CF 246: Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity Today we’re going to talk about Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity 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, look down your nose at people 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 #246 Now if you missed last week’s episode , we talked about Upregulated Central Nervous System & Shared Decision Making With The Patient. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Back to school has us down in numbers as it dies every year but we are in the rebound already So, I’ve got a few things working as far as marketing goes but let’s talk about something; have you ever hired a full time clinic rep or marketing rep? Someone that has the full time job of promoting your clinic. I have not done this but I was having a conversation about it with a colleague last week.
My friend expressed how $80k per year was just not realistic for a chiropractor. My friend has four clinics in a metroplex so I got to thinking……is it unrealistic? If so, how unrealistic is it exactly? So I started crunching numbers. Let me share my thoughts. First, I’ve always thought that I’d spend $100k to make $150-$200k/ year. Why wouldn’t you? That’s a $50k raise in pay and you can do a lot with $50k. Keeping that in mind, I went to tracking some numbers. First, what’s my case value? What is one patient worth to our practice? $500? $600? $1500? To work this out, you must know this number. Once you have the rep’s salary, we’ll say it’s $80k/year, then you alright, let’s divide the salary by our per patient case value. For easy math let’s take $80k salary divided by let’s say $800 for the case value. That equals 100 patients. So it will take 100 new patients over the course of a year to pay for that rep.
Everything over 100 patients is gravy.
If you were paying a rep that much, would t you expect at least 10 new patients per month from their efforts? If they truly know what they’re doing, I think that’s super conservative. So 10 new patients per month times 12 months in a year is 120 new patients. So 20 are gravy. 20 gravy patients times out case value of $800 is and extra $16,000 that year. But do you think a professional rep that is marketing your clinic all day every day is only going to bring in 10 new patients per month? And is you case value sitting at $800? Your case value may be $1500.
That would be a no brainer then wouldn’t it? Then you’d pay that salary in 53 new patients and at 10 new ones per month,120 let’s year minus 53 = 67 gravy patients and 67 c a case value of $1500 means an extra $100,500 that year, But again, a rep worth anything will be bringing in a lot more than 10 new patients per month. So, think about it. Is a rep out of bounds? I don’t know depends on the salary and the case value but I’d definitely pull a Stu McGill and say……It Depends. If you have experience hiring a rep, I’d love to hear your thoughts. Please email me at Dr.firstname.lastname@example.org so I can get a better idea of how all of it works.
First one is called “Risk Factors Associated with Healthcare Utilization for Spine Pain” by Higgins, et al. (Diana M Higgins 2022) He’s a PhD. There are seeveral PhDs on this paper, I see a coupl dof MDs and one DC. It was published in Pain Medicine in August 2022. Shaaaazzzaaam! Hot.
Why They Did It
This study examined potential risk factors associated with healthcare utilization among patients with neck and back pain.
How They Did It
A two-stage sampling approach examined spine pain episodes of care among veterans with a yearly outpatient visit for six consecutive years.
What They Found
- Among 331,908 veterans without spine pain episodes of care during the 2-year baseline observation period, 16.5% had a new episode of care during the following 2-year observation period.
- Of those 54,852 veterans, 37,025 had an outpatient visit data during the final 2-year follow-up period, with 53.7% evidencing continued spine pain care.
- Those with continued care were more likely to be overweight or obese, non-smokers, Army veterans, have higher education, and had higher rates of diagnoses of all medical and mental health conditions examined at baseline.
- Among several important findings, women had 13% lower odds of continued care during the final 2-year observation period.
Wrap It Up
A number of important demographics and clinical considerations were associated with increased likelihood of seeking new and continued episodes of care for spine pain Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.
The last one today is called, “Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial” by Bagg, et. al. (Bagg MK 2022) and published in JAMA on the 2nd of August, 2022. Schiizaa, sizzlin’
Why They Did It
- The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear..
- The authors wanted to estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain.
How They Did It
- Randomized clinical trial recruited participants with chronic nonspecific low back pain from primary care and community settings.
- 276 adults were randomized to the intervention or sham
- Took place in Sydney, Australia.
- December 10, 2015 to July 25, 2019.
- Follow-up was completed on February 3, 2020.
- Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain.
- Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity.
- The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation.
- The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale to 10 for which the between-group minimum clinically important difference is 1.0 point.
What They Found
A graded sensorimotor retraining intervention, compared with a sham procedure and attention control, resulted in a statistically significant improvement in pain intensity at 18 weeks (estimated mean difference, 1.0 point on an 11-point numeric rating scale
Wrap It Up
In this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.
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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!
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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bagg MK, W. B., Cashin AG (2022). “Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial.” JAMA 328(5): 430-439.
Diana M Higgins, P., Ling Han, MD, PhD, Robert D Kerns, PhD, Mary A Driscoll, PhD, Alicia A Heapy, PhD, Melissa Skanderson, MSW, Anthony J Lisi, DC, Kristin M Mattocks, PhD, Cynthia Brandt, MD, MPH, Sally G Haskell, MD, MS, (2022). “Risk Factors Associated with Healthcare Utilization for Spine Pain.” Pain Med 23(8): 1423-1433.