CF 113: w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment
Today we’re going to be joined by Dr. William Lawson to talk about some brand new guidelines that came out in December regarding neck pain and the treatment of neck pain for chiropractors. Be sure and listen so you’re up on the latest and you’re not doing it wrong!
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.
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You have found yourself smack dab in the middle of Episode #113
Now if you missed last week’s episode, we talked about what effect lifestyle might have on dementia and we talked about whether or not the feeling of having a stiff back actually means that you have a stiff back. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily.
I swear to you, I see chiropractors always asking about research papers and what research is there on this or that. I want to yell at the top of my lungs to go and check my damn website. But, you don’t want to look like you’re self-serving and pumping your own tires so…..I say nothing. It IS called social media for a reason. It’s not called to get online and sell your stuff to everyone all the time. So I don’t.
With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
It just makes sense to be but hell, I used it all of the time because I can’t remember everything off the top of my head. I’m old now. My brain doesn’t brain like that anymore.
On the personal end of things…..
Guys and girls…..you wouldn’t believe me if I told you. That’s if you’ve been listening regularly over the last 3 months. Now, remember, there’s a two-week delay on these podcasts so keep that in mind but, yesterday afternoon my step-dad went to the ER with heart issues. He’s 80 and he’s the one that had the appendectomy on Christmas day.
Keep in mind that my biological dad is still in a nursing home at 76 years old after he suffered a stroke back on November 9th.
Lots of other stuff is going on with other members of my family as well but those are the biggies for now.
Anyway, it looks like he’ll be getting a heart cath today. I’ll keep you updated.
On the bright side, I got my certificate to get in a big fancy frame. It’s the one that says I’m a Diplomate of the International Academy of Neuromusculoskeletal Medicine and I have to be honest, I remember being brand new in practice and really admiring the fact that some would go to the lengths of getting a Diplomate.
I never considered that I would ever be one to do it though. When I got out of college, I didn’t want to see another book or class. I would say I was a bit of a lazy student back in the college days. I learned better from studying notes than I learned from listening to some boring teacher drones on and on day after day.
Other than the lab classes, it was torture for me. I learn better by having words in front of me and studying them over and over. That’s why the school was so damn difficult for me. Especially histology. Lordy lordy. We had a 98-year-old with a monotone voice teaching us histology at Parker in Dallas. Can you imagine a more dry subject and it was taught by the driest person with the dry-est delivery. Hell no, folks. Hell no. If I had them, I would have given up the nuclear codes just to get him to shut up. It was awful.
Anyway, the thought of my undergoing another 2-year course of study to get a Diplomate just wasn’t on the radar. And it stayed that way for about 20 years. Until one day. One day I was walking through the exhibit hall at ChiroTexpo ’18 in Dallas, TX and I met one Dr. Tim Bertelsman. He was pumping the tires on ChiroUp. BTW, if you want to go to chiroup.com and sign up with the code Williams99, you can get the first six months for only $99/month. You won’t regret it.
Anyway, once he went through all of the amazing stuff that ChiroUp can do for me and my patients, he looked up at me…..I’m a pretty tall dude….and he said I should come to his lecture on back pain later that day. He said that it counts as 10 hours toward the 50 live hours needed toward the Orthopedic Diplomate. He said very confidently, “Come check it out. You’ll like it. You’ll stay.”
He got a chuckle out of me on that. I had other things I wanted to do for the weekend. Ten hours in a classroom wasn’t in the plans. Hell, being in TCA leadership, I already get about 40 or more hours a year anyway.
Plus, The Diplomate was not on my radar so that didn’t mean anything to me but I was intrigued by the idea of focusing my knowledge and thoughts on the low back so I made sure I sat in on his class. At least for a bit just to check it out.
Well, it’s obvious at this point, but I sat through the whole weekend. Dr. Bertelsman just nailed it. He’s engaging and interesting and extremely knowledgeable. He’s a star on the speaking circuit.
So, I finished that class and thought, if that information was so good, what could I learn from the next one and on and on? Plus, I’d already knocked out 10 of the 50 live hours. Makes sense to at least look at it as a possibility.
The more I looked at it, the more I realized that the Academy, Dr. James Lehman with the University of Bridgeport, and the Australian group with Dr. Anthony Nicholson and Dr. Matthew Long called Chiropractic Development International have all really really gone to great lengths to make getting that Diplomate easily accessible. They are working together to create a new culture of chiropractors. Chiropractic practitioners that are on a different level – a different plane from your regular run of the mill general chiropractor.
I would have to say they have done just that. With only 5 live hour weekends required over the course of a year and half to 2 years, and the ability to take all of the other 250 hours in the comfort of you home…..well, it made sense. I get a ton of hours every year anyway so….why not?
I put the pedal to the metal and got the hours knocked out in about 6 months and spent the rest of my time just studying and reviewing the material. It worked out. Here we are, about the frame a certificate.
The point is, it’s more convenient than it’s ever been and you can and should do it. If for now other reason than to be the best in your community at assessing, diagnosing, and treating. I mean really, who the hell doesn’t want that?
We are joined on the podcast today by the doctor that made it more convenient for folks in Texas to take on the Diplomate program. Dr. William Lawson is our guest today.
Dr. Lawson is located down in Austin, TX
He has a diplomate in Chiropractic Orthopedics as well as a Diplomate in Integrative Medicine college of pain management.
He has a masters degree in Health Care Administration
He is certified in acupuncture
He is heavily involved in the Texas Chiropractic Association
He is an Air Force veteran
He does Designated Doctor work as well as medicolegal work
Let’s welcome Dr. William Lawson to the show. Thanks for taking some time out to come on the show today, Bill. Welcome!
This is actually your second time on The Chiropractic Forward show. The last time was September 27, of 2018 and it was episode #41. Here we are in episode 113 so it’s been a bit. Tell me what all has been going on in the life of Dr. Lawson since then
A quick review at chiropracticforward.com tells me that the last time you were on, we spent the episode discussing research targetting the cervical region. I remember fussing because we have so much research-based around the lumbar region and low back pain but nothing near as robust for the cervical region. Then, you got involved in research paper having to do with neck pain and treatment. Tell us how that came about and tell us what part you played in it. What was your contribution to it?
So it turns out, all I have to do is raise a fuss to get neck pain some attention and voila…..here we are. : )
I noticed in the Acknowledgements section, some of our other friends were also involved in contributing. Drs Kris Anderson up in North Dakota, Dr. Craig Benton in Lampasas, TX, your name of course, and Dr. Dean Smith who is active with the Evidence-Based Chiropractor group. It looks like an excellent group.
Let’s go ahead and give it this paper the Chiropractic Forward treatment if that’s OK
This paper you were involved in is called “Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain” authored by Wayne Whalen, Ronald Farabaugh, Cheryl Hawk and a slew of others. It was published in the Journal of Manipulative and Physiological Therapeutics on December 20, 2019 – Hot potato…
Why They Did It
Dr. Lawson, since you were involved in it, walk us through their reasoning for doing the paper if you will.
How They Did It
I must admit to only reading the abstract so far so lead us a little deeper into how they go about formulating these guidelines and recommendations?
For those that don’t know or don’t really get deep into research, can you give us a layman’s explanation of what exactly a Delphi Panel is?
What They Found/Wrap Up
Tell us what they came up with. At the end of the day and after all of the effort, what do we have going forward?
(This is a good point to go beyond the abstract and cover the 16 points made in the Best-Practice Recommendations For Chiropractic Management of Neck Pain section of the paper)
- Begin care management with a thorough history.
- Follow the history with a condition-specific examination. It is the duty of the provider to perform an examination consistent with the complexity of the case, based initially on history, which includes the mechanism of injury.
- Evaluate patients with complaints of neck pain for potentially serious red flags.
- Consider referral for diagnostic imaging or other studies based on established clinical practice guidelines (see “Diagnostic Imaging” later).
- Develop a care plan based on history and examination. The care plan includes appropriate diagnostic tests. Sometimes referred to as a report of findings, the history, examination findings, plan of care, and prognosis should be reviewed with the patient through a process of shared decision-making and with their consent to proceed obtained.17
- Document factors that may delay recovery. (Yellow Flags?)
- Develop a working diagnosis and, when clinically indicated, consider differential diagnoses.
- Reassure the patient regarding the generally benign nature of minor neck pain and encourage activity and movement. With moderate to severe neck pain, emphasize the importance of treatment plan compliance.
- Determine whether to (a) manage the patient exclusively, (b) co-manage, or (c) refer to another provider.
- Begin treatment with a brief trial of care, 6 to 12 visits, followed by evaluation for treatment effectiveness. The initial trial is not the same as a limit or cap on care.
- Evaluate the patient briefly during each encounter, pre- and post-treatment. Conduct a more focused condition-specific evaluation after each benchmark in the treatment plan. Examples: Every 6 to 12 visits, or in 30-60-90-day intervals.
- Some patients’ responses to treatment may not follow a predictable pattern, or they may not respond. In this case, consider a modification to the treatment plan that may include, but may not be limited to (a) change in technique and/or modality, (b) referral to another provider within the same discipline for a second opinion, (c) referral to another provider outside the discipline for a second opinion and consideration of other treatment approaches, or (d) referral for diagnostic tests (eg, X-ray, magnetic resonance imaging [MRI], computed tomography scan, neurodiagnostic or blood studies)
- Refer patients with new or worsening symptoms or evidence of psychological issues to providers with expertise in those areas (eg, behavioral health).
- Determine at each visit and/or evaluation if the patient is improving, is worsening, or has plateaued, and discharge if appropriate.
- Encourage and provide home and self-care approaches.
- Document the history, clinical examination, treatments performed, the rationale for and response to care, and any referrals.
In the paper, just after the section we just covered, they recognize that not all patients recover fully. Unfortunately, we’re all well-aware. Tell me a bit about what they have to say about that.
For patients who have reached MTB, the question then becomes: What is the best course of care to help control the ongoing pain? In general, patients unable to reach full recovery fall into one of these categories:
- 1. No physician/provider intervention is necessary. The patient has residual minor neck pain but can manage it with self-care strategies: ice, nonsteroidal anti-inflammatory drugs, home-based exercise.
Physician/provider intervention is necessary in periodic episodes of care. The patient experiences pain that exceeds his or her ability to self-manage and must return for care in an episodic fashion.
Physician/provider intervention is necessary on an ongoing basis. The patient experiences pain that exceeds his or her ability to self-manage, and in the absence of care the condition deteriorates. These patients often benefit from 1 to 2 visits per month to providers of nonpharmacologic conservative care who use spinal manipulation, to be reevaluated every 6 to 12 visits.
Now, I have been seeing this paper being shared and discussed all over the Forward Thinking Chiropractic Alliance Facebook page as well as the Evidence-based Chiropractor Facebook group. Those are all very like-minded docs in there and we all love practice guidelines, the idea of professional standardization, a certain level of standards within that construct, and those sorts of things.
So it’s no surprise that a paper putting guidelines into the profession is well-accepted by those groups. I wonder if you’ve seen or noticed any thoughts or opinions elsewhere? Basically, what is the paper’s reception as far as the rest of the profession is concerned? Or do you know? A lot of chiropractors don’t know a thing about research or new research and may not even know it exists.
Let’s start wrapping it up a bit, do we have any more research papers you’re contributing to? What is next on your horizon?
Thanks for coming on the show this week
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!
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….
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, DC, FIANM – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger