119- The Lancet Series of Research Papers

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Hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmead. This week was a fantastic week in the world of research. The Lancet released a series of low back papers and we are going to touch on those today. Before we get started, I will say a few words about Rocktape. Rocktape is revolutionizing the soft tissue world again with new Rock Blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polish tool and two attachments silicon sleeve and an ABS Rock Blades Mohawk unlock never before seen treatment protocols to help reduce pain, improve mobility and address issues like nerve glide and neuropathy. They are 175 bucks. You can learn more and see all of the educational courses@rocktape.com Mohawk so unless you were living under a rock. Last week the Lancet released a very exciting series of papers that were all about low back pain. So at first glance low back pain does not sound like it should be very exciting, but what these papers revealed is something that all of us need to be acutely aware of. It is fantastic knowledge to have for your practice. It is also unbelievably fantastic knowledge to have when building relationships with other healthcare providers. We actually fast tracked this research as our research brief for all members of the evidence based Chiropractor which came out yesterday. So literally within the week of of the papers being released, we fast tracked it and made sure we got it out there to our members to utilize to bridge the gap and to ultimately build referral relationships with other healthcare providers. So what was so exciting about these studies? Well, it was a series of papers and we'll kind of go high level on them today. First, the papers identified that pretty much the leading cause of disability worldwide is related to spine and low back complaints. Probably something that we've all known and seen, but it's a pandemic and it is accelerating not only in high income countries, but certainly in low and mid income countries. Low back pain and the disability associated with it is affecting, I believe that they estimated over 500 million people any given day. Over half a billion people are suffering with a spine related complaint each and every day. So let's put that into perspective against some of the previous studies that we've touched on here on the Evidence Based Chiropractor podcast. We know that 30% of the daily volume in a primary care doctor office is relative to spine and musculoskeletal care. We know that 90% of people, or excuse me, 90% of PCPs report being asked about chiropractic care. Now we also know, here's the bad part, only 11% have initiated a formal referral to a chiropractor. To me, that is the smell of opportunity. So we know millions, hundreds of millions, half a billion people are suffering with spine related low back complaints. In my opinion, it is unequivocal that chiropractic should be at the forefront of that. We'll talk about that in a few moments. Yet our utilization resides somewhere between 15 to 20%. This is a fantastic opportunity to utilize again research like this that substantiates what we do in the conservative care realm to again bridge that gap. People out there are hurting and when they go down the routes of medications, when they go down the route of injections, when they ultimately end up in the route of surgery, hey, there's a time and place, thankfully very thin, when that is the best choice. But predominantly a collaborative approach, conservative care approach and chiropractic adjustments, in my opinion are some of the best things that individuals can do to get well and stay well. So over half a billion people suffering from low back pain, it's being seen in offices all across the world each and every day. So here is where I, I think I got really excited reading these papers. Number one, let's break out a few quotes from it. So the researchers found, quote, guidelines recommend self management, physical and psychological therapies and some forms of complementary medicine. Place less emphasis on pharmacological and surgical treatments. Okay, Less emphasis on meds and surgery. That's always a good thing for sure. Let's take a look at a second quote, second quote, Promising solutions include focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care. That's another fantastic one. I like it. We're talking about best practices. We're talking about the redesign of clinical pathways away from the meds and the surgery and integrated care. Additionally, they say, quote, guidelines now recommend pharmacological treatment only following an inadequate response to first in non pharmacological interventions. So again they are saying, hey, before you start diving into all of these meds, you want to make sure that you do non aggressive, non pharmacological solutions first. And only upon their failure do you start thinking about those medications. So here's what also is interesting. They looked at a variety of treatments, exercise Therapy, spinal manipulation, medications, injections, disectomies, and laminectomies. And here is where things get really exciting. So for acute low back pain, they said laminectomy, insufficient evidence. They said disectomy, insufficient evidence. They said epidural glucocorticoid injection, not recommended. Exercise therapy with limited use, and medications not typically recommended for spinal manipulation. They deemed it an adjunctive treatment option. So, yes, adjunctive treatment option, when you read that offhand, doesn't look like a glaring endorsement. But when we look at the others that say not recommended, not recommended, insufficient evidence, limited use, adjunctive treatment option is about as nice as it gets. I think one of the first things that they said is reassurance, of course, that the patient's going to get through that bout of low back pain is something that should be used routine. And in my opinion, what chiropractors do a fantastic job of is reinforcing the healthy lifestyle, reinforcing that patients can get back their quality of life. So I'm sure we're all doing that. And let's take a look at the other side of the coin. A persistent low back pain. They recommended exercise therapy as routine use. That's great. They looked at some medications and said not recommended. They looked at epidural glucocorticoid injections and said limited use. And they looked at discectomy and laminectomies as adjunctive options with persistent low back pain. They also said spinal manipulation. Drumroll, please. And other adjunctive treatment options. So between acute low back pain and persistent low back pain, really the only treatment option aside from reassurance. You know, when we look at the list that I just said, the only one that touches on both as a adjunctive treatment option ultimately is spinal manipulation, the routine use. They look towards reassurance, et cetera. And then when you look at the medications, not so much. When you look at the injections, either not recommended or limited use. When you look at the dissectomy and the laminectomy, insufficient evidence in acute low back pain for both. And an adjunctive option upon failure of other conservative means for persistent low back pain. So I love this study because it really lays things out. Here's another aspect of this study that's interesting. Some fantastic. I don't know them personally, but some fantastic chiropractic researchers were involved in the production of this study. So that also is something that we can hang our hats on. They were right there. These are from the Lancet. They are a series of papers that are gonna be referenced hundreds, if not thousands of times. If you've been kind of keeping your eyes open online, you've already seen there have been chiropractors. All sorts of physicians on various news programs spread worldwide, including Catherine Quinn over with the British Chiropractic association and a variety of others have already had the opportunity to hop onto television shows and speak about what these papers mean. So I'm going to take a little bit of a turn here and talk about a couple other aspects of this paper that I liked or these papers, I should say. The researchers also pointed out that there is a substantial gap between evidence informed clinical guidelines and the practical application of care. They called it right out. And they certainly also said that they advocate for a collaborative model of care. These are things that of course are sweet music to my ear at the evidence based chiropractor because I could not agree more. It's been shown in previous research studies that we've reviewed that the evidence based care guidelines for spinal complaints are drastically different than the practical application of what's happening in many physician offices. Highly guideline discordant was the quote from the research paper quite a while back. So the emphasis of that, again pointing it out is one of the first steps towards change. Additionally, when they take and take a step forward and advocate for a collaborative care model, that is just very, very important, a collaborative care model and they actually call out even chiropractic within that. So that is huge. Very often these papers either ignore chiropractic, go over the head of it somewhere in between. In this instance, they call out conservative care options such as chiropractic as really being a pillar of, of that collaborative model of care. So these are all very, very exciting things and why I believe the Lancet paper is an important cornerstone that we will look back on the series of papers, I should say, and it's a great opportunity to get out there and speak to your community. I would tell all members of the evidence based chiropractor as you receive your research brief to get out to other physicians in your community. Also use this as something that you can talk about through your social media channels, on Facebook, in the office, etceter, and really utilize research like this to substantiate your credibility in your community. Use it as something that you can hang your hat on and say, hey, collaborative care is where it's at. Chiropractic is a part of it. The medications, the injections, the surgery are only recommended in long term pain in a small subset of people. But spinal manipulation, chiropractic adjustments can be recommended acute, they can be recommended chronic, and anything in between. That is it is a core modality out there and that is something all of us can get excited about. If you've been listening to the podcast for the last few weeks or maybe even year plus, thank you. We have been over 9,000 Kairos listening each and every week. Last week we had a great episode with Dr. Blake. Be sure to check that out if you have not and I would have one big ask for you if you have not leaved us any feedback or ratings within itunes. I would greatly, greatly appreciate it. It is how itunes puts the algorithm in play for more people to hear what we are up to and I would appreciate it if you take a mom, give some feedback or rating within itunes. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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