Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting
CF 266: Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting
Today we’re going to talk about Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting
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. 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 creekstonecare@gmail.com 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 #266 Now if you missed last week’s episode , we talked about where to adjust and the types of adjustments that were most beneficial. Make sure you don’t miss that info. Keep up with the class. On the personal end of things…..
Man oh man…..we’ve been having such an interesting time around these parts. If you’ve been listening along with me, I lost 3 of my 4 full time employees within only a 2 week span. That’s almost like starting completely over. Stressful, kind of shock and awe type of thing. But, turns out, if you have a spouse or partner that knows the front desk and has the flexibility in their work schedule to put other things on the back burner and come in and help you turn it around, then that’s freaking gold, people. Listen to the words exiting my piehole. “Make sure your significant other knows how to run the front desk, bill, verify insurance, and put in charges. Without this, we would have been in terrible shape. My wife is my failsafe. She’s fierce when backed into a corner as well. So, when we kind of feel on the defensive, BAM!
Mama bear comes out and makes it happen.
And she has. She’s the gamechanger. In case you haven’t followed along, we lost all 3 within 2 weeks. The first two both gave us one month notice. The last one, our front desk staffer, gave us no notice at all. Just up and quit. Thanks to my wife, we were up and running on day one and haven’t missed a beat. In fact, we’ve already grown our weekly visits. Just two weeks in with a new front desk that cares and is knocking it out for us.
Turns out, my low numbers all this Fall and Winter weren’t bad marketing and all that. It was that the simple jobs or booking and re-booking weren’t being tended to the way we asked. That didn’t just fall on the shoulders of one person. It was several. Now that we’ve started from scratch, our systems are being re-implemented and it’s making a difference quickly. Now you get to not hear about it anymore very soon. I’m only sharing with you so that, should you go through some of the stuff I’ve dealt with recently, you’ll have a broader knowledge base to make corrections from. When you’d increased your marketing yet the numbers remain low, it’s probably internal. Not external.
I’m 50 and still learning lessons.
During the Fall 2022 Slowdown ….that’s what it will forever be referred to by the way….the Fall 2022 Slowdown…..we brought Darcy Sullivan of Propel on board to get our website SEO enpoint and dialed in. If I’m going to have a slowdown, it’s not going to be because of being cheap and not taking care of the #1 source of referrals….which is Google.
So I brought Darcy on and did the package where they basically do the whole thing for me because, let’s be honest, I don’t have the time nor the expertise for it. We’ve gone through the process and now she’s updated my website and we’re ready to see what happens with the Google machine. Between Darcy at Propel and my wife handling front desk duties until she gets the new staffer trained up….I’m in a no-lose situation my friends. I’m looking forward to reporting back on how well Darcy’s crew does for us. Now, let’s get going with the research, shall we?
Item #1
The first on today is called, “Benefits and harms of treatments for chronic non-specific low back pain without radiculopathy: Systematic review and meta-analysis” by Ronald J. Feise and published in The Spinal Journal on November 15, 2022. Dayum. That’s hot.
Why They Did It
The aim of this review was to compare the benefits and harms of treatments for the management of chronic low back pain without radiculopathy and to report the findings in a format that facilitates direct comparison (Benefit-Harm Scale: level 1 to 7).
How They Did It
- This was a registered systematic review and meta-analysis of randomized controlled trials. I
- nterventions included non-pharmacological (acupuncture, spinal manipulation), pharmacological and invasive treatments compared to placebo.
- Best evidence criteria were used. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal.
What They Found
- The search retrieved 17,362 records.
- Three studies provided data on the benefits of interventions, and 30 provided data on harms.
- Studies included interventions of acupuncture (n=8); manipulation (n=2); pharmacological therapies (n=9), including NSAIDs and opioid analgesics; surgery (n=8); and epidural corticosteroid injections (n=3).
- Acupuncture and manipulation were effective in reducing pain intensity compared to sham.
- The benefit of the other interventions was scored as uncertain due to not being effective, statistical heterogeneity preventing pooling of effect sizes, or the absence of relevant trials.
- The lowest risks were for acupuncture, spinal manipulation, NSAIDs, combination ingredient opioids, and steroid injections, while they were higher risks for single ingredient opioid analgesics (level 4) and surgery (level 6).
Wrap It Up
- There is uncertainty about the benefits and harms of all the interventions reviewed due to the lack of trials conducted in patients with chronic non-specific low back pain without radiculopathy.
- From the limited trials conducted, non-pharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions.
- There were high harms ratings for opioids and surgery.
Before getting to the next one, Next thing, 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.
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Item #2
Our last one this week is called, “Chiropractors in interprofessional practice settings: a narrative review exploring context, outcomes, barriers and facilitators” by Corrie Myburgh and published in Biomed central on 16 December 2022. Hot potato!
Why They Did It
To determine the added value of interprofessional interventions over existing mono-professional practice, elucidation of specific health care issues, service delivery contexts and benefits of combining multiple service provider is required.
How They Did It
- A search of relevant databases was performed
- The search was conducted in October 2021.
- Two reviewers independently screened the articles. In case of disagreement consensus was reached through discussion.
- An article was included if it described interprofessional practice including a chiropractor and outcome measurements relating to interprofessional service delivery were reported.
- In particular, articles were included if they had peer-reviewed scientific content in the form of journal articles, book chapters, and conference proceedings
Wrap It Up
- Very limited evidence from which to judge the value of interprofessional practice interventions involving chiropractors is currently available. Exploratory studies have outlined issues relating to feasibility and potential value of interprofessional practice initiatives across at least four domains of practice.
- However, only one study was identified with the specifically stated purpose of investigating an interprofessional practice practice intervention for a particular health care issue; this being low back pain in older patients.
- The discourse relating to interprofessional practice involving chiropractors appears to be at an early stage of development and further studies conducted specifically to evaluate interprofessional practice solutions for specific health care issues are urgently required.
So, we need some research. We want to be part of the team so let’s prove that we can provide value and be a valuable member of the team. 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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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
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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