Podcast episode (April 2, 2018) from the Evidence Based Chiropractor (host Dr. Jeff Langmaid) marking the show's two-year anniversary. The episode revisits a 2003 randomized clinical trial published in Spine that compared spinal manipulation (performed by chiropractors), acupuncture, and medication for chronic spinal pain. Key reported trial outcomes: ~27% of participants receiving spinal manipulation became asymptomatic (100% relief), acupuncture yielded under 10% asymptomatic, and medication ~5%. Manipulation group showed large improvements (≈50% Oswestry, ≈30% NDI, ≈50% VAS). The host emphasizes the trial's conclusions (insufficient evidence for NSAIDs in chronic low back pain; notable GI toxicity risk) and provides practical outreach/relationship-building advice for chiropractors to increase referrals and position manipulation as a conservative care option.
Questions this episode answers
April 4, 2016 (4-4-2016)
April 2, 2018
2003, Spine
Over 27%
Under 10%
Welcome to the Evidence Based Chiropractor. Providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth courtesy of your host, Dr. Jeff Langmaid.
Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we have a special episode. It is the two year anniversary of the Evidence Based Chiropractor podcast. The first episode came out 4-4-2016 and we have been going strong ever since. And in that vein we are actually going to do a flashback and we're gonna do a new take on a piece of research that we highlighted early on and it's a great one. It's titled Chronic Spinal A Randomized CL Clinical Trial Comparing Medication, Acupuncture and Spinal Manipulation and it was performed by a chiropractor. This came out in Spine in 2003 and I have a feeling you are going to like the results. But before we get started I will say a few words about Rock Tape. Roc Tape is revolutionizing the soft tissue world again with new Rock Blades Mohawk Featuring three tools in one, a surgical stainless steel hand polished tool and two attachments silicon sleeve and an ABS comb. Rockblades Mohawk unlock never before seen treatment protocols to help reduce pain, improve mobility and address issues like nerve glide and neuropathy. They're 175 bucks and you can learn more@rocktape.com Mohawk Additionally, I know that Rock Stock 2018 tickets are on sale. It's gonna be held in Miami. I'm sure to be there. So if you wanna check that out, please grab your tickets now. And as I said we are gonna touch on an interesting piece of research and it is titled Chronic Spinal A Randomized Clinical Trial Comparing Medication, Acupuncture and Spinal Manipulation. So the researchers basically found people that were having obviously chronic spinal pain. They segmented them to medication, acupuncture and or spinal manipulation as the treatment options. And I just want to hit it right off the bat with a piece that I found very intriguing. The highest proportion of people to get asymptomatic were with manipulation. Over 27% of the individuals allocated to the spinal manipulation group had 100% relief. Second to that was acupuncture which was under 10% and medication coming in at a lowly 5% marker. That is substantial. Over 25%. Technically over 27% of the individuals who received spinal manipulation got 100% better. Only 5% of the individuals that were taking medication additionally spinal Manipulation had the best overall results. They had improvements. 50% improvements on the Oswestry scale, 30% improvements on NDI, and that's impressive. 50% on the VAS as well. So those are substantial improvements in the spinal manipulation group. And let's read a few quotes from the authors that I think hammer these points home. Number one, they found insufficient evidence for the use of NSAIDS to manage chronic low back pain. I'm going to say that one one more time. There's insufficient researchers found, quote, insufficient evidence for the use of NSAIDS to manage chronic low back pain. They get right out there with it. Additionally, the Researchers found, quote, GI toxicity induced by NSAIDs is one of the most common serious adverse drug events in the industrialized world. So GI events with NSAIDs, and I think we've touched on it on some previous episodes, this results in hundreds of thousands, if I'm not mistaken, of hospitalizations per year. I wanna say it's about 100,000, with maybe 3,000 deaths directly attributed. That's insane. So again, and the researchers are coming out and saying, hey, GI toxicity, one of the most common serious adverse drug events in the industrialized world. They also found numerous studies have shown that patients with low back pain do exhibit abnormal spinal motion. This is what we see every day, right? People come in, they have abnormal postures, they have muscles that are hypertonic, they have compensations going on. Everything that we know to be true. And the researchers are saying, hey, that is true. Abnormal spinal motion is a key component. Consequently, on a sidebar here, this is very likely why spinal manipulation does so well, right? It inhibits, or let me say, it assists in regaining a function and active range of motion, which is very, very important. Additionally, when there's any sort of active care or rehab around that, it's great to get the muscle balance back as best as it can be. And certainly when people are functioning and they're feeling better, they're able to improve their quality of life, move more naturally, do things they like, and then a lot of the psychological components of chronic spine pain can start to dissipate. So that's great. They also found, and this is interesting because I think it touches to a couple other pieces of research that we've talked about as well. The researchers found, quote, pathologic cause cannot be identified for most episodes of spinal pain. And clinicians often have great difficulty establishing the underlying cause. And hand in hand with that, they said, quote, only about 15% of patients receive a definitive diagnosis because it is often impossible to reach a specific diagnosis. And we've seen this. I believe it was Dr. Ulrich from Spine Health. This is in one of the presentations that I do, but it basically is regarding surgical intervention and they're saying, hey, surgeries, I'm paraphrasing. Surgeries only work when the definitive diagnosis and pain generator can be identified. And 85 to 90% of the time we can identify that pain generator. So we wonder why there's so many failed back surgeries. Well, you know, right there, that tells the story pretty darn well. So this paper was a great one. It came out in 2003. I loved the fact that the manipulation in this study was actually done by chiropractors, which is nice because sometimes it's not. And additionally, let's touch on a few of those things again. GI complaints. GI complaints are a huge issue in the inability to take NSAIDs or big time serious adverse events. If people who are taking GI medications happen to take NSAIDs. Not a good situation. Many hospitalizations and quite a few deaths per year. This is why when we go through with all the training regarding the evidence based chiropractor, with all of our members that are getting out there, reaching out to other physicians in the community, one of the big questions we want our docs to ask when they're in an MD meeting, when they're meeting with other healthcare professionals is what is their current treatment protocol for patients that have musculoskeletal or spine complaints. If you're standing there, you're probably not their number one option. So you need to find out what they are currently doing so you can value add and bring your unique skill set to the table. Now the great thing about that is we know 99% of the time you're gonna get one of three answers. They're going to be treating with NSAIDs. Number one, referring to physical therapy, number two or referring through another specialist MD or D.O. number three. So this touches on the NSAID component and this drives exactly home to what we train on and teach within the evidence based chiropractor, which is there is massive low hanging fruit for if the response from these docs is NSAIDs. And I'll give an example of this right now. If a doctor says to me, I'm meeting with, in this situation, I'm meeting with a medical doctor, right? And I've asked them, what's your current treatment protocol? We have a few lead in questions to this which are very, very, but we get into, eventually we get into, hey, what's your current treatment protocol for these patients? Doctor responds well, we typically Start by treating in house with NSAIDs. One of the ways that I may choose to go with that is exactly down this GI path. And I might say, hey, a lot of our referral partners start out the same way, but they get extremely frustrated with patients that have GI complaints taking GI meds that are unable to take those NSAIDs. Our office absolutely helps many other providers in the community get their patients started conservatively. So you can see it's a very simple retort. And if we break that down, it basically is telling that, doc, I understand what you're doing. It's not my first rodeo. Here's a frustration you must have and here's how we can solve for that. That's one paraphrase simplistic example, but you see where I'm going with that. Anytime studies like this come out and showcase that spinal manipulation, chiropractic adjustments are superior to acupuncture in this case and NSAIDs, but really provide a superior efficacy, it is not only imperative to be able to showcase that efficacy through the research to other providers and say, hey, you might not be making the best choice, but sometimes that can come off as a little bit combative. So that's where we come back and say, well, let's position it. If we know that they're already currently choosing to do something, let's position us as a supplement, as maybe not a subtraction or substitution, but as an addition to their care plan. Then as they get comfortable with chiropractic, as they get comfortable with your office, as they see the results the patients are getting now, you start to open wider and you really start to dive into how you can assist a plethora of their patients each week, each month, each year, as time goes on. But again, with all of this, it's relationship building. So finding where you can value add for those other providers, first make things easy for them. It's difficult for somebody to imagine, you know, putting 100% of their patients that are suffering from spine or musculoskeletal complaints into your office. It's just not realistic. But if you can set and showcase a few specific examples where you can become a fantastic alternative, showcase the social proof that you are already doing that for other providers in the community. Nobody wants fomo, fear of missing out. So that really starts to position your practice. The fantastic thing is research like this from spine, which was again, chronic spine pain, it's an rct, highest level randomized clinical trial and chiropractic or spinal manipulation comes out head and shoulders above is absolutely awesome. So hopefully not only was this a good refresher on a piece of research from a couple years back, but hopefully you got a couple quick tactics to utilize in your next MD meeting. If you really wanna go deep on that. If you're looking to get more referrals into your practice, visit us@the evidencebasedchiropractor.com come on as a member. We'll get you all set up. We've recently even added on a done for you component where we'll do the research mailings, we'll even make phone calls to get out there and schedul meetings for you to get in with other docs so you choose what level you want to come in at. We're happy to really provide you all the tools and resources and we're happy to do the work for you. That is up to you and your office, but I wanna make sure that you are feeling good, deepening relationships in your community and helping more people stay well with natural and conservative healthcare research like this keeps coming out. We will continue to have a fantastic foundation to do that. If you have not left a rating, feedback or review on itunes and what the heck, I'm two years in here. This is the two year anniversary of the podcast. Hop on over to itunes, leave some feedback, leave ratings that helps us reach more and more chiropractors each and every week. I hope you have a fantastic week in practice and I will talk to you soon.
We appreciate you joining us for this episode of the Evidence Based Chiropractor. Learn more tips for explosive practice development@the evidencebasedchiropractor.com youm can also join the Premier MD monthly membership enabling you to use what you just heard to max results in your office. We look forward to providing you with more dynamic communication tools for immediate growth right here on the Evidence Based Chiropractor.
