nutrition

Western Diet Hurts and Acupuncture

 CF 186: Western Diet Hurts and Acupuncture Today we’re going to talk about new research based on chronic pain and our regular Western diet. Then we discuss  But first, here’s that sweet sweet bumper music

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #186 Now if you missed last week’s episode , we talked about high impact chronic pain and we talked about newer research on the use of cannabinoids in adolescence. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m feeling pretty good today, folks. I’m feeling pretty optimistic. If I had known what a process building a medical clinic truly is, I may have thought it through just a little bit more than I did. There really is a solid reason more chiropractors don’t take the steps to do it. And that’s because it isn’t easy.  Attorneys, medical directors, hiring the nurse pracs, setting up training, getting the malpractice in place, getting the DEA number of the medical director to have your address on it so your NP can order the things they need, getting your NP credentialed, getting the entities created correctly by the CPAs……it’s a process for damn sure. 

I remember when I started this path, my good buddy and consultant on it, Dr. Tyce Hergert in Southlake, TX, he told me get your seatbelt on because the majority of the work is in the first 90 days. I feel like it’s starting to loosen up a bit and the clouds are clearing on this integration deal. Which is exciting. Because then you can go from wading through the paperwork and minutiae and start focusing on their training and growing the word of mouth and actually start working on the business. That’s where my skill level lies.  I’m not 100% out of the initial struggle to get it set up and off the ground but I’m getting toward the rear end of it and that’s encouraging. For instance, my morning this morning was setting up an account with a medical supplies company and getting started with my first order of IV equipment, cotton swabs, medipore tape, and things of that nature.  Right…..I know…..ugh.

But it’ll be worth it eventually. At least it damn sure better be! Beyond that, last week was better as far as clinic numbers. Moving in the right direction. I believe as a solo practitioner I had about 167. Still not pre-COVID numbers but not awful. I can deal with stuff mentally when I know it’s moving the right direction. It’s when it’s staying slim and there’s no longer rhyme or reason for it that makes me lose my mind. 

So, the mind is intact today and I’m looking forward. Onward and upward today.  Still no emails from any of you on what you’ve done to help the rest of you get your patients back. So, any help and advice from the think tank here would be good for the rest of the crew. Share. Give. It’ good for you. 

Item #1

This first one his an article that appeared in the Seattle Times called “Study finds correlation between high-fat Western diet and pain” by Theresa Braine of the New York Daily News (Braine 2021). It was published on June 24, 2021 and it’s hotter than hot stuff! And on a side note, You’d be in a hell of an awkward position if you last name was Braine but you were an idiot wouldn’t you? Think about that a minute. Your name is brain but you’re basically walking around bumping into walls…..people snickering behind your back…..Brain….right, right.  Anyway, that’s a little peak into my brain for you.

Anyway…since it’s an article, as always I just basically summarize and hit the high spots. 

  • They say the Western diet is associate with many ills and now chronic pain might be added to the list. 
  • A new study looks at the potential for omega-6 fats’ influence on neuropathic pain in people with diabetes and other conditions.
  • Researchers at the University of Texas Health Science Center at San Antonio studied the effects of omega-6 fatty acids themselves by measuring the role of these dietary lipids in pain conditions and found that the substances themselves seem to cause pain and inflammation.
  • Diabetes, autoimmune disorders and cardiovascular diseases are known to be affected by nutritional choices, the researchers said. But excessive consumption of omega-6 fats, which are found largely in commonly consumed processed foods, had not been studied in terms of the acids themselves and their role specifically in pain.
  • They studied polyunsaturated fatty acids in both mice and humans.
  • The five-year study was published in the June edition of the journal Nature Metabolism.
  • Omega-6 fats mainly occur in foods with vegetable oils
  • “But Western diets associated with obesity are characterized by much-higher levels of those acids in foods from corn chips to onion rings, than healthy omega-3 fats, which are found in fish and sources like flaxseed and walnuts,” the researchers’ statement said. “Generally, unhealthy foods high in omega-6 fats include processed snacks, fast foods, cakes, and fatty and cured meats, among others.”
  • Reversing those dietary habits and increasing omega-3 fats “greatly reduced these pain conditions,” the researchers found. “Also, the authors demonstrated that skin levels of omega-6 lipids in patients with Type 2 diabetic neuropathic pain were strongly associated with reported pain levels and the need for taking analgesic drugs.”

So, we’re seeing more and more studies like this talking about inflammatory diets, high-fat, and things of that nature. All being related to increased levels of pain. This is something chiropractors can get behind. I can be very honest when I say that the main gap missing in my clinic is weight loss. Diet and nutrition. Things of that nature. As a result, I’m having our nurse practitioner trained in medical weight loss so we can fill that gap and be well-rounded. 

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Item #2

Next up, I’ve been asked to put together a talk based on evidence-based, patient-centered practice and what makes it the future of our profession. The special request was to end the talk with some research-based around acupuncture research. Texas chiropractors continue to go through battles and one of them is against the acupuncturists in the state.  So, with that, I’m going to offer up a couple of papers. I’ve got a bunch of good ones but thought I’d just cover a couple here. The first one is called “Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain A Systematic Review and Meta-Analysis” by He et. al. (He Y 2019) and published in JAMA Oncology on December 19, 2019 and it goes a little sumpin’ like this. 

The first thing that jumps out here, especially for those somewhat new to reading through research, is that this is a systematic review and meta-analysis. That is at the top of the research pyramid. For example simple little case studies and animal studies, pilot studies….things of that nature….they live at the bottom, less meaningful or less impactful part of the pyramid. As you climb the pyramid to the more important stuff, you’ll see cohort studies and randomized controlled trials. Then, at the very top, the most meaningful studies are the systematic reviews topped off by the meta-analysis.  What I’m saying is that this paper is good stuff. It’s good information. And it appears in a very respected journal. The Journal of the American Medical Association’s Oncology branch. It’s high level from several aspects.  

Why They Did It

The authors wanted to answer the question, “Is the use of acupuncture and acupressure associated with improved cancer pain management compared with sham intervention and/or analgesic therapy alone?

How They Did It

  • It was a systematic review of 17 randomized clinical trials and meta-analysis of 14 trials in the current English-language and Chinese-language literature
  • Three English-language databases and 4 Chinese-language biomedical databases were searched for RCTs published from database inception through March 31, 2019.
  • Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included.
  • The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool
  • The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.

What They Found

A significant association was found between real (compared with sham) acupuncture and reduced pain, and acupuncture combined with analgesic therapy was associated with decreased analgesic use. However, heterogeneity lowered the level of certainty of the evidence.

Wrap It Up

This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

Item #3

This last one is called “Acupuncture for neck disorders (Review for The Cochrane Collaboration)” by Trinh et. al. (Trinh K 2016) and it can be found in the Cochrane Library published in May of 2016 so it’s about 5 years old at this point. 

Why They Did It

  • Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain.
  • To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.

How They Did It

  • They searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015
  • They searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.
  • We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomized controlled trials 
  • Of the 27 included studies, three represented individuals with whiplash‐associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non‐specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). So there was a big mix of conditions represented with a solid sample size when you add them all up. 

What They Found

  • For mechanical neck pain, we found that acupuncture is beneficial at immediate‐term follow‐up compared with sham acupuncture for pain intensity; at short‐term follow‐up compared with sham or inactive treatment for pain intensity; at short‐term follow‐up compared with sham treatment for disability; and at short‐term follow‐up compared with wait‐list control for pain intensity and neck disability improvement.
  • This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.

Wrap It Up

Moderate‐quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short‐term follow‐up, and that those who received acupuncture report less pain and disability at short‐term follow‐up than those on a wait‐list. Moderate‐quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short‐term follow‐up. Alright, for those not yet on the acupuncture train, take another look.

The VA here locally are sending veterans to us right now for our acupuncturist to work with them and these old grizzly vets absolutely love it. Yep, that’s anecdotal as hell but I’m telling you, there’s something to it and research seems to be catching up to it.  Patients ask me how it works and I have to be honest……I’m not sure. I have some guesses but it’s a lot like a damn TV. I can’t tell you the exact way a program’s signal gets to my house and shows up when I turn the damn TV on. But I know how to enjoy the results.  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. 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

https://www.amazon.com/dp/B096RST3WW

 

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disabilities and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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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

Bibliography

  • Braine, T. (2021). Study finds correlation between high-fat Western diet and pain. Seattle Times.
  • He Y, G. X., May BH, (2019). “Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis.” JAMA Oncol 6(2): 271-278.
  • Trinh K, G. N., Irnich D, Cameron ID, Forget M (2016). “Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2016,.” Cochrane Database of Systematic Reviews 5.

 

Working Class Rising Death Rates & Nutrition Affects Chronic Pain

CF 179: Working Class Rising Death Rates & Nutrition Affects Chronic Pain Today we’re going to talk about the fact that there are rising death rates among folks that are of working-class age. Not just the elderly. Why is that happening? Then we’ll talk about diet and chronic pain.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #179 Now if you missed last week’s episode , we talked about  whether chiropractors cause disc herniations or not and we talked about how family doctors still aren’t getting the message. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. This medical integration thing is about to take off. Wee ahve the contracts all drawn up, questions answered, and ready to get them all signed.  New EIN, new credentialing for me and the NP, and full steam ahead. Did you know that I have to re-credential under the new entity as well? What a pain in the backside, right? Hell yeah it is. I’m OK referring patients back and forth within the same group. You start to run into risk of getting in trouble with the Stark, anti-kickback laws when you are referring patients back and forth across different entities.  So, yeah….there’s that. I won’t bore you with the particulars but it’s definitely a ride we’re on and it’s go time.  Everything I’ve seen and experienced thus far tells me that we’re in a good spot and things are proceeding fairly smoothly. Slowly but smoothly. Next will be credentialing and that will slow everything down for a couple of months but that’s probably a good thing I’m guessing.  I’m fortunate to have a genius for a wife that understands a lot of the legal end of things that I’m just not talented at. Plus we have an attorney in Austin that literally wrote the integration law that has set it all up for us. And we have Dr. Tyce Hergert with Southlake Physical Medicine consulting us so we have a talented and very smart team.  Surrounding yourself with good people is the first step to success. We can’t be expected to be the smartest expert on everything that we encounter in our personal or professional lives. We need good people in our lives and our network. Good and talented people who have the right kind of heart for our style.  That’s exactly what I have right now so I’m very confident going forward. I don’t take big risks. I take measured, smart risks. That’s exactly where I’m at.  Alright, busy busy this week so let’s get scooting with this episode.  Item #1 This one called “High and Rising Working-Age Mortality in the US. A Report From the National Academy of Sciences, Engineering, and Medicine” by Mullan Harris, et. al. [1] published in JAMA on May 10, 2021. Servin em up steamy and saucy.  Why They Did It They say, “Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years).1 Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation.” They found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). Drug and alcohol use were the largest contributors to increasing mortality among working-age adults, accounting for 8% (an estimated 1.3 million) of deaths in this population between 1990 and 2017 (an average of 44 869 per year). The increase was largest among White male adults and older Black male adults. They go on. They say, “The drug crisis was the product of 2 influences: an increase in access to legal and illegal drugs and the vulnerability of certain populations. The licensing of OxyContin in 1996, subsequent flooding of the market with prescribed opioids, and waves of highly potent heroin and fentanyl that coincided with growing demand for these substances have been described as a perfect storm.3 The drug supply expanded with limited government oversight, substantial marketing by the pharmaceutical industry, and overprescribing by physicians.” With regards to Suicide, they say, “Suicide, which accounted for 569 099 deaths among working-age adults during 1990-2017 (an average of 20 325 per year), increased primarily among White adults, especially White men, and in less populated, rural areas. Few studies have established a cause for this trend. Economic stresses are a possibility; suicide is associated with economic downturns, wage stagnation, weak health care safety nets, and foreclosures.4 Another potential contributing factor is declining social support from churches, civic organizations, and families. Such social supports, which protect against self-harm, have declined in recent decades, especially among lower-educated White adults. Easier access to firearms is associated with increased suicide rates; however, the greater increase in nonfirearm suicides during this period suggests other causes. Other risk factors for suicide include mental illness, comorbid conditions, disability, and substance use.” With regard to cardiometabolic disease they say, “Cardiometabolic diseases caused more than an estimated 4.8 million deaths among working-age adults during 1990-2017 (an average of 173 062 per year). The largest relative increases in cardiometabolic mortality occurred among younger adults (aged 24-44 years) in all racial/ethnic groups, White men and women, Black men (in recent decades), and those living in rural areas. Cardiometabolic mortality rates increased after 2010 for 2 reasons: (1) mortality from endocrine, nutritional, and metabolic diseases and hypertensive heart disease generally increased during 1990-2017 and (2) after a period of substantial reductions in mortality from ischemic heart disease and other circulatory diseases from the 1970s onward, progress stalled after 2010.” “The report discusses 3 explanations for this trend. First, the most important was the increased prevalence of obesity and its cardiometabolic consequences. Obesity rates increased in the early 1980s as a period-based phenomenon that affected the entire population, but the related cardiometabolic consequences occurred in a cohort fashion; younger cohorts born in the 1970s-1990s experienced obesogenic environments their entire lives, whereas exposure in older cohorts was limited to older ages.5 As a result, many young adults are entering their work lives with a high prevalence of chronic diseases associated with obesity. “ “The recent increase in mortality among working-age adults shows no signs of receding. Obesity rates are unrelenting, drug- and alcohol-related deaths and suicide rates, already high among working-age adults, increased during the COVID-19 pandemic” So what does all of that mean? Well, it means we are providers and we need to know this stuff and be aware of it. We need to be able to refer to specialists when we see the signs of drug or alcohol abuse, suicidal tendencies, or nutritional concerns.  It’s not just a, “‘hey he should get his crap together while he still can.” It’s a little more immediate than that I think .  CHIROUP ADVERTISEMENT Item #2 Item 2 today is called “Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis”” by Field et. al. [2] published in Pain Medicine on November 17, 2020 and that’s a bit roasty.  Why They Did It The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management. How They Did It
  • A structured search of eight databases was performed up to December 2019.
  • A meta-analysis was performed in Review Manager.
  • Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified
What They Found
  • A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement
  • Twenty-seven studies reported significant improvement on secondary metabolic measures.
  • Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type.
Wrap It Up There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology   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.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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 – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography 1. Harris KM, W.S., Gaskin DJ,, High and Rising Working-Age Mortality in the US: A Report From the National Academy of Sciences, Engineering, and Medicine. JAMA, 2021. 2. Rowena Field, M.P., Fereshteh Pourkazemi, PhD, Jessica Turton, Kieron Rooney PhD,, Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Med, 2020. 22(3): p. 694-714.

Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

 CF 173: Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

Today we’re going to talk a lot about pain. Nutrition for chronic pain, CBT and CFT for chronic pain, we’ll talk about TMJ treatment, and we’ll talk about deaths in 2020. This episode is full of info so let’s dive in. 

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.  

If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #173

Now if you missed last week’s episode , we talked about useless research and we talked about insult vs. inflammation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I don’t know if I mentioned it or not but I got my book back from Dr. Chris Howson up in the Great State of North Dakota. He spent some time editing it. Dr. Howson is the inventor of the Drop Release tool and is just a super dude on top of being brilliant. If you don’t know about Drop Release, go check it out at https://droprelease.com. It’s pretty cool and something you can use to speed up soft tissue work in your practice. 

Now that we have gone through that process, I am teaching myself the way to self-publish this dude. When there are so many options, it can be daunting. It’s hard to know exactly where to go and how to do it. 

So that is the process I’m undergoing currently. Fortunately, I just noticed a colleague of mine that has recently published a book and it’s #1 on Amazon in its category. I reached out to her and she gave me a path to follow. So down the path I go. 

Still working on the medical integration here at the office. I’ve been having weekly calls with the integration consultant we are using. We are using Dr. Tyce Hergert down in Southlake, TX who has been integrated for 5-6 years at this point. Maybe even longer. He’s been through it for sure. If you are going through integration and need a little guidance, email me at [email protected] and I’ll get you in touch with Dr. Hergert. 

Our attorney and CPA group got together and got it all figured out so we are moving forward with that aspect of it. Now, if we can just get that Nurse Practitioner hired. I made a mistake that could be seen as misleading. On the Indeed ad I placed, I put the wage at $65/hr. What wasn’t in the ad because there wasn’t a place for it, is that we have only about 33 hrs of hands on time per week. We are starting our NP off at around $85-$90k per year. 

I think one of the NPs got PO’d at me because I was absolutely hiring her. No doubt. She was the one. When it came down to it, she asked my the yearly salary. I told her and she said she wouldn’t and couldn’t do it for less than $125k/year. 

Well, damn. Back almost at square one on that end of things. I had made my mind up on her. Not only that, I think she was mad at me. Lol. So, I went and changed it to the yearly salary to make sure I wasn’t being misleading in any way. 

Now, the goal is to start at $85k and have them up to $120k within 3-4 years. But you can’t start something brand new at that level when you have no clue how it’s going to all work out and come together. It’s already a huge risk to start with. Why make any riskier from the get go?

So, that’s where all of that stands for now. Getting the book together, getting the medical entity rolling, and getting busy as hell again. Oh my gosh. It’s going to take a minute to get used to treating the numbers we were treating back before COVID came along. Today, as I found a little window to start typing today, I’ve got 56 on the schedule. That hasn’t happened since December of 2019. Maybe January of 2020. Maybe. 

February 2020 came along and destroyed business. BAM…..30% at least was gone. We went from 185-200 visits per week all the way down to 115 or so. It wasn’t awesome. I’m not going to lie. OK, it was awful actually. We paid the bills but nobody made any money. That’s for damn sure. 

Now, for the last 2-3 weeks, things are beginning to get a little crazy again. Thank goodness. I hope you are experiencing the resurgence I am experiencing. I think deep down, we all know it’s going to be OK but it’s sure refreshing to finally start to feel it and see it. 

Onto the research!

Item #1

The first one today is called “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review” by Elma et. al. [1] and published in the Journal of Clinical Medicine in March of 2020 and that’s only a little smoky but still hot enough!

Why They Did It

They say, “Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain”

How They Did It

  • (PRISMA) guidelines were used
  • Online databases PubMed, Embase, and Web of Science were used 
  • 20,316 articles screened and only 12 found eligible to be included in this review
  • They consisted of 9 experimental and 3 observational studies

What They Found

  • 7 out of 9 experimental studies showed a pain-relieving effect of dietary changes
  • Protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold

Wrap It Up

In an interesting conclusion, the authors say, “Plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.”

CHIROUP ADVERTISEMENT

Item #2

This second one is called “CBT and CFT for Chronic Pain” by Graham Hadley and Matthew Novitch [2] and published in Current Pain and Headache Reports on April 1, 2021. Dammit stand back, we got a hot one. 

Why They Did It

Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA. 

  • Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life. 
  • Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors. Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort….
  • and as we just covered, diet might play a part in it as well. 
  • Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. 
  • This itself increases healthcare costs, and treatments can be invasive and have risks of their own. 
  • Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. 
  • As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. 
  • Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions. 
  • Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. 
  • Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. 
  • While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.
  • CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner
  • With a robust set of data, one can conclude that CBT and CFT are exceptional therapeutic methods in improving chronic pain or the overall well-being of our patients. 

Item #3

This one is called “The Leading Causes of Death in the US for 2020” by Ahmad et. al. [3] and published in JAMA on March 31, 2021 and that’s definitely some hot stuff right there. 

This is more of an article rather than research and it won’t take us long to hit the high points here. 

  • Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer
  • Cause-of-death data are based on the underlying cause of death, which is the disease or condition responsible for initiating the chain of events leading to death.
  • The provisional number of deaths occurring in the US among US residents in 2020 was 3 358 814, an increase of 503 976 (17.7%) from 2019
  • COVID-19 was the third leading cause of death in 2020, with an estimated 345 323 deaths, and was largely responsible for the substantial increase in total deaths from 2019 to 2020.
  • Substantial increases from 2019 to 2020 also occurred for several other leading causes. Heart disease deaths increased by 4.8%, the largest increase in heart disease deaths since 2012

I know……I know….car wrecks were reported as COVID and all that. I know….you do you boo. 

Item #4

This last one is called “Manual therapy for temporomandibular disorders: A review of the literature” by Kalam ir et. al. [4] and published in Journal of Bodywork and Movement Therapies in January of 2007. Definitely not hot. 

Why They Did It

The contemporary biopsychosocial health paradigm emphasizes a reversible and conservative approach to chronic pain management. Manual therapy for temporomandibular disorders (TMDs) claims to fulfil these criteria. An assessment of the utilization and efficacy of manual therapy for this condition is therefore required. 

How They Did It

  • A review of the literature pertaining to manual therapy for TMDs was undertaken between September and December 2005. Keywords used in the search were: TMD, manual therapy, massage, manipulation, mobilization, adjustment, chiropractic, osteopathy, physiotherapy, exercise.
  • A four member reviewer panel identified eight (n=8) randomized controlled trials of sufficiently reliable power to be suitable for inclusion in the review, of which only three included manipulative treatment of the temporomandibular joint. 

Wrap It Up

The results of manual therapy trials for this condition suggest that manual therapy is a viable and useful approach in the management of TMD. Manual therapy has also been shown to be more cost effective and less prone to side effects than dental treatment. 

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. 

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

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Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. 

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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

 

Bibliography

1. Elma O, Y.S., Deliens T, Coppieters I,, Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med, 2020. 9(3): p. 702.

2. Hadley G, N.M., CBT and CFT for Chronic Pain. Current Pain Headache Reports, 2021. 25(35).

3. Ahmad F, A.R., The Leading Cause of Death in the US for 2020. JAMA, 2021.

4. Kalamir A, P.H., Vitiello A,, Manual therapy for temporomandibular disorders: A review of the literature. J Bodyw Mov Ther, 2007. 11(1): p. 84-90.