression. Axillary compression was not a condition of the shoulder that was on my radar screen prior to this course. 

That is one simple little example but there was a gob of nuggets for the nugget pouch and as always, I really walked away feeling that I will be better at my job on Monday. But it’s always that way. Even after just a 2-hour online course. It’s phenomenal.

Personal

Continuing the ongoing saga of hiring a front desk staff member in the year 2018. Here’s what all I’m going to say about it. Looks like my wife has found a new full-time job. Lol. Get the picture?

It looks like I may have a cool speaking gig coming up in February. Nothing solid but, if I were to come to your state convention or to some sort of event you are at, what topic along the vein of Chiropractic Forward’s typical content would you like to learn more about? 

If you are a regular listener and familiar with what we have been doing here this last year, I’d really appreciate it if you would take just a minute and email me at dr.williams@chiropracticforward.com and give me a little guidance. What topics would you want to see in a presentation?

I’m glad you’re here and hopefully, I didn’t ramble too much before getting to the meat and taters. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

On To The Research

Picking up from last week, we want to start in on the changes disc herniations undergo when axial pressure is placed on them. In other words, what happens to disc herniations from the time the MRI is taken laying down to the point where the person sits up. 

I have to preface it all by saying go listen to last week’s episode which is #47, please. It tells you how it is very common in the medical field amongst even radiologists to assume or guess that there is no change in the disc or in the herniation when axial pressure is applied. Research tells us differently. 

This week we want to start with a paper called “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” It was done by Ferreiro Perez, et. al[1]. and published in the European Journal of Radiology

How they did it

  • 89 Patients studied
  • 45 of them had their low back imaged
  • 44 patients had their necks imaged
  • The images were done in both the lying down position as well as the sitting.

What They Found

  • The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
  • Overall combined recumbent underestimation rate in cases of pathology was 62%
  • Overall combined upright-seated underestimation in cases of pathology was 16%.

Wrap It Up

Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniations and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.

Next, this one is titled, “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al[2].

Why They Did It

The authors in this paper were wanting to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure. 

How They Did It

They had 51 patients with symptoms of neurogenic intermittent claudication and/or sciatica that had their MRIs loaded as well as non-loaded. 

The foramen involved were all measured for changes in sizes.

Wrap It Up

Here’s what they found, “More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2-4 disc degeneration is present.”

AKA:” Seated or loaded MRIs are superior for assessing lumbar stenosis. 

Next, this one is by Willen[3] and it’s called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” It appeared in Spine Journal in 1997. 

They had 50 people with CTs, 34 were imaged with MRI, the imaging was performed laying down as well as axially loaded. 

They closed it up by saying, “Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”

Next Paper

This one is by Kanno, et. al[4]. called “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” It appeared in Spine Journal in 2012. 

44 patients, with imaging in the supine position and then with axial load added. The dural sack was measured 

“The size of the sack was significantly reduced in the axially loaded imaging and the axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98%) than the conventional MRI.”

Next paper

This one is by Danielson et. al. from 2001 called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper appeared in Spine Journal in 2001 as well. 

MRIs were performed lying down as well as with axial load on the participants. The axial loading was performed lying down, face up with a compression device built for this study specifically. The diameter of the dural sack was measured to check for the differences. 

The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”

Pretty cool stuff right there people. 

I want you to go forward this week knowing what you get from listening to this podcast every week. You get things you can absolutely use and implement immediately. Some of you may gain confidence now that you know some research that you maybe didn’t know previously. Some of you may now be able to tell a patient that has a 5mm central posterior herniation that 5mm isn’t telling us the whole story. 

It’s telling us part of the puzzle but that discs respond to positioning and various stresses we put on the discs through our activities. 

Use it or lose it

This can give you some extra guidance in your recommendations when you consider disc herniations change and get worse, stenosis gets worse when the patient sits up or bends forward. 

If you aren’t up on directional preference exercises, McKenzie, and CRISP protocols, it’s time to get there folks. It’s time to get there. The anatomy absolutely responds to movement and positioning. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact Us!

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We love to stay in touch and want to offer you discount specials when we get our educational products up and rolling. 

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. 

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

CF 035: Chiropractic & Disc Herniations

Bibliography

1. Ferreiro P, e.a., Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol, 2007. 62(3): p. 444-8.

2. Ahn TJ, e.a., Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading. Neurol Med Chir (Tokyo), 2009. 49(6): p. 242-7.

3. Willen J, e.a., Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976), 1997. 22(24): p. 2968-76.

4. Kanno H, e.a., Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976), 2012. 37(16): p. E985-92.

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

Tyce hergert chiropractor southlake

Integrating Chiropractors

Today we have a special return appearance from a friend of the show and we’re going to talk about chiropractic maintenance care also known as chiropractic preventative care. Chiropractors have recommended a regular schedule to their patients for generations but it was mostly as a result of experience and intuition. But what about research on the matter? We’ll get to it.

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.  

Be sure you have signed up for our newsletter slash email. You can do that at chiropracticforward.com and it lets us keep you updated on new episodes and new evidence-based products when they come out. Yes, eventually there will be some pretty cool things available through us. We won’t email any more than once per week and the value outweighs the risk. Kind of like in cervical manipulation. So just go get that done while we’re thinking about it. 

You have confidently strutted right into Episode #42 and we are so glad you did. 

I would really like to just turn this mic on and automatically be the #1 chiropractic podcast in the world but that’s not the real world, right? But I have to say that we continue to grow. I’m impatient and it’s never quite fast enough but we are continually growing and that’s always exciting. When you see the growth chart consistently going up and to the right, then hell yeah. Ka-bam shazam. 

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.

My Week

But first, my week has been nuts. When was the last time you tried to hire someone? It’s absolutely stupid these days. Honestly, I posted a job on indeed.com. I got literally 175 resumes, scheduled 15 interviews, only 7 showed up for the interview, and we have one really good prospect. 

This is the second round by the way. We tried to hire for the front desk position a few weeks ago and went through 120 resumes. We actually hired a girl but then her dad got sick and after thinking it over, decided we weren’t a good fit. Lol. Can you imagine? 

I don’t know if you can tell from this podcast or not but….I’m generally a pretty darn good guy and really care about my staff and care about people and care about making connections with others. 

I don’t yell, I don’t fuss a lot. Even when they’re wrong. That’s just not my style. I don’t think I stink or anything having to do with body functions so, I can’t figure it out other than people have just changed. Or has it always been hard to find good help? All I know is that I’m having a hell of a time finding the right front desk personnel and it’s making me more than a little crazy. 

Welcome Dr. Tyce Hergert from Southlake, TX

Now that we have all of that out of the way, I want to welcome our guest today. You could say we sort of know each other. In fact, we grew up in the same neighborhood from elementary school all the way through high school. Even though I was a couple years older, we definitely knew each other. He lived right next door to my best friend and we played football in his front yard pretty often. 

We were at the University of North Texas at the same time living in Denton, TX and then we were down at Parker College of Chiropractic at the same time as well. If that weren’t enough, we have both served in statewide leadership positions for the Texas Chiropractic Association. In fact, Tyce is part of the reason I got involved in the first place. 

He took it a step further than me though. Dr. Hergert actually served as the President of the TCA two terms ago and helped steer the profession to a historic 4 chiro-friendly bills passed in the state legislature that year. This is important because the bills that were passed in our favor prior to that would be basically zero, none, nada, goose-egg, zilch. 

About an Integrated Practice

Dr. Hergert also runs an integrated practice down in Southlake, TX so he’s an excellent resource for our kind of podcast. 

Some people kind of think he’s a big deal and there’s a good argument to be made for that but I’m not going to be the one making it because I’ve known him way too long. 

Not only is he an ex-Pres for the TCA, but he also has the bragging rights of being a guest on 2 of our top five most popular episodes of all times here at the Chiropractic Forward Podcast. Those are episodes 6 and 11 with 11 actually being our most listened to episode of all time so congrats to Dr. Hergert on that. 

If you enjoy his guest appearance on this episode, although I’d be a bit flabbergasted as to why you enjoyed it….you can always get more of Tyce on those. Again, I’m not sure why you’d ever want to do that. Lol. 

Welcome to the show Dr. Hergert. Thank you for taking the time to join us. 

Tell us a little bit about Southlake, TX for the ones unfamiliar with the Dallas/Ft. Worth area. 

Tell us a little bit about running an integrated practice. What’s it like? Have you become more of an owner/administrator or are your elbow deep in treatment and the physical aspects of seeing patients all day every day still?

Getting To The Research

This first paper….I alluded to back in episode #36 but very briefly. We covered a little more in depth back in Episode #19 as well which posted back in April of this year. I think in light of a brand new paper that just came out, it’s worth covering this one again if you do not mind. It’s all about chiropractic maintenance and chiropractic preventative treatment.

It’s called “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal[1]. 

For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”

Why They Did It

The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance and chiropractic preventative treatment adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.

How They Did It

  • 60 patients having chronic low back pain of at least six months duration
  • Randomized into three different groups:
  • They included 12 treatments of fake treatment for one month
  • One group had 12 treatments of chiropractic adjustments for a month only
  • They also had a group with 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
  • Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment

What They Found

  • Patients in groups 2 and 3 had a significant reduction in pain and disability scores.
  • ONLY group 3, the group that had chiropractic maintenance and chiropractic preventative treatment adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
  • The groups not having chiropractic maintenance and chiropractic preventative treatment adjustments, pain and disability scores returned close to the levels experienced prior to treatment.

Wrap It Up

The authors’ conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

Dr. Hergert, what do you have to say on this one? I’m not sure what there is to say except, “Told you so!”

What do you typically recommend to your patients as far as chiropractic maintenance and chiropractic preventative treatment care goes?

Paper #2:

Actually, this one is a webpage linked in the show notes for you at ChiropracticForward.com in episode #42. 

http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml

This article was compiled by Dr. Anthony Rosner, Ph.D and called Documentation Supporting Maintenance Care[2]. 

The article starts by saying that the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were NOT and found that the individuals under continuing chiropractic care were:

  • Less likely to be in a nursing home
  • Were less likely to have been in the hospital the previous 23 years
  • They were more likely to report better health status
  • Most were more likely to exercise vigorously

Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions[3]. 

The next paper on chiropractic maintenance and chiropractic preventative treatment is by Dr. Rosner and talks about was a review of a larger cohort of elderly patients under chiropractic care and those not under chiropractic care. Basically, comparing monies spent on hospitals, doctor visits, and nursing homes[4] They found the following: Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare. 

  • $3,105 vs. $10,041

How’s it looking so far, Tyce?

Tyce, you’re going to like this one. Chances are, you’re probably going to want to tell people all about this one. 

Let’s get to the newer paper I mentioned before. It’s called The Nordic Maintenance Career program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain – pragmatic randomized controlled trial and it was compiled by Andreas Eklund, et. al[5]. 

Why They Did It

The authors wanted to explore chiropractic maintenance and chiropractic preventative treatment in the chiropractic profession. What is the effectiveness for prevention of pain in patients with recurrent or persistent non-specific low back pain?

How They Did It

  • 328 patients
  • Pragmatic, investigator-blinded. Pragmatic. What does that mean exactly? According to Califf and Sugarman 2015, It means it is “Designed for the primary purpose of informing decision-makers regarding the comparative balance of benefits, burdens and risks of a biomedical or behavioral health intervention at the individual or population level” Meaning they are attempting to run a trial to inform decision-makers of responsible guidelines going forward. That’s it for the dummies like me in the room. 
  • Two arm randomized controlled trial
  • Included patients 18-65 w/ non-specific low back pain
  • The patients all experienced an early favorable result with chiropractic care. 
  • After an initial course of treatment ended, the patients were randomized into either a maintenance care group or a control group. 
  • The control group still received chiropractic care but on a symptom-related basis. 
  • The main outcome measured was the number of days with bothersome low back pain during a 1 year period. 
  • The info was collected weekly through text messaging. 

What They Found

  • Maintenance care showed a reduction in the number of days per week having low back pain
  • During the year-long study, the chiropractic maintenance and chiropractic preventative treatment group showed 12.8 fewer days. 
  • The chiropractic maintenance and chiropractic preventative treatment received 1.7 more treatments than the symptom-related group. 

Wrap It Up

The authors wrap it up by saying, “Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”

Basically, both groups still underwent chiropractic maintenance and chiropractic preventative treatment. It’s like we tell people, stay on a schedule and you’ll do well. Wait until you hurt and the chances are good that you’ll spend the same amount getting over that complaint anyway. 

This study showed that exactly except, over the course of just one year, the maintenance chiropractic care (preventative chiropractic care) people had 1.7 more visits but suffered pain almost 13 days less. 

Bring it home

Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes. 

Dr. Hergert…what say you?

Lay some sage-like wisdom on us here and bring it all home for us won’t you please?

This week, I want you to go forward with the knowledge that, when you write “patient recommended preventative chiropractic care schedule going forward” you can do so confidently knowing your are right and there is research showing it. 

You don’t have to recommend chiropractic maintenance and chiropractic preventative treatment simply because you heard to do that at school or because your old boss always did it. 

You can make those recommendations because it’s best for your patients. 

Dr. Hergert, do you have anything to add, this is probably your last time on the podcast after all. 

Thank you so much for hanging out with us today, I was kidding of course. We will make time and do it again down the road. 

Integrating Chiropractors

Affirmation

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.

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.

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. 

Website

http://www.chiropracticforward.com

Social Media Links

https://www.facebook.com/groups/1938461399501889/

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

 

Bibliography

1. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.

2. Rosner A. Documentation Supporting Maintenance Care. Chiro.org 2016; Available from: http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml.

3. Coulter ID, Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program. Topic in Clinical Chiropractic, 1996. 3(2): p. 46-55.

4. Rupert R, Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II. J Manipulative Physiol Ther, 2000. 23(1): p. 10-19.

5. Eklund A, The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One, 2018. 13(9).

CF 040: w/ Dr. Brandon Steele: Chiropractic Standardization & The Future of Chiropractic

 

CF 038: w/ Dr. Jerry Kennedy – Chiropractic Marketing Done Right

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

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice

 

CF 039: Communicating Chiropractic

Communicating Chiropractic 

Integrating Chiropractors

Today we’re going to talk about communicating chiropractic and chiropractic utilization. What am I talking about? Stick around

But first, here’s that bumper music

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

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

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

You have potato sack jumped yourself right into Episode #39. In case you are new to the Chiropractic forward podcast, there is a different way to get into this podcast. Moonwalk, do the twist, electric slid, grooved, you get the point. 

We are talking about communicating chiropractic and I want to start the research part of our podcast today with a pretty cool paper that just passed through my email. I have my buddy and colleague, Dr. Craig Benton down in Lampasas, TX to thank for this one. It’s called “Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain.” It was authored by PM Herman, et. al. and published in the Journal of Manipulative Physiology and Therapeutics on August 15th of 2018[1]. Brand spanking new, people. https://www.ncbi.nlm.nih.gov/pubmed/30121129

Why They Did It

Since chronic low back and chronic neck pain dominate our population and since chiropractic is a common approach to the conditions, the authors wanted to explore the characteristics of chiropractic patients suffering the conditions here in the United States. Further knowledge here helps with communicating chiropractic more effectively.

How They Did It

  • They collected information from chiropractic patients with different levels of information that included regions, states, sites, providers and clinics, and patients. 
  • The sites and regions were San Diego, Tampa, Minneapolis, Seneca Falls, and Upstate New York, Portland, and Dallas. 
  • Data was collected through an iPad prescreening questionnaire in the clinic and through emailed links to full screening and baseline online questionnaires

What They Found

  • 518 patients with chronic low back pain only
  • 347 with chronic neck pain only
  • 1159 with both chronic low back pain and chronic neck pain. 
  • In general, most participants were highly educated white females that had been using chiropractic care for years. 
  • Over 90% of the participants reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care.

Wrap It Up

The authors concluded, “Given the prevalence of CLBP and CNP, the need to find effective nonpharmacologic alternatives for chronic pain, and the satisfaction these patients found with their care, further study of these patients is worthwhile.”

As a side note, at the first ChiroTexpo event for the Texas Chiropractic Association state convention, these researchers were there recruiting offices for this paper which is kind of cool. 

How much of the population do chiropractors see on average? At least in American? For years, the number has been from 7% to 11% but there is research out there that suggests the number is actually bigger. We can answer that question a little more accurately thanks to some research from Palmer that was published back in 2015. 

This next paper goes more toward helping us in communicating chiropractic than any other paper in recent memory.

It’s called “Americans’ Perceptions of Chiropractic,” it was performed in conjunction with Palmer and Gallup and was submitted by James O’Connor of Palmer and Joe Daly of Gallup[2]. I have linked it in the show notes for you. 

https://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup-report-palmer-college.pdf

The report states from the get-go that half of the adults in the US have been to a chiropractor as a patient. 

  • 14% of adults say they saw a chiropractic within the last 12 months. 
  • 12% say they saw a chiropractor in the last five years
  • 25% say they saw a chiropractor more than 5 years ago
  • Women are more likely to love and visit their chiropractor regularly
  • Adults under 50 are more likely to say that the chiropractor is their first stop for neck or back pain. 
  • Over 50% of adults strongly agree or agree somewhat that chiropractors are effective at treating neck and back pain. 

All of this is great news, y’all. Great news. In the conclusion of this report from Gallup and Palmer College, they say yes…over half of Americans view chiropractors as effective for neck and back pain but uncertainty about costs and misinformation about potential dangers of chiropractic are potential obstacles to them utilizing our services. 

I addressed the whole stroke issue the medical field has tried to saddle us with in a blog, in a YouTube video, and in a series of three podcasts and highly encourage you to re-visit the information in episodes 13, 14, and 15. I will link them for you in the notes. 

The blog, YouTube video, and podcast series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You must have this information. If you do anything this week, do that. I laid it all out and I did it in blog form, video form, and podcast form so you could pick your preference and get the information. So do it. This information will go a long way in helping you with communicating chiropractic.

YouTube: https://youtu.be/tRXpG_Ie0Rs

Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

Podcast Episode #13: https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Podcast Episode #14: https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Podcast Episode #15: https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

The report suggests we try to be transparent when it comes to the costs of chiropractic which also means providing details on insurance coverage, visits required, etc. Here’s the deal though…..if someone comes up to me on the street and asks me how much it costs to come see me, what the hell am I supposed to say?

Quite literally, I don’t have a single damn clue what it’s going to cost them. I don’t know what kind of insurance they have. How do I know if their issue is acute, chronic, or a combination of issues spanning the acute as well as the chronic? I have no way of knowing if their deductible is met. I can’t know what their co-pay is. How can you tell people any of that crap and I’m sure as hell not going to be having a long enough conversation with them when I’m out and about with friends or family to figure it out either. 

Palmer is crazy on that part of this. I’m all about communicating chiropractic but people are grown-ups. They have a Google machine in their pockets. Figure out what your deductible is and how much you’ve met. Figure out what your co-pay is. Google up the offices in your area and try to get an idea of how they practice. If they’re talking about fixing ear infections, boosting your immunes system, and not getting your kids vaccinated, well….chances are they’re going to want to see you 1.23 million times through your lifetime. 

If they’re talking about exercise/rehab, evidence, research, and things of that nature, then they’re going to address your issue quickly and relatively inexpensively. 

Then get on your Facebook machine and ask your friends which evidence-based chiro in your area you need to be seeing and go do that. It’s easier today than ever before. Palmer doesn’t really need to put that directive on chiropractors in my opinion. 

They go on to say that about 37% of Americans are unsure whether or not chiropractic is dangerous. Palmer suggests we chiropractors try communicating chiropractic more clearly in regards to the level of education we have gone through. I think that’s a great suggestion. I do hate the fact that MDs and DOs aren’t going around having to tell everyone about the classes they took and we DCs obviously do need to do that but, it is what it is. You want that in Espanol? Here it is: “Es lo que es.”

Just trying to spice it up, folks. Go with it alright?

The report had some cool news. What news is that you might say? To that, I’d say this: current users of chiropractic typically see their doc an average of 11 times per year which they say shows a strong commitment to chiropractic care.

If the description is a strong commitment to chiropractic care, then count me in. I’m on board. I’m on that team. 

The last sentence of the report says this, “The chiropractic community would do well to increase awareness among the public about the benefits of chiropractic care and the costs associated with it, including offering flexible methods of payment and assistance with navigating insurance, to ensure potential users have what they need to make an informed decision regarding care.”

OK….where to start here?

Dammit. We all know all too well that chiropractors increasing awareness among the public about the benefits of chiropractic care is a slippery slope. Do I want to encourage a chiropractor that doesn’t believe in vaccinations to be out there talking about the amazing benefits of Chiropractic? Ummmm….nope. Nope, I sure don’t. 

Now, if you have a doc talking about how awesome chiropractic is and how spinal manipulation combined with exercise rehab is a powerful combination and is now recommended by the American College of Physicians, JAMA, The Lancet, the FDA, the CDC, The Joint Commission, the current occupant of The White House, and even Consumer Reports…..well hell….I think you have a winner on your hands. That’s what I’m talking about when I say communicating chiropractic. 

Luckily, the only docs listening to me right now are the ones that are going to be talking about the latter rather than the former. 

So listen up evidence-based men and women…..unfortunately, you have to start telling people more about your education and you have to start telling people more about the research and evidence and support behind what it is we do from day to day. 

I’d like to say that it is super duper big-time double fortunate that you have resources like, oh say, maybe a podcast called the Chiropractic Forward Podcast that does all of the work for you by gathering and talking about research every week that can help you on this. 

Now, onto our last topic this week.

This one is an article from June 19, 2018, that was posted on the ACA Blog and linked in the notes on our website for this episode. 

https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/374/Communicating-Chiropractic-An-Algorithm-to-Answer-Difficult-Questions

The title of the article is “Communicating Chiropractic: An Algorithm to Answer Difficult Questions[3].” It was written by Dr. Stephanie Halloran who did an excellent job on this article in my opinion. Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System.

Dr. Halloran started the article by covering some common questions that can be asked of chiropractors within an interdisciplinary setting. The questions she mentions are:

  • What are the typical conditions treated by chiropractors and specific treatments utilized?
  • We to know the contraindications for treatment?
  • It’s important to be able to describe the mechanisms of manipulation and/or acupuncture?
  • What adverse events from chiropractic treatment, including post-treatment soreness and cervical manipulation and stroke?

All sound like reasonable questions but think about them for a minute. What would your responses be to them and would your answers really stand up to scrutiny in the medical kingdom?

Dr. Halloran cites her site director, VA Chiropractic Program Director Dr. Anthon Lisi as being key in helping her formulate an approach we can use to guide us to develop our own answers to these questions. She lines out 4 steps we should be looking at. 

  1. Have a great depth of knowledge – She says, “First and foremost, you must have an extensive understanding of what you are being asked. Whether the inquiry is as vague as “What is chiropractic?” or more specific, such as “What is the physiologic mechanism of manipulation?” or more sensitive, such as “Does cervical manipulation cause stroke?” it is imperative to know what the evidence does and doesn’t support. “ My goodness…where on Earth could you ever be educated on research and what the evidence says? Hmm….I’ll just wait here until….yes. You’ve found it right here!
  2. Selectively Present that knowledge – Answer with only the most pertinent information. Sometimes less is more and sometimes more is too much information but, be sure you can expound on the neurophysiological effects if specifics are asked.
  3. Be mindful of an appropriate stopping point – She says, “It is reasonable to assume that an encounter will occur at some point with a specialty physician possessing unwavering negative views of chiropractic treatment, and the reality is some will not be swayed despite the evidence presented. The goal of the interaction is to present the evidence, to meet them where they are, and to leave the door open for further conversation at a later date.” And then you punch them in the face and push them down on the playground while saying nanny boo boo. 
  4. Remain altruistic throughout – She says we need to stay focused on the overall goal of health care which is, according to her “to increase functional outcomes, improve quality of life, and provide the best care for patients.” I can get on board with that description myself. 

All of this goes toward helping you in communicating chiropractic. She wraps it up by saying, “In respect to success in integration, my biggest takeaway from being exposed to interprofessional collaboration on a day-to-day basis in the VA is the need for chiropractors to prepare answers to questions regarding what chiropractic care is, common conditions seen, neurophysiological effects of treatment, and the incidence of adverse events. These answers should be instantaneous and provide evidentiary support. One must also be prepared to hit the brakes when met with substantial resistance and to admit lack of familiarity with a topic, when appropriate.”

Can’t we all agree with this article? It makes perfect sense. If you can’t communicate and relay what it is you do, then what are you doing?

This week, I want you to go forward with the idea that we are not a dying profession. We are, in fact, growing and our utilization is growing. We maintain that growth through communicating chiropractic and better patient education as to our level of education and our cost-effectiveness. In addition, in regards to integration, let’s make sure we are prepared to answer questions and do it in a way that is 100% backed by solid and respected research and evidence. You can’t lose when it’s done that way. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

When you are communicating chiropractic, 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. 

??Website

http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

Bibliography

1. Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.

2. O’Connor J, Gallup-Palmer College of Chiropractic Inaugural Report: Americans’ Perceptions of Chiropractic. Palmer College of Chiropractic, 2015.

3. Halloran S, Communicating Chiropractic: An Algorithm to Answer Difficult Questions, in ACA Blog, ACA, Editor. 2018: ACA Blog.

This podcast episode was about communicating chiropractic. Communicating chiropractic effectively is a big part of moving the chiropractic profession forward. Bobby Massie Authentic Jersey

CF 033: Did You Need Proof That Chiropractors Help Headaches?

Did You Need Proof That Chiropractors Help HeadachesIntegrating Chiropractors

Today we’re going to talk about how chiropractors help headaches, we’ll discuss a couple of pretty cool papers that came out fairly recently, one of them only a couple of weeks ago from this recording, that had to do with spinal manipulation and the effectiveness in treating headaches and migraines. Psssst…..here’s a hint…..it’s good for chiropractors. Except for the very ending.

 

But first, here’s that bumper music

 

OK, we are back. You have shimmied into Episode #33. Chiropractors help headaches is basically our topic.

 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I have to say that in the last month specifically, this podcast really started to take off in terms of downloads and listens.

 

You know, when you first start something, there’s an excellent chance that nobody really gives a hoot. Lol. Isn’t that always the fear when starting something new? Does anyone care? Am I going to be able to offer any value? I have diagnosed myself with an anxiety issue. I over think and over think things. In the end, it’s simply because, no matter what it is I’m doing, I just want to do a good job.

 

I tell my son that, even if I don’t necessarily like somebody on a personal level if they are a hard worker, I will respect them. Everyone can respect a hard worker. Well, that’s what I try to be. I try to work hard and I try to bring things of value to me to you through writings, videos, social media, and podcast.

 

I’ll be honest with you. I have zero clues where all of this will eventually lead me. Lol. No clue at all. There’s no grand plan behind it.

 

All I know is I see it’s value and more and more of you are finding it’s value every week and it’s exciting. Maybe I’ll eventually put a course together for marketing your practice from an evidence-based perspective. Maybe I’ll have in-office patient education products. I’d love to be a speaker and travel the world bringing this information to evidence-hungry crowds. I have no idea where it can go but for now: I’m having fun.

 

Maybe it’s the old traveling musician in me. Maybe I just have to have people tuned in or I’m just lost. Lol. I have no idea but I know it’s fun and I’m glad you’ve come along with us so far. I’ll keep working hard if you’ll keep listening and we’ll just see where things go down the road together. I’m always keeping my eyes out for colleagues that see what I see. If that’s you, send me and email and let’s connect. Also, we’d like to ask you to join not only our Chiropractic Forward Facebook page but we also have a Chiropractic Forward Facebook GROUP where we have started sharing the papers we use, accepting comments, and will probably be including some of them in future episodes. We want our podcast to be a group effort if you’d like to participate. Come join us. The link is in the show notes.

 

https://www.facebook.com/groups/1938461399501889/

 

On a completely different note, I had mentioned back in mid-June or so that I was at the ChiroTexpo event in Dallas that was put on by the Texas Chiropractic Association and I met Dr. Tim Bertelsman down there. He was there for two reasons. One reason was as a vendor for his and Dr. Brandon Steele’s ChiroUp product and the other reason was to teach the Low Back portion of the Diplomate of American Chiropractic Orthopedists (DACO) program put on through the University of Bridgeport.

 

As this episode is recorded, I am about a week and a half from going through my second ten-hour course. This one will be taught by Dr. Brandon Steele down in Dallas again and I’m looking forward to it.

 

This is a really valuable program these guys are teaching and I encourage you all to check it out but, what I really wanted to tell you about is this ChiroUp thing they have going on. It’s crazy. Crazy in a good way.

 

I saw in one of the private groups on Facebook where a poster was asking for some good pointers on a report of findings.

 

Immediately, about 7 of the 10 posts had to do with recommending ChiroUp and, one of those posts was mine. I said it’s a game changer because, well….it is. I started using it about a month ago and it has literally changed the game for my busy office without adding a lot of demand to my staff. We’re talking patient education, activities of daily living, patient follow up, patient exercise-rehab recommendations, and even expediting online reviews. I have tried several products and services during my 20 years and most of them are just hype and take your money.

 

In my experience, so far….ChiroUp has been beyond what I expected. I’m jaded as hell. But, when Dr. Bertelsman started showing it to me, my jaw dropped a bit. I think I started slobbering. I’m not sure. Anyway, he showed it to me for about a minute and a half and that was it. Shut up and just take my money.

 

I want you to know, I don’t have any “deal” set up with those guys. Not yet anyways!! Lol. If it’s up to me I will because they’re amazing but, as of now, they don’t sponsor this show, no affiliate marketing deal….nothing like that. I’m just like your buddy down the road telling you hey man, I’m doing this thing and it’s been pretty freaking great. You should look at it. That’s all.

 

If you want to look into ChiroUp, go to www.chiroup.com and give it a look-see. And, if you like what you see and join up, you may mention our podcast and me, Dr. Jeff Williams. It never hurts for people to know who was out there pumping their tires, ya know. Sometimes what goes around comes around and I believe in always trying to project the good mojo.

 

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.

 

It’s all about headaches from this point forward today. I want to first direct you to a podcast we did that cited a bunch of headache papers that I hope you’ll go and listen to right after you listen to this one. It was Episode #14 but 14 is right smack dab in the middle of a series of podcasts I did on Debunking the myth that Chiropractors cause strokes. Specifically, the series starts on episode #13, #14 is the one with the headache research, and #15 is the conclusion of the stroke series we did. I CANNOT stress enough how valuable I feel those three episodes are.

 

We will have them linked in the show notes.

 

https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

 

https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

 

https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

 

We will get going with this paper from February of 2018 called, “Dose-response and efficacy of spinal manipulation for the care of cervicogenic headache: a dual-center randomized controlled trial.” It was done by Haas et. al[1]. and was published in the prestigious Spine Journal on February 23, 2018. Here’s how chiropractors help headaches.

 

Why They Did It

Although the researchers know that spinal manipulation chiropractors help headaches (which is nice to see) there has been little information on the dosage of spinal manipulation for them. They wanted to evaluate the efficacy of chiropractic by comparing it to a light massage control group.

How They Did It

  • This is a two-site, open-label randomized controlled trial.
  • Participants were 256 adults with chronic cervicogenic headache.
  • The primary outcome was the number of days with cervicogenic headache in the previous 4 weeks evaluated at the 12- and 24-week primary endpoints
  • Secondary outcomes included cervicogenic headache days at remaining endpoints, pain intensity, disability, perceived improvement, medication use, and patient satisfaction.
  • Participants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions
  • They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned
  • Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks.

 

Wrap It Up

In the authors’ conclusions, they say, “There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 spinal manipulative therapy visits, cervicogenic headache days were reduced by half and about 3 more days per month than for the light-massage control.”

Here’s one I thought was pretty darn cool when we talk about how chiropractors help headaches and it’s buried all the way down in the middle of a website for the Wiley Online Library. This site has all of the research covered at the 60 thAnnual Scientific Meeting American Headache Society June 28-July 1, 2018 at the San Francisco Marriott Marquis in San Francisco, CA.

This particular paper covered was by C. Bernstein and called “Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation[2]”

Why They Did It

While medications are often the first?line treatment for a migraine, many migraineurs do not experience clinically meaningful responses to preventive drug treatments or discontinue medication use due to side effects. Chiropractic care is a non?pharmacologic intervention commonly used for the treatment of pain conditions, including a migraine. You got that right!

 

They go on to say, “Observational studies and small trials have shown that spinal manipulation may be an effective therapeutic technique to reduce migraine pain and disability. We present results of a meta?analysis of spinal manipulation on migraine pain and disability and describe the design of a randomized controlled trial (RCT) evaluating comprehensive chiropractic care for the treatment and prevention of migraines.”

 

Oh yeah!! Sounding good. It appears that indeed, chiropractors help headaches. This talk appears to be on a new study they will be going through based on some preliminary work here.

 

How They Did It

  • They searched PubMed and Cochrane Library databases for clinical trials that evaluated spinal manipulation and migraine-related outcomes published through April 2017
  • The effect sizes and heterogeneity for pain and disability were estimated using meta?analytic methods.
  • The Cochrane Risk of Bias Tool was used to evaluate the methodological quality of retrieved studies
  • The results of this meta?analysis informed the design of a randomized controlled trial evaluating the addition of chiropractic care to usual medical care for women diagnosed with low-frequency episodic migraine.

 

What They Found

  • On the basis of 6 identified RCTs, random effects models indicated that spinal manipulation significantly reduced pain with an overall moderate effect size
  • Spinal manipulation also significantly decreased disability with an overall moderate effect size
  • However, the existing studies focused primarily on isolated spinal manipulation and not on comprehensive chiropractic care. To address this gap in the literature, our RCT will assess the safety, feasibility, and effectiveness of multi?modal chiropractic care for women aged 20?55 who experience 4?10 migraines per month and are not using preventive medications
  • Our modular chiropractic care approach may include, as needed, posture correction/spinal stabilization exercises, soft?tissue relaxation techniques, spinal manipulation/mobilization, breathing and relaxation techniques, stretches, self?care, ergonomic advice, and/or bracing and supports

 

Conclusion

The authors said the following, “Our meta?analysis indicated that spinal manipulation shows promise as a therapeutic technique to reduce migraine pain and disability, yet highlighted the need for rigorous studies evaluating the full scope of chiropractic care for migraineurs. The results of our meta?analysis provide the rationale for the design of our RCT.”

I can’t wait to see the result of the RCT. Wanna know why? Because I already know the results. At this point, it’s anecdotal but the results will show that chiropractors help headaches and migraines. I’m looking forward to hearing all about it.

 

If I don’t find it first, I know my colleague, Dr. Craig Benton down in Lampasas, TX. He’ll probably find it before me though. Lol. He’s on it every single day. I get a lot of information from a lot of different places but that guy just gets it first.

 

Lastly, I want to direct you to Episode #6 of our podcast. This one was with Dr. Tyce Hergert down in Southlake, TX called “Astounding Expert Information On Immediate Headache Relief. “

 

https://www.chiropracticforward.com/dr-tyce-hergert-astounding-expert-information-immediate-headache-relief/

 

We covered a paper. A paper that I thought had an outstanding quote in the conclusion.

 

The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[3].”

 

Now, in that episode, we explain that it was authored by Physical Therapists and that they have come up with their own term for a chiropractic adjustment and their term is “translatoric spinal mobilization.”

 

The point being that chiropractic adjustments can provide immediate relief for cervicogenic headaches. That’s sexy folks. Straight up awesome. Chiropractors help headaches.

 

The sub-points or something extra I’d like you to notice is the fact that physical therapists are moving in, adopting our ONE THING. So much so that they have taken it upon themselves to re-name our ONE THING for their own use.

 

This goes back to what we covered in episodes 28, 29, and 30….. We must integrate into the medical field and quit being out on the fringe. Otherwise, those that are already in the medical realm (physical therapists) will simply take our ONE THING, steal it, and we will still be sitting out there in the rain knocking on the window and watching them all eating steaks inside the private club. Lol.

 

That’s a little dramatic. There are those in our field that want to stay separate and distinct and I understand that. I understand your stance and your viewpoint. I just don’t agree with it. That’s all.

 

For me, integration into the medical realm ensures our profession’s survival and the health or our ONE THING. We make sure it sticks around. I’m afraid that if we stay out on the fringe, we LOSE our ONE THING to other professions, our reimbursements continue to fall, our income falls year after year because they getting “translatoric spinal manipulation” rather than chiropractic adjustments, and eventually, we cease to exist.

 

Just some random thoughts but, I truly think it’s time. Move toward the middle or suffer the consequences. I honestly see very few other options.

 

The research proves time and time again that we can EASILY move toward the middle. It’s coming out every week. More and more validation.

 

But, then there’s this. The ACA sent out an email recently discussing the fact that, in a continuing effort to be the absolute worst health insurance company in the world, United Healthcare is now discontinuing any coverage of chiropractic for the treatment of headaches[4]. What? What in the hell? Wait, let’s go through the website for UHC real quick so we know exactly what’s going on here. Got your gripey pants on? You’re going to need them. Chiropractors help headaches but UHC hasn’t received the message apparently.

 

On their website we’re linking here in the show notes:

https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf

 

UHC says the following:

Manipulative therapy is unproven and/or not medically necessary for treating: ·Non-musculoskeletal disorders, including but not limited to:

o Lungs (e.g., asthma)
o Internal organs (e.g., intestinal)
o Neurological (e.g., headaches)
o Ear, nose, and throat (e.g., otitis media)

  • Temporomandibular joint (TMJ) disorder
  • Scoliosis

Manipulative therapy is unproven and/or not medically necessary for preventive or maintenance care. The role of manipulative therapy in preventive or maintenance care has not been established in scientific literature. A beneficial impact on health outcomes has not been established.

They go on to say Craniosacral therapy (cranial manipulation/Upledger technique) or manipulative services that utilize nonstandard techniques including but not limited to applied kinesiology, National Upper Cervical Chiropractic Association (NUCCA), and neural organizational technique are unproven and/or not medically necessary for any indication.

Manipulative therapy is unproven and/or not medically necessary when ANY of the following apply:

  • The member’s condition has returned to the pre-symptom state.
  • Little or no improvement is demonstrated within 30 days of the initial visit despite modification of the treatment plan.
  • Concurrent manipulative therapy, for the same or similar condition, provided by another health professional whether or not the healthcare professional is in the same professional discipline.

I went that far into the paper just for the “huh, really?” effect but the main point here is, how can they say that spinal manipulation/mobilization is not clinically proven for headaches? In addition to the papers I pointed to here in this podcast, there are more in the links and episodes I provided. As in around 10 or so others showing and proving effectiveness. Just in episode 14 alone.

 

What exactly do they need and why the change?

 

Is this part of the Texas Medical Association’s attack on Texas Chiropractors where they are attempting to remove the neuro- from the neuromusculoskeletal treatment scope from chiropractors? It sounds like it to me when you look at it. I get the internal organs part. I get the asthma part. I do NOT understand how they classify headaches as strictly neuro in nature and have made a line where they do not cover any neuro treatment for chiropractors.

 

It’s unreal. It really is. Here on this site, they cite Chaibi et. al. (2017) and Seffinger and Tang (2017). In these papers they site, both conclude that spinal manipulation was effective. The second paper showed spinal mobilization to be more effective than physical therapy but….guess what. They need more studies. Probably studies like I’ve been telling you all about for 7 months now.

 

This kind of stuff makes me want to punch myself in the nose and go home and kid my daughter’s cat. Straight up punt that sucker. That’s nothing new though but seriously. To borrow a phrase from one of my very favorite football coaches, “This kind of garbage just makes my pee hot.” It really does folks.

 

Chiropractors help headaches. Every day all day and the research sure as hell shows it too.

 

Just keep on keepin on and stay strong, ladies and gents. What other option do you have without going back to school? It’s still the best time to be a chiropractor. It’s still the time in which there is more opportunity than ever before. This stupid insurance company cites only two papers and both of them showed effectiveness for headaches. It’s only a matter of time before all of the idiots start to catch up with the research and with what chiropractors have known for generations.

 

This week, I want you to go forward speaking with confidence and knowing that you are effective for headaches and migraines. You can change people’s lives. If you are not being effective for your patients’ headaches, seek some advice from a mentor. Sometimes it’s just a little tweak here and there and you’ll be on the road to being your patients’ hero. When done well, research backs us on this all over the place. For more proof, go check out show notes on Episode #14 or our Stroke blog at https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

Integrating Chiropractors

 

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

 

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

 

Send us an email at dr dot williams at chiropracticforward.comand 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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http://www.chiropracticforward.com

 

?Social Media Links

 

?iTunes

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About Dr. Jeff

 

 

  1. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.Spine, 2018: p. S1529-9430.
  2. Bernstein C. Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation. in 60th Annual Scientific Meeting American Headache Society. 2018. San Francisco Marriott Marquis San Francisco, CA.
  3. Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
  4. Policy, U.H.C.M. Manipulative Therapy. 2018 1 June 2018]; Available from: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf.

 

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

No More High Risk & Useless Drugs From Here On – Getting Off OpioidsIntegrating Chiropractors

Today we’re going to talk about getting off opioids. Even with the opioid crisis going crazy in our country, every single week, I have patients come in and they’ve been prescribed opioids as knee-jerk reactions right off the bat. We know that ain’t right! It’s time to start getting off opioids. 

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, 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. 

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. Big goals. It’s a thing, folks… shoot big, and even if you fail, you’re still getting somewhere you weren’t going previously. It’s a win-win. 

You have sashayed all fancy like into Episode #31

I spent the weekend last week in Longview, TX. Folks, I swear if you just looked out to check the weather, your face would fry right up like a pork rind. And pork rinds are gross so, if you’re down South, keep your face in the house. The sun is downright dumb right now, at this point in time. Certainly in the South. 

Now, let’s turn our attention to drugs. Or getting patients off of them. Getting off opioids. This brings to mind an uncle of mine. He’s having some chronic pain. Granted, he’s very elderly but, he’s always been a healthy guy. Always. No seriously bad habits. Nothing like that.  

The doctor said he was going to try taking him off of some of his 16 medications to see if that helped. Lol. Ya think so doc? Holy smokes and save the gravy. Sixteen medications. Imagine the obstacle courses of side effects with every single one of the sixteen medications he was taking? It boggles the mind. Hell yes, he’s sick. When does this mentality change?

We hope with podcasts like this, like evidence-based chiropractic groups on social media. There are people out there like us screaming and hollering to make it happen. 

I had a young lady in my office just two weeks ago. Probably about 24 or 25 years old. She had fairly acute low back pain and had gone to the Urgent Care for it the day before. Guess what they did? Gabapentin was their first-line choice. First line. 

No sir, no ma’am. That is NOT in keeping with every known current recommendation from the medical field. Here it is lined out for you. 

Chiropractic, exercise/rehab, heat, and massage, maybe acupuncture if it’s a chronic issue. Throw in cognitive behavioral therapy and some other therapies I’m not all that familiar with to round it out. Some guides will say aspirin, ibuprofen, etc..

Second line would mostly be the anti-inflammatories like ibuprofen and aspirin. We covered a study some time back on the blog where ibuprofen was shown more effective than Tylenol but, other than that, do as you will. 

Last line would be injections, more serious medications, and very last would be surgery. This is all about getting off of opioids.

That’s the order. You don’t skip everything and go right to Gabapentin. Not anymore anyway. The word isn’t percolating through the ether right now and getting to the physicians seeing this stuff on the front line. It’s all about getting off opioids, folks.

Here’s why. Let’s start with this one called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis” by Oliver Enke, et. al. and published in CMAJ(Enke O 2018). CMAJ stands for the Canadian Medical Association Journal so, it’s basically JAMA for Canadians. By making this clear to the listeners here, you know this isn’t chiropractors picking apart medical doctors and medicine. This comes from the authorities in the medical field. 

Why They Did It

There’s scant evidence that an anti-convulsant like gabapentin is effective for low back pain yet the incidence of its use has gained significantly recently. The authors here wanted to find out if there was actually any effectiveness for the medication for low back pain. 

How They Did It

  • 5 databases were used to search for prior info and research on the matter. 
  • The outcomes were self-reported pain, disability, and adverse events
  • Risk of bias was assessed and taken into account
  • Quality of the info was assessed as well
  • The info was gathered and numbers put on the information to make it make sense. 
  • 9 trials compared Topiramate, Gabapentin, or Pregabalin to placebo
  • There were 859 participants

What They Found

  • 14 out of 15 so…..93.3%….found anti-convulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain
  • There was HIGH-QUALITY evidence of no effect vs. placebo for chronic low back pain in the short term.
  • There was HIGH-QUALITY evidence of no effect for lumbar radicular pain in the immediate term 
  • The lack of effectiveness also comes with HIGH-QUALITY evidence of an increased risk of bad side effects. 

Wrap It Up

The authors wrapped it up by saying, “There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.”

So, we can close the door on gabapentinoids right? Time shall tell. How are we going to do our part to get the word to the right folks on this? Shoot me your suggestions. Count me in. 

OK, we know now that gabapentinoids are foolish to prescribe for low back pain. What about opioids? If you’ve been listening very long to the Chiropractic Forward Podcast, then you likely already know the answer. But I like to add to the pile so here we do with a new one called “Changes in pain intensity following discontinuation of long-term opioid therapy for chronic non-cancer pain” by McPerson, et. al. and published in the Journal of the International Association for the Study of Pain. This paper was published on June 13 of 2018. (McPherson S 2018)

Why They Did It

The objective of this study was to characterize pain intensity following opioid discontinuation over 12 months.

How They Did it

  • The paper was a retrospective VA administrative data study
  • 551 patients were identified and included.
  • They took data over a 24 month time period which included 12 months before discontinuation and 12 months after discontinuation. 
  • The Numeric Rating Scale for pain was used as an outcome assessment

Wrap It Up

“Pain intensity following discontinuation of LTOT does not, on average, worsen for patients and may slightly improve, particularly for patients with mild-to-moderate pain at the time of discontinuation. Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients.”

Well then, getting off of opioids should be easy. All of the info tells they do no good anyways right? 

I had a new patient come in today. She’s 23. Last year, she had discectomies at three different levels. Can you imagine? Now, to be fair to the surgeon, she tried two months of physical therapy and was still unable to work or function in her daily life. She would intermittently go numb from the waist down. That’s big stuff but, should she have had surgery that quickly?

Does that mean she had cauda equina syndrome? Well….maybe. Numb from the waist down sort of sounds like it but did that include loss of bowel or bladder control? I’m not sure yet. I’m going to find out more about it as we treat. The surgeon may have been correct if it was indeed cauda equina and I’m not one to second-guess the guy right now going off of what I know right now. 

The main point here is that she said she was on all kinds of meds the whole time and afterward and is still on gabapentin and trying to wean herself off of it. I went over the Canadian Medical Journal article we just went over at the start of this podcast and showed her how it’s doing nothing for her. She said she knows that. It doesn’t help her one bit but she has withdrawal issues if she takes less than a certain amount per day. These folks need our help and I hope I’m able to do my part for her. 

We can avoid this stuff. I hate that I’m getting to her afterward though. I have to tell you. What if, on top of physical therapy (which I don’t see doing a ton of good for discs in my experience), what if on top of PT she would have been told to do massage, spinal manipulation, and I would argue spinal decompression and cold laser as well? Did she try an inversion table at all? What about Tai Chi, yoga, cognitive behavior therapy? 

What I’m saying here is that PT is just part of the cocktail. The power is when PT is mixed with the rest. We are getting off opioids, folks.

I have shown you all paper after paper showing evidence-based proof of the effectiveness of chiropractic care but how about some cultural proof? Let’s do it!

What name is more respected by consumers in American than Consumer Reports? Honestly, I remember the name from when I was a kid. Consumer Reports is ingrained in the membrane, isn’t it? I say that it is so it must be so. 

Here is an article from Consumer Reports from May 4, 2017(Carr T 2017). Just over a year ago. 

The article talks about Thomas Sells, a veteran receiving alternative therapies through the VA. Along with chiropractic care, the article mentions alternatives for low back pain treatment like tai chi, yoga, massage, and physical therapy. 

The article says, “Growing research shows that a combination of hands-on therapies and other nondrug measures can be just as effective as more traditional forms of back care, including drugs and surgery. And they’re much safer.”

That feels pretty nice, doesn’t it? Just a little “Awwww yeah…..”

They refer to the updated recommendations from the American College of Physicians that we have mentioned a million times here on the Chiropractic Forward Podcast. Even with only having had 31 episodes, we’ve probably mentioned it that many times. 

They also mention a prior Consumer Report survey of 3,562 back pain sufferers where over 80% of them had tried yoga, tai chi, massage, or chiropractic and said it helped. 

A big kudos to Consumer Report for also saying this, “But here’s the problem: People also told us that their insurers were far more likely to cover visits to doctors than those for non-drug treatments—and that they would have gone for more of that kind of treatment if it had been covered by their health insurance.” 

Remember in the previous episodes where we have talked about the White House report that said clearly that CMS and health insurance policies in general “create barriers” to a patient seeking out effective, but an alternative, means of treatment? The link is in the show notes for your perusal.(2017) 

https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf

Well, there you have it. Right there in Consumer Reports. 

They also include a great quote from a woman in St. Charles, Illinois, “Spinal manipulation did me a world of good. My chiropractor had me do a lot of exercises on my own, which I continue to do. I’m so happy to get my active life back.”

We, chiropractors, see and hear this stuff all of the time but, the average Joe reading Consumer Reports or some other popular publication doesn’t usually. 

This week, I want you to go forward with the knowledge that this profession is moving ahead. Not at a snail’s pace either. It’s moving fast right now. Paper after paper is coming out and 99% are in our favor. 

Not only are we moving ahead, we’re moving ahead with help. Help from the big boys. Help from the White House to a certain extent, help from Congress to a certain extent (VA Bills), help from the medical profession to a certain extent, and help from your evidence-based colleagues like this podcast, the Forward Thinking Chiropractor podcast, the Evidence-based chiropractors facebook group, and other groups similar to them. 

This stuff is happening. You can hold onto your ideas whatever they may be but I’m telling you, the door is cracked open and, if we are to bust that sucker down and shatter it into splinters, we will only do it through research and through an integration or merging of our profession with the thoughts and actions of other professions. 

Key Takeaways

  • We can get these folks off useless and harmful drugs and we can help keep more from becoming addicted. The process of getting off opioids has begun.
  • You are educated at a level that you should never be intimidated or nervous to tell a GP that gabapentin is no longer a first-line treatment. Do it for yourself, do it for your patients, and do it for future patients. If not you, then who?

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

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 your 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. 

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http://www.chiropracticforward.com

??Social Media Links

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??Stitcher:

??TuneIn

CF 019: Non-Opioid More Effective While Chiropractic Maintenance May Be The Most Effective

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

 

 

Bibliography

(2017). The President’s Commission on Combating Drug Addiction and The Opioid Crisis.

Carr T. (2017). “The Better Way to Get Back Pain Relief: Growing research suggests that drugs and surgery may not be the answer for your bad back.” Consumer Report  Retrieved May 4, 2017, from https://www.consumerreports.org/back-pain/the-better-way-to-get-back-pain-relief/.

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

McPherson S (2018). “Changes in Pain Intensity Following Discontinuation of Long-Term Opioid Therapy for Chronic Non-Cancer Pain.” PAIN.

Getting off opioids

Getting off opioids

Getting off opioids

Getting off opioids

Getting off opioids