085- Adjustments vs Medication vs Acupuncture

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with another piece of hard hitting research from Spine Journal and it is a good one. It is an rct, a randomized clinical trial comparing medication, acupuncture and spinal manipulation. So this is a great, another great real world example of the decisions that our patients what are they gonna do for their health? What are they gonna do to feel better? Who are they going to visit and what treatment options are they going to take? And it is another one. I'm gonna kinda let the cat out of the bag. That positions spinal manipulation, a hallmark of chiropractic care. Chiropractic adjustment as I will call it in a context head and shoulders above medication and acupuncture. So before we dive in, I'll say a few words as I do each and every week about Rock Tape. And it's gonna come down to what I've said for the last few weeks. Rock stock 2017 it is coming up, it's in Huntington Beach. Reason number one to go. Reason number two to go. If you do taping, if you're into evidence based practice, if you are into sports, chiropractic or anything along that spectrum, then this is the event in 2017 that you do not want to miss. So be sure to check out the link in the show notes or you can go directly to Rocktape. I'm going to be there doing video, doing interviews. I'd love to meet up with you. You can always reach me jeffeiropractor.com I'm looking forward to it. I've said it before, I'll say it again. I'm not scared. I'm going to be out there surfing. I'm not the best surfer in the world. If you want to show me up, come on down. If you want to teach me a thing or two, come on down. So I'm going to be out there at Rock Stock and I cannot wait to get out there. But for this week we are talking about a paper from Spine Journal, Volume 28, Number 14. This was released in 2003 and the official title is Chronic Spinal Pain. A randomized clinical trial comparing medication, acupuncture and spinal manipulation. And if you know and if you've been following the Evidence based Chiropractor podcast. You know, an rct, a randomized clinical trial, is near, if not at the top of the heap in terms of its esteem, should I say in research. It's not a case study of one. It is a top type of study is a randomized clinical trial. And RCT is the hallmark. And while NSAIDs have been a choice for patients with chronic spinal pain for many, many years, we all know the guidelines from the American College of Physicians, the American Pain Society, the FDA and more are saying hold the meds and explore other options first. And patients with chronic spinal pain really had consistent, statistically significant improvements beyond acupuncture and medication, without the side effects or safety warnings of NSAIDs. So people did well with chiropractic care is what I'm getting at in this study. And when these patients were followed up after the initial study period, it was found that the patients who had manipulation were retained their efficacy longer. So let's talk about these things in a little bit more detail. So we know that historically, and I say historically, it's still going on today. How many patients do you see in practice, new patients, that when you ask about their medications, they're taking NSAIDs, they're taking Aleve, they're taking these either prescribed or over the counter medications before they come into your practice. If we're truthful to each other, probably a majority individuals that come in are taking some form of medication because while all of these guidelines have recently come out stating that they shouldn't, the trickle down to the average provider has not taken place yet. And that's a teaching, that's an educational moment. It's not a moment to bash another provider over the head with the guidelines they should already be following, but it's an opportunity to subtly introduce what we know to be the case and what the science proves to be the truth. And that is that chiropractic care is one of the first choices they should be exploring before any medications. So that's why I like this study, because again, we look at chronic spinal pain. So people that have been in pain longer than three months, degenerative changes, most Medicare patients, I mean, you just throw it out there. And there is a substantial portion of the population that has chronic spinal pain. And this is an RCT that compares medication to acupuncture to spinal manipulation. And again, as they found, there were statistically significant improvements for those patients that had spinal manipulation that were head and shoulders above acupuncture and medication, with, mind you, none of the risks or warnings associated with. With NSAIDs. And I believe, I think I talked about this a few weeks back on the podcast, but it was something like thousands of individuals per year ended up in emergency rooms or ended up seeking additional care as a result of taking NSAIDs. And we think of NSAIDS at the bottom of the pile. I mean, opioid epidemic has run rampant, which is a whole nother story that we don't need to talk about specifically today. But even NSAIDs deemed, quote, unquote, safe, by and large, are challenging, and they result in thousands of thousands of hospital visits and ER visits every year. So the other thing that's interesting about this study that really drives the message home is that sometimes there's a criticism of, oh, yeah, chiropractic adjustment. You feel good when you walk out the door, and by the time I get home, it wears off. We've probably all heard patients say that, but the truth of the matter is the science is statistically does not support that. Now everybody has variability, and not everything works for everybody. But the majority of the time, what we're finding is, again, especially in this study, when these patients were followed after the initial study period, it was found that the patients who had manipulation retained their efficacy far, far more than the medication or the acupuncture. And this study looked at really two big brackets that we'll talk about. VAs and Oswestry. So these are two. A VAs, a visual analog scale, is a standardized test or scale that we use as an objective measure to determine a patient's pain level. Same with Oswestry. VAS and Oswestry are the two bar, none, simplest, easiest, and most utilized pain measures, so to speak. And what they found was, and this is going to be a little bit shocking now, what I'm going to describe is the individual percentage changes per modality, so to speak. So on a VAs back scale, those individuals that had medication as their option, the overall percentage change was literally zero. They were no better at the start than at the end. Those patients that had acupuncture had a 15% improvement. Not bad. Acupuncture had a 15% improvement in VAs. Manipulation, spinal manipulation, chiropractic adjustment, hallmark of chiropractic care. 55, 0. A 50% improvement compared to 15% for acupuncture and dead zero for medication. That is staggering. Additionally, let's look at the Oswestry, the Oswestry back disability with that medication. All right, little bit of improvement. A 4% improvement on the Oswestry scale for those individuals that took medication as a Treatment option for acupuncture outperformed medication again, 5% improvement. Manipulation the same number, 50% improvement. That is unbelievable. So statistically significant. Excuse me. And clinically significant is an understatement. The percentage changes after initial assessment for those individuals with chronic spinal pain, in this case low back pain, were unbelievably staggering. In favor of manipulation still improved for those patients that had acupuncture. And there's a lot of us out there as chiropractors that have acupuncturists in and adjacent to our clinics or we do it ourselves. So there's some viability there. No questions asked. The medication dead 0 or 4% at best, depending on if you were looking at VAS or Oswestri. So again, this is just more ammo in the tank, so to speak. This is just more and more research that is coming out. And this was from Spine Journal, an unbelievably esteemed top tier research that has nothing to do with chiropractic. They don't have a stake in the game whatsoever. It's. And again, I say this time and time again, the breadth and depth of chiropractic research has never been better than it is today. And this paper proves it again. So if you want a direct link to this paper, you can absolutely check that out in the show notes. It will be there. There will also be a link if you want to come hang out with me, hang out with everybody else at Rock Stock 2017. You can check out a link to that rocktape.com rockstock or check out a link that I put in the show notes. Check that out. And the third ask I would have of you is that if you have not left us a rating, a ranking or feedback on itunes, I would greatly appreciate it. There are thousands of listeners each and every week to this podcast. It is humbling. I give you great gratitude that you would choose to share your morning and or afternoon with me. And I would love it if you gave us some honest feedback, an honest rating or review on itunes because that helps spread the message of this podcast out even farther. And I think that an educated public, an educated physician, an educated chiropractor, and a better educated population makes better choices about their healthcare. And I wanna make sure that we are doing all that we can as chiropractors to illuminate what we do each and every day in practice, lean back on the science, to help substantiate what we see and what we know, and continue to spread the message of chiropractic care. That's what it is all about. If you're looking to take your practice to the next level, if you want to step things up, if you want the complete system to build referral relationships in your community, then I'd welcome you to join the Evidence Based Chiropractor as a member. You can of course do that@the evidencebasedchiropractor.com if you're not ready to take the full plunge on that yet, which there is basically zero risk whatsoever. But if you don't want to do that, I have been offering my book Marketing Chiropractic to Medical Doctors for free plus shipping. So you can't go wrong. Literally, you pay the shipping. I will email you a hard copy of Marketing Chiropractic to Medical Doctors. You can check that out. Theevidencebasedchiropractor.com, click resources. Click Free Tools again, that's click Resources then Free Tools and you scroll down. You will find a direct picture. Click on you can check out my book for absolute free. And I hope that you have a great week in practice and I will talk to you very, very soon.

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