136- Pain Thresholds and Adjustments

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are back with research and it is all about adjustments or spinal manipulation and their effect on pressure pain thresholds. So this is a good one. If you see patients, this one is going to apply to you. But before we get started, I will say a few words about Rock Tape. Roc Tape has revolutionized the soft tissue world again with the new Rock blades Mohawk. So featuring three tools in one, a surgical stainless steel hand polished tool and two attachments silicon sleeve and an ABS comb, Mohawk unlocks never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide and neuropathy. They're 175 bucks. You can learn more and see all the educational courses@rocktape.com Mohawk so as we talked about at the top, this week is gonna be all about pressure pain thresholds. So I'm gonna read the title of the article and then we'll dive right in. The title of the article is the Regional effect of Spinal Manipulation on the Pressure Pain Threshold in Asymptomatic A Systematic Literature Review. This was produced just this year in 2018 by chiropractic and manual therapies. And I'll link that in the show notes, of course. So again, the Regional effect of Spinal manipulation on the pressure pain Threshold in Asymptomatic A Systematic Literature review. So basically what these researchers did is they looked back at all, this is a review. So they looked back at all of the studies that may have highlighted how an adjustment or manipulation impacts or changes the pressure pain threshold. And then they determined whether or not those studies were good studies, were they bad studies, were they included, were they not included? And basically, what's the gist of the best literature? What does it have to say about this subject? So that is what this paper was about. So when we look at people who come in with pain, there are multiple, multiple, multiple ways that pain can be caused, but two of them certainly temperature can affect that, pressure can affect that. And a pressure pain threshold essentially is a, if you wanna think about your thumb and if you press down on an area of the body, there's a certain amount of force that would eventually cause some sort of pain or discomfort. That is essentially what a pressure pain threshold is. When There is force when there's push into a tiss. How much pressure? What's the level of pressure before pain occurs? And it's a reliable measure that's been used in multiple studies. And you have to keep in mind the flip side of that, right? Which is sensitization. Sometimes when somebody experiences pain, their tissues can become sensitized and the nerve fibers can almost become sensitized. So the greater the threshold, the more pressure can be applied previous to pain occurring. The, the lower the threshold, I should say, the less amount of pressure before pain is caused. And if tissues are sensitized, essentially, that means it's gonna cause very little pressure and pain is going to occur. And that is part of what can occur in a chronic pain type situation. There are many complicating factors with that as well. But keep in mind, when somebody's experiencing chronic pain, often that tissue is, that tissue's hot. Maybe not literally, but sometimes literally, it's inflamed. And ultimately that area is just ready to cause pain at any given mom. So the larger the threshold, in theory, the greater amount of pressure or buffer a person has with their activities before pain would occur. So what these researchers found were a couple very, very interesting things, and I'll point out a few of them right now. The researchers found, quote, patients often report immediate improvement of pain after spinal manipulation. For example, 63% of 984 patients with low back pain reported immediate improve in a multicenter study. That is a great quote that came from the top of this paper. So no disputing that. Secondarily, these researchers found, quote, four of the five studies that measured the pressure pain threshold in the cervical spine had positive findings with spinal manipulation. So it's great. So the cervical spine is very reactive to what we do, meaning in this case, that after an adjustment, that pressure pain threshold was altered for the positive, which is a great thing. Additionally, the researchers found a significant difference was noted between spinal manipulation versus sham and between spinal manipulation and an inactive control. So nice to see that as always. And finally, the researchers found spinal manipulation has an effect regionally on pressure pain thresholds in asymptomatic subjects. So why asymptomatic subjects? Well, this is an interesting point, and I agree with the researchers wholeheartedly in what they found. They certainly know more about it than myself, but I agree with them nonetheless. When there are painful subjects, there can again be a multiple of factors causing that pain, influencing that pain. Comorbidities. There is just a plethora of things that come with that but theoretically, if you take an asymptomatic subject or patient, somebody's not experiencing pain, there's a certain baseline that could be established, right? They're not actively experiencing pain. Are they a 7 out of 10? Are they a 3 out of 10? No. All these people are zero. So you have a nice little baseline where then when you start to perform testing pre and post, you can really isolate down pretty well the mechanism of action or is what you are doing causing the effect? And to that point, they also came out with a couple other quotes, and one of them I'm going to read directly because I don't think I can do it justice really by paraphrasing it. So I'm going to read a couple lines here of the explanations paragraph that these researchers found, which I think is really, really impactful. The researchers found, quote, it would not be surprising that a treatment in comparison with an inactive control results in better results, as the study subjects in the control group would be able to guess that they did not receive an active treatment. Interestingly, we found that when the sham was credible, the results were more likely to be significant than when the sham lacked credibility. This finding therefore contradicts the placebo effect, which would have been expected to occur rather in studies with poorly concealed, inactive treatments. And here's the clincher. Therefore, our findings point in the direction of a true effect of spinal manipulation on pain pressure thresholds in asymptomatic subjects. So that's a really telling fact. We hear a lot about placebo and a lot of times it's used in a negative context. But placebo is something that's been with us since the dawn of time. Our thoughts, our mind are unbelievably powerful in our life experiences, including that of pain and or healing and recovery. So it's no surprise that placebo effect has a big effect. But this study is really interesting because they pointed out again that, hey, when the placebo effect would have seemed to have been maximum, this seemed the results were the opposite direction. Therefore, there is as direct of a correlation between the adjustment and the manipulation and that pain pressure threshold as humanly possible, which is really, really awesome because it adds credence and credibility to what we do from an adjusted perspective and of course how that it can impact that pain pressure threshold. And when you're impacting that, you're ultimately impacting that individual's experience of pain. As they said earlier on in the study, hey, there's no question that a majority of patients who receive chiropractic manipulation in a Multicenter study had immediate improvement. So something's going on there and part of that probably is related to impacting that pain pressure threshold. So I love this week's research because I think it's just a really good one. It's pragmatic to what we do in practice. It certainly is a good conversation starter for you with your patients, especially those in chronic pain, and really just talking them through the process. Hey, now, when we adjust you, here's one thing that happens. Your body is, you know, you have thresholds for when pain occurs or pain doesn't occur. And we wanna keep that water under the lip of the glass, so to speak, and maintain a buffer so you can do things in your d life and not be experiencing a ton of pain. One of the ways we do that is through an adjustment and it's been shown in the research and in the literature. It's one of the things that takes water out of that cup, gives you the ability to put water in with doing activities and not overflowing over the top. So you could use some simple metaphors like that and have a great conversation with your patients this week. Additionally, this piece of research will go out as our monthly research brief for all members of the EvanSpace Chiropractor. So if you want to start utilizing things just like this to bridge the gap and build relationships with other healthcare providers in your community, check us out@the evidencebasedchiropractor.com you can get started, no contract for 79 bucks a month and really get the whole kit and caboodle to bridge the gap and build those relationships. And additionally towards the end of this, I just really wanted to extend a huge thank you to everybody that's been listening. We've been over 10,000 listeners each and every week for quite a while and it's just I'm honored and really humbled at that. So really thank you from the bottom of my heart for paying attention, for listening, for wanting to and to learn and have conversations with different people in your community, whether it be patients or other healthcare providers. And secondarily to that, this week was a big, big week at the evidence based chiropractor on Facebook as we went over 10,000 people liking the page there. And that's taken a lot, did not happen overnight. Believe me, that's taken many, many years to get there. But really I truly appreciate everybody that's paid attention, that's utilized, that's shared, that's really gotten anything out of the content I've produced. I had no intent that it would grow that big when, heck, I was pumped when there was a hundred people following the page. So to have 10,000 Kairos following the page, over 10,000 listening each and every week, I just want to give you a sincere thank you and if there's anything that I can do to further support you, any content that you'd love to hear dissected and talked about or anything under the sun, never hesitate to reach out to me. Jeff the evidencebasedchiropractor.com My goal is to continue to put out the best information that I can in the proper context so you can utilize it. And any feedback that you're wanting or willing to give, I'm more than happy to hear. And also just kind of as we come to a conclusion, huge thank you to everybody at Palmer College of Chiropractic, Florida. That's where I went to school over a decade ago. I went back there to teach last week, a social media session. I posted it online as a live stream and over 3,000 docs watched it for something like 15 hours or some outrage I think. Actually, let me rephrase it, I think it was like 60 some odd hours, not 15 hours. So if you checked that out. Thank you. I'm updating that content calendar as well, which will be a free download so you guys can utilize that as a templ to be able to get your social media out there and have a nice little research based okay so to speak template and content calendar. So thank you for listening. Hope this week was a good one for you. Have a great week in practice and I will talk to you soon.

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