CF 174: Low Back Disability and Research on Osteoarthritis
Today we’re going to talk about the global impact of low back disability and what the numbers look like in 2017 vs. 1990. Has it gotten better or worse? I bet you have a good guess if you’re a regular here. We’ll also talk about new research on treatment for osteoarthritis. Stick around.
But first, here’s that sweet sweet bumper music.
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
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You have found yourself smack dab in the middle of Episode #174
Now if you missed last week’s episode, we talked about nutrition to control pain, CBT and CFT, and TMJ, and 2020 deaths. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I’ve been working working working. The clinic is finally getting busy. It’s nice but it also presents an obvious challenge with getting all of the other stuff I do in a timely manner.
Monday, I write and record the podcast. How busy are your Mondays? I saw 58 patients last Monday. I have about 50 today. You can see the problem. But we’re getting it done between patients.
Tuesdays, I write and post a blog to my personal page. Then I record the video for my clinic’s YouTube page. If you ever want to watch any of those, it’s under Creek Stone Integrated Care. Lots of good stuff over there I hope. I believe most of you would enjoy and maybe learn something over there.
But, to write, post, and record a video in one day can be a challenge on top of everything else. But, it’s a priority. It has to be if you’re going to be competitive in the marketplace. It has to be.
Wednesdays are the weekly email and then on to all of the extra stuff I do like book editing, gathering content for social media, voice-over marketing, medical integration, and all of the stuff that goes into life.
I finally broke down and hired a virtual assistant from Pakistan for voice-over leads. I have one in India for a couple of my websites. I’m looking for more ways to farm out my responsibilities so that I can do everything possible to free up more and more time. At the end of the day, there are just some things that can’t be farmed out. You can’t have blogs and videos farmed out.
Can you imagine if I tried to farm out this podcast? It wouldn’t be me and wouldn’t be something I’m happy with. So, we’ll try to figure out the other things that can be handled remotely and go down that path.
I am going through the marketing and publishing process on this new book of mine. It’s written. It’s getting formatted and all of the ducks are in getting line. That’s a cool thing I’m really looking forward to seeing that get out there in the ether and seeing what happens with it.
And finally, we are about 3 days away from officially hiring a nurse practitioner. Pretty excited. Pretty nervous about everything starting to get very real for us on that end of things. It’s not 100% real until you make that hire. Then it’s pedal to the metal, full speed.
As always, I’ll continue to keep you all updated on the process for those interested and following along.
Let’s start with our first paper called “Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017
” by Wu et. al.  and published in the Annals of Translational Medicine in March of 2020 and that’s just hot enough!
Why They Did It
Low back pain (LBP) is a common musculoskeletal problem globally. Updating the prevalence and burden of LBP is important for researchers and policy makers. This paper presents, compares and contextualizes the global prevalence and years lived with disability (YLDs) of LBP by age, sex and region, from 1990 to 2017.
How They Did It
What They Found
- Data were extracted from Global Burden of Disease, Injuries, and Risk Factors Study) 2017 Study.
- Age, sex and region-specific analyses were conducted to estimate the global prevalence and years lived with disability of LBP, with the uncertainty intervals (UIs).
- The prevalent numbers of people with LBP at any one point in time in 1990 was 377.5 million, and this increased to 577.0 million in 2017.
- Age-standardized prevalence of LBP was higher in females than males.
- LBP prevalence increased with age, and peaked around the ages of 80 to 89 years, and then decreased slightly.
- Global years lived with disability were 42.5 million in 1990 and increased by 52.7% to 64.9 million in 2017
- Years lived with disability were also higher in females than males and increased initially with age; they peaked at 35-39 years of age in 1990, before decreasing, whereas in 2017, they peaked at 45-49 years of age, before decreasing.
We have so many of the answers in a good, evidence-based, patient-centered chiropractic or integrated clinic. The more of this stuff…..this information….they publish, the more I believe the medical complex is forced to look at the higher functioning chiropractors. They just have to. Eventually. I hope.
This second and final paper this week is called “Pain-related behavior is associated with increased joint innervation, ipsilateral dorsal horn gliosis, and dorsal root ganglia activating transcription factor 3 expression in a rat ankle joint model of osteoarthritis” by Bourassa et. al.  and published in Pain Reports in October 2020, still steamy
Why They Did It
They say, “Osteoarthritis (OA)-associated pain is often poorly managed, as our understanding of the underlying pain mechanisms remains limited. The known variability from patient to patient in pain control could be a consequence of a neuropathic component in OA.”
First, what is monoiodoacetate? Also known as MIA. Well, MIA is an inhibitor of glyceraldehyde-3-phosphate, which disrupts cellular glycolysis, which in turn leads to eventual cell death. Knowing this, the MIA model has become a standard for modeling joint disruption in OA in rats and mice.
The model, which is easier to perform in the rat, involves injection of MIA into a knee joint that induces rapid pain-like responses in the ipsilateral limb, the level of which can be controlled by injection of different doses.
How They Did It
They used a rat MIA model of the ankle joint to study the time-course of the development of pain-related behavior and pathological changes in the joint, dorsal root ganglia (DRG), and spinal cord, and to investigate drug treatments effects.
What They Found
Wrap It Up
- Mechanical hypersensitivity and loss of mobility (as assessed by treadmill) were detected from 4 weeks after MIA
- Pain from cold stimulus was detected from 5 weeks
- Through histology and imaging, they confirmed significant cartilage and bone degeneration at 5 and 10 weeks
- They detected increased nociceptive fiber innervation in the subchondral bone and synovium at 5 and 10 weeks.
- Sympathetic blockade at 5 weeks reduced pain-related behavior.
- At 5 weeks, they observed, ipsilaterally only, dorsal root ganglion neurons expressing anti-activating transcription factor 3, a neuronal stress marker.
Besides a detailed time-course of pathology in this OA model, we show evidence of contributions of the sympathetic nervous system and dorsal horn glia to pain mechanisms. In addition, late activating transcription factor 3 expression in the dorsal root ganglia that coincides with these changes provides evidence in support of a neuropathic component in OA pain.
Further down in the conclusion of the paper, the authors say, “We also observed that the pharmacological suppression of sympathetic fiber function, microglia reactivity, and astrocyte function led to mild ameliorations of pain-related behavior. Taken together, our data reinforced the concept that multiple factors are contributing to pain in OA. We believe that further investigation of a neuropathic phenotype in OA pain has important implications for the development of therapeutic approaches.”
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Remember the evidence-informed brochures and posters at chiropracticforward.com
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. Wu A, M.L., Zheng X, Huang J,, Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med, 2020. 8
2. Bourassa V, D.H., Yousefpour N, Fitzcharles MA,, Pain-related behavior is associated with increased joint innervation, ipsilateral dorsal horn gliosis, and dorsal root ganglia activating transcription factor 3 expression in a rat ankle joint model of osteoarthritis. Pain Reports, 2020. 5
(5): p. e846.