Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions
CF 255: Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions Today we’re going to talk about Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions 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. I’m so glad you’re spending your time with us learning together.
I want to get to this before getting to the research and even some more real estate investing talk this week.
Go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.
Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at firstname.lastname@example.org If you haven’t yet I have a few things you should do.
- Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #255 Now if you missed last week’s episode , we talked about Gluteal Tendinopathy. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I have a short week this week so I’m preparing to go to Key Largo to be with my MCM Florida Mastermind group. I went to the website and saw that 2023 is sold out for the group. I have to say, it’s really an impressive group, folks. I tried to get you all in. Lol. We will be at this amazing place I recommend you check out someday. It’s in Key Largo and it’s called Playa Largo. It’s a resort and spa with restaurants and all of the comforts. It’s just wonderful and I can’t wait to go back. It’s a Monday now and by Thursday, afternoon, assuming the weather cooperates, we’ll be on the beach.
In other news, I’m curious, on the previous episode, #254, I covered my experience with real estate investing and gave, what I hope, is really interesting and really useful information on investing in short term rentals. Go listen if you’re interested and you missed it. What makes me think about that this week is that we have a first home. We bought it back in 2006 I believe. Very nice neighborhood. The house is 100 years old and I needed something newer and more current. When we moved to our current house about 5 years ago, we kept it as a rental just for giggles.
This was before we got serious about real estate. We were just hoping to make a few hundred a month and have someone else buy our equity. Which is exactly what happened. Fast forward and this year, we re-financed it to get a gob of money out to invest in a short term rental elsewhere. Well, a couple of months ago, we decided, you know what? Why don’t we just sell it to get it off our books so we can qualify for a hefty loan on something more tropical than Amarillo, TX. So we listed it. Guess what? As our luck holds steady, the real estate market takes a dump about a week or two before we got it ready and listed. So now we can’t sell it for it’s appraisal price.
Now, here’s the beauty of real estate. There are lots of options!!
- Take a bath and cut the price so deep that we lose money but get rid of the house.
- Keep it as a long term rental
- Make it a short term rental
If you listened last week, then you probably already know the answer. Instead of taking a $15k-20k hit by cutting the price to sell it, we can take that money and furnish the house and make it a short term rental. So that’s what we’re doing.
I was at the house last night putting together a queen size bed with a trundle while my wife hung curtains. We went to a site called airdna.co and using their Rentalizer tool, we evaluated the potential of that specific address and BAM…..it was a no-brainer. So we are off and running.
One last note, if you go Airbnb and you get a property manager, you’re a sucker! They want 20% of your profits when, once set up, it’ll take you literally 15 minutes per week per listing to self-manage. Go back to last week’s episode and listen but you can manage an STR in Florida from AZ with no problem. You need a wireless thermostat, a wireless Schlage Encode deadbolt, Ring cameras, a maintenance person, a lawn person, and a good cleaner. That’s it. Happy investing.
Now, onto the research. Item #1 The first one is called “The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature” by Cote et. al. (Côté P 2021) and published in Chiropractic Manual Therapeutics on February 17th of 2021 and goes a lil sumpin’ like this.
Why They Did It
A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial.
They say, We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders.
How They Did It
The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence.
What They Found
We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders.
Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report.
Wrap It Up
Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.
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.
Our last one today is called “Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis” by Sakamoto et. Al. (Sakamoto JT 2018) and published in Academy of Emergency Medicine in March of 2018.
Why They Did It
Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain.
How They Did It
We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses.
What They Found
Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain.
Wrap It Up
Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management. 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.
Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
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!
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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 (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
Côté P, H. J., Axén I, Leboeuf-Yde C, Corso M, Shearer H, Wong J, Marchand AA, Cassidy JD, French S, Kawchuk GN, Mior S, Poulsen E, Srbely J, Ammendolia C, Blanchette MA, Busse JW, Bussières A, Cancelliere C, Christensen HW, De Carvalho D, De Luca K, Du Rose A, Eklund A, Engel R, Goncalves G, Hebert J, Hincapié CA, Hondras M, Kimpton A, Lauridsen HH, Innes S, Meyer AL, Newell D, O’Neill S, Pagé I, Passmore S, Perle SM, Quon J, Rezai M, Stupar M, Swain M, Vitiello A, Weber K, Young KJ, Yu H (2021). “The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.” Chiropr Man Therap 29(1): 8.
Sakamoto JT, W. H., Vissoci JRN, Eucker SA (2018). “Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis.” Acad Emerg Med.