008- Adjustments, Medication, or Home Exercise for Neck Pain?

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Hello and welcome to another week of the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to look at a study from 2012 from the Annals of Internal Medicine. It's titled Spinal Manipulation Medication or Home Exercise With Advice for Acute and Subacute Neck A Randomized Trial. But before we dive in, I'd like to say a few words about Rock Tape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. New from Rock Tape is rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. Rock Tape is more than just a tape company. They are a movement company. Learn more and get access to your medical discount by visiting rocktape.com so today we're going to look at an awesome study from the Annals of Internal Medicine. One of the reasons that I like this study is that it is new, it is from 2012, and that it comes from a journal that's not typically associated with chiropractic care. And that's the Annals of Internal Medicine. Again, the title of this article is Spinal Manipulation Medication or Home Exercise With Advice for Acute and Subacute Neck Pain. A Randomized Trial. So, so the other great thing about this study is it's looking at neck pain, not back pain. Secondarily, it is a randomized trial. So that's fantastic. As well as the fact that this study, the longitude of this study, it goes out 52 weeks. So that also is very good. This research, I mean in 2012 it was released and published. And really as far as the medication is concerned, one, they look at spinal manipulation, so chiropractic adjustments on the whole. Second to that they're looking at medication. Medication they're deeming acetaminophen, NSAIDs, muscle relaxants or narcotics. So it really spans the gamut in terms of the medication available to be prescribed to the patient. And then the third component of course is they're looking at home exercise and advice. And again, this is for acute and subacute neck pain. And then they look out about a year from there, the average age of the participants in this study is 48 years old. The number of participants is 272 and and almost 25%, 22.5% had pain radiating into the upper extremities. So radicular pain secondary to that neck complaint. The researchers found spinal manipulative therapy seemed more effective than medication according to the various measures of neck pain and function. We're gonna go back to that one. They also found, quote, for pain, spinal manipulative therapy had a statistically significant advantage over medication after 8, 12, 26 and 52 weeks. Third, they found for participants with acute and subacute neck pain, spinal manipulative therapy was more effective than medication in both the short and long term. So let's take a closer look at each of those statements. First of all, they found that spinal manipulative therapy seemed more effective than medication according to various measures of neck pain and function. One thing I love about this is it is not only pain, but it is about function, function, function. And when the research, research shows through objective, and of course I'm sure that they found subjectively as well, that patients are reporting decreased pain, that's great. But when the patients are also reporting increased functional ability, I think that's fantastic. Really. Function is the core key of all documentation from the front end to the back end. My friend John de Villa, Dr. John de Villa, certainly has a lot of great information regarding the congruency of documentation and really its relation to function more than. And he dives certainly very much into why that is imperative, not only as a chiropractor, but really in terms of again, congruency of documentation across the board. So I love the fact that this research from Annals of Internal Medicine talks about improved functional ability for patients, not only a decrease in pain. So that's really great. Secondarily, they really look again at that longitudinal aspect. So a patient might get better for a week or two and if they dive off the deep end and seem to get much worse, there's limited relative effectiveness of that care. But in stark contrast to this, the researchers found that again, spinal manipulative therapy, what I'm going to call chiropractic adjustments, had not only advantages, but statistically significant advantages over medication at 8, 12, 26 and 52 weeks. So up to one year after the start of care, patients that had received adjustments or manipulative therapy had statistically significant advantages over those who are prescribed medication. That is extremely powerful to me, especially when, as anybody who follows the evidence based chiropractor knows, we talk about that communication between MD And DC or do and dc. And one of the big things that the more allopathic side the DOs and the MDs always look for is really an early prescription of NSAIDs. Typically, usually that first visit when a patient's reporting pain, they're going to go first to treating in house or that medication. So having the statistical backing to say, hey, spinal manipulative therapy shows statistical advantages over that previous protocol, not only in the short term, but really getting towards the long term at one year plus is an extremely important point in terms of positioning your practice, using the Socratic method to learn more about what they do and how you can add benefit to their patients, et cetera, et cetera. The third component is that they found for participants with acute and subacute neck pain, chiropractic care, spinal manipulative therapy was more effective than medication in both the short and long term. So this we touched on a little bit already. Really, it's not just about a one week marker or two week marker or four week marker, but really it's up to one year, one month, six months, eight months, ten months, twelve months down the road. The patients that had had chiropractic care or more specifically spinal manipulative therapy have statistically significant advantages over those who received medication alone. So it's for these reasons why I really love this study. Again, to me, it touches on a couple different things which is of extreme importance. Number one is it really pits an adjustment or manipulation against medication and then again against home exercise. So that's nice because those are three things that all practitioners look towards as potential treatment options or potential options for patients with acute and subacute neck pain. Second, it's a randomized trial. Great. Third component to that, it's in the Annals of Internal Medicine. Fantastic publication and certainly something that can turn heads for practitioners who may be unfamiliar with chiropractic research. Then when we look into the research of the study itself, some of the things I love about this are that it touches on function and pain. So it's not all about pain, but it also is about function. That's very important in terms of your outcome assessment tools, in terms of your ability to communicate with others. And from my perspective as a core chiropractic tenant, function, function, function is where it's at. So it's nice to see them address that. Certainly an additional component to that is the statistical advantages long term, I love that. And certainly when it's statistically significant, that's nice as well. Let's dive a little bit more into the positioning in terms of this study, one of the things I briefly touched on was what we find is for patients that come into a primary care setting or an internal medicine setting, there really are three big options where the providers refer the patients. Either one treat in house, which typically means that they're giving medication. Number two is that they'll refer to an orthopedic doc or a neurologist. Or the third component is that they'll directly refer to a physical therapist. So this really hunkers down on one of those because one of the things that I like to talk about with our members is the ability to get that information from the provider. In other words, asking questions to find out what their typical treatment protocols are. Once you have an idea of what their typical treatment protocols are, then you have the ability to show them an advantage. In this case, for patients that are receiving medication, one of the things that I always harp on are patients that have cardiac complaints that can't take medication. So to be able to offer an alternative, so to speak, or be able to offer patients where the provider can't do their primary or their first choice is an easy way to begin building that relationship. And when you can start to build that relationship, that is really where the referrals can start coming in. Once you're able to then send case notes. Once you're able to have the social proof of the patients getting well in your office finding improvement, you're able to document that appropriately and start that conversation, then you really start some momentum moving forward. So all of those reasons are why I love this study. I hope you enjoyed it as well. And if you didn't get a chance to check out the article on Kobe Bryant and how he employs two chiropractors to stay as top shape, please check that out online and I'll also have it linked in the show notes. So I hope you have a great week in practice and we will be back next week at the Evidence Based Chiropractor podcast. Take it easy and we'll talk to you soon.

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