pain medication

NSAIDS And GI Events & Chronic Pain In The VA System

CF 181: NSAIDS And GI Events & Chronic Pain In The VA System

Today we’re going to talk about NSAIDS and their relation to GI events and then we’ll talk about how primaries are handling things within the VA system for their chronic pain veterans here in the US.  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. 
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You have found yourself smack dab in the middle of Episode #181 Now if you missed last week’s episode, we talked about Sitting on your butt and what that’ll get you and we talked about catastrophizing MRI results. Both for the practitioner as well as the patient. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. New Orleans was great. We stayed a little longer than we normally do but it was good. They acted like it’s been a bit of a ghost town down there since COVID came along. Restaurants were still closed and some of the ones open were understaffed. The door guy at our hotel was trying to hire our Uber driver today on the way to the airport. Life is getting there but it is most definitely not back to normal and business as usual just yet. We’ll get there though.  Priorities. Let’s talk briefly about if. Here’s some honest talk about what ‘I didn’t have the time” really truly means. This is actually a blog I just wrote for my personal website but it’ll work for you as a chiropractor and business owner as well.  We all seem to be short on time, don’t we? Emails, notifications, pings, bells, chimes, and phone calls just to name a few. It seems that we are always on call and expected to respond.  That goes for our actual jobs but it goes for our personal lives too. Social media alerts alone are enough to make a person lose it.  So when someone says, “You know, I just didn’t have the time,” you want to believe them. Because it makes sense. Life has just gotten very busy and more complicated than it has ever been before. Weren’t computers and technology supposed to make our lives easier? But then you remember that people still make time to go to the movies. They make time to go out to eat. They make time go to the park with their kid. At least they should be! When it comes to observing my own kids, they make time for friends, sitting around on their phones, or lounging and watching TV. Time is available. It may be in short supply for some of us, but it is most definitely available. I heard a saying once that went like this, “Saying that you didn’t have time to do something is just a less abrasive way of saying that it wasn’t a priority.” That hit me between the eyes.  Because it’s so very true. I’ve seen this in my kids’ and acquaintances’ actions and I’ve seen it in my own actions. When I’m interested in something and when I really want it, I can typically make it happen. Because it’s a priority. It’s a focus and our focus goes where energy flows. Or something like that I’m sure came from Tony Robbins. When I want to get better at one of my hobbies, I obsess a little about it and I make the time for it. The point is, when it’s important, we make it a priority and we make the time. We get it done. Stop using a lack of time as an excuse to not get the things done you know need to be done. Maybe it’s marketing. Maybe it’s calling that one attorney you need to speak with but don’t really really want to speak with. Maybe it’s going to a Chamber of Commerce event. Maybe it’s writing that blog or starting that podcast you’ve wanted to start for a while.  Make it a priority. Make the time. Item #1 This first one is called “A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain” by Kikuchi et. al. [1] and published in Pain Medicine in May of 2021.  Hot stuff, coming up.  Why They Did It The authors say the reason for the paper is that the real-world burden of gastrointestinal (GI) events associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in Japanese patients with osteoarthritis (OA) and/or chronic low back pain (CLBP) remains unreported. How They Did It
  • Used the Japanese Medical Data Center database to retrospectively evaluate anonymized claims data of medical insurance beneficiaries employed by middle- to large-size Japanese companies who were prescribed NSAIDs for OA and/or CLBP between 2009 and 2018.
  • 180,371 patients were included in the analysis
  • 32.9% had OA
  • 53.8% had CLBP
  • 13.4% had both OA and CLBP
  • NSAIDs were administered as first-line analgesics to 161,152 (89.3%) of the patients in the sample
What They Found
  • The incidence of GI events was 9.97 per 10,000 person-years
  • The risk of developing GI events was high in elderly patients and patients with comorbidities and remained similar for patients receiving oral vs. topical NSAIDs
  • Longer treatment duration and consistent NSAID use increased the risk of GI events
Wrap It Up NSAID-associated GI toxicity imposes a significant health and economic burden on patients with OA and/or CLBP, irrespective of whether oral or topical NSAIDs are used. Well, that’s what it’s about isn’t it? It’s about getting people well without the use of drugs or surgery if possible. I’m not advocating never using medicine. Medicine is vital to our health and our lives but let’s don’t pretend they don’t have consequences. They do. Even the mild ones.  CHIROUP ADVERTISEMENT Item #2 Our last item today is called “Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study” by Leonard et. al. [2] and published in Pain Med on September 24, 2020 and that’s just hot enough! Why They Did It Chronic pain is more common among veterans than among the general population. Expert guidelines recommend multimodal chronic pain care. However, there is substantial variation in the availability and utilization of treatment modalities in the Veterans Health Administration. We explored health care providers’ and administrators’ perspectives on the barriers to and facilitators of multimodal chronic pain care in the Veterans Health Administration to understand variation in the use of multimodal pain treatment modalities. How They Did It
  • They conducted semi-structured qualitative interviews with health care providers and administrators at a national sample of Veterans Health Administration facilities that were classified as either early or late adopters of multimodal chronic pain care according to their utilization of nine pain-related treatments.
  • Interviews were conducted by telephone, recorded, and transcribed verbatim. Transcripts were coded and analyzed through the use of team-based inductive and deductive content analysis.
  • They interviewed 49 participants from 25 facilities from April through September of 2017
What They Found
  • They identified three themes
  • First, the Veterans Health Administration’s integrated health care system is both an asset and a challenge for multimodal chronic pain care
  • Second, participants discussed a temporal shift from managing chronic pain with opioids to multimodal treatment.
  • Third, primary care teams face competing pressures from expert guidelines, facility leadership, and patients.
Wrap It Up Health care providers often perceive inadequate support and resources to provide multimodal chronic pain management. Efforts to improve chronic pain management should address both organizational and patient-level challenges, including primary care provider panel sizes, accessibility of training for primary care teams, leadership support for multimodal pain care, and availability of multidisciplinary pain management resources. I know where we fit in. IF they’re using an evidence based, patient-centered chiropractor in the mix, their patients are getting off of the pharmaceuticals, they’re sleeping better, they’re not thinking of suicide as much, and they’re beginning to become a part of their lives again.  I see it all of the time because we see veterans straight from the VA. You’re getting it from he horse’s mouth. We make such a difference in these people’s lives. But we still battle that BS all of the time don’t we? No matter how good you try to be, you still have that jackass primary somewhere inside the system spoiling the water. Locker room poison. Just bashing chiropractors when they don’t have any experience themselves regarding the things they’re saying.  Keep trudging though. If we were wrong, we’d have been eliminated generations ago.  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
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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. Shogo Kikuchi, M., PhD, Kanae Togo, PhD, Nozomi Ebata, Koichi Fujii, MD, PhD, MBA, Naohiro Yonemoto, PhD, Lucy Abraham, MSc, CPsychol, Takayuki Katsuno, MD, PhD,, A Retrospective Database Study of Gastrointestinal Events and Medical Costs Associated with Nonsteroidal Anti-Inflammatory Drugs in Japanese Patients of Working Age with Osteoarthritis and Chronic Low Back Pain. Pain Med. 22(5): p. 1029-1038. 2. Chelsea Leonard, P., Roman Ayele, PhD, MPH, Amy Ladebue, BA, Marina McCreight, MPH, Charlotte Nolan, MPA, Friedhelm Sandbrink, MD, Joseph W Frank, MD, MPH,, Barriers to and Facilitators of Multimodal Chronic Pain Care for Veterans: A National Qualitative Study. Pain Med, 2020. 22(5): p. 1167-1173.