182- Resilience, Pain, and Your Practice

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are talking about a paper that can frame the interactions that you have with the patients in your practice. It's titled the Path to Capacity, Resilience and Spinal Chronic Pain. This was published by Spine in 2012. It's a great paper. We're gonna dive into the meat of it in just a few moments, but before we get started, I'll say a few words about Rocktape. Rock Tape is proud to be a sponsor of the Evidence Based Chiropractor and if you haven't checked out Rock Blades Mohawk, you need to do so immediately. Head on over to rocktape.com mohawk. You can pick up the tools, you can pick up the attachments, the case, all for 175 bucks. And you can see all of the educational courses that they are hosting throughout the world at this point. So be sure to do that. The tool is awesome and if you haven't seen it kind of in person, so to speak, I guess this isn't in person, but you can check out the review that I did on my YouTube channel as well. Also, I am recording this on Thursday, Tomorrow, Friday Adjust yout Marketing My live In Person event starts here in Tampa. I am pumped. The sessions are looking awesome and I can't wait to see everybody that's coming down here in Tampa. If you did not get the opportunity to come down for this one, I am probably hosting one. Probably hosting one in the fall as well. So shoot me an email jeffevidencebasedchiropractor.com and let me know if you'd like to learn more information the specific dates about it. This is something that I've again I've been planning for years. You've heard me talk about it on the podcast. I am super super excited at getting out there hosting my first live event and the response has been awesome. So if you don't want to miss out and you'd like to pick up a ticket for the one in the fall, shoot me an email at jeffevidence Based Chiropractor. But as I said at the top today we are talking about the path to capacity, resilience and spinal chronic pain. This was put out in spine in 2012. I'll link that in the show notes. You know it, so you can check it out on PubMed. But these researchers looked at resilience. They looked at anxiety, depression, all of these factors with chronic spinal pain and how they play off each other. And ultimately how can that play a role in how somebody recovers. And I know we've all had those individuals. I had a couple yesterday. I own a spinal imaging company where we do functional analysis of the spine in motion and do imaging. And I saw a couple patients, and the pain scales were just widely varied. It's so subjective. And the mental state of an individual can play a huge role in that. So what these researchers did is they first defined resilience. They defined resilience as the ability to adapt to stressful circumstances and that it's been strongly associated with decreased perceptions of stress. So really, the ability to adapt, right? Core aspect of being a dynamic human being. Core aspect of what we talk about as chiropractors, right? Homeostasis, balance, and the fact that stress, the stretching of a comfort zone, can lead to growth. But on the same token, that overboard can lead to challenge, right? So resilience is the ability to adapt to stressful circumstances as they define it. And I'd agree with that. And basically what they did is with a variety of individuals, they got a massive amount of clinical data that showcased the individual's mental states. And I'll get to the key points in a moment, but I want to go one step further with resilience. They talked about resilience preventing patients from suffering emotional distress because higher levels of resilience are associated with lower levels of depression and anxiety. Anxiety. I'm gonna repeat that one more time. So they said resilience is the ability to adapt to stress. And the more resilience you have, it is less likely that you will become depressed or anxious, especially these individuals. We're talking about people with chronic spinal pain. So if you're resilient, if you have the ability to adapt, if you have the ability to change, especially under stressful circumstances, I would say chronic pain is one of those circumstances for sure. Then it is highly likely or that you are associated. It's highly likely they're gonna have levels of depression in and anxiety. So what does that mean as far as key points are concerned? Let's dive into a couple that these researchers found. They found, quote, adjustment to chronic pain is mainly explained by psychological variables such as resilience, pain acceptance and coping, and not length of time in pain. So the amount of time in pain, they found it is not a variable. However, resilience, acceptance and coping are variables important to remember as you take those case histories. The researchers also found, quote, resilience prevents patients with chronic spinal pain from suffering emotional distress because higher levels of resilience are associated with lower levels of depression and anxiety. What we just touched on, right? So they're not going to be distressed. If you have the ability to adapt and change, AKA resilience, when you're in pain, you are not going to become distressed because you're going to understand, I am going to get through this. I know that I'm dealing with something right now, but there's a better day ahead. I know I can adapt and survive. So those are some key points. Additionally, the researchers found, quote, this study shows that resilience is an important resource for recovery from distress for individuals with chronic spinal pain. So building up that resilience. We'll talk about that in a moment. And finally, they found positive personality characteristics could play a crucial role in patient adjustment. And thus clinicians should take into account the positive path to capacity to better understand the chronic pain experience. Wow. So let's dive into those last two statements because for me, this screams careful case history. This screams empathy. This screams the ability and desire to empower your patients throughout time. So we know resilience is the ability to adapt and change. We now know that it is a very key variable to the recovery process. And we know that, that there's probably some flexibility in there. People probably have a natural disposition for how adaptive to change they are. But you can push and pull that depending upon your circumstance. I don't think there's any question about that whatsoever. So my question to you becomes, are you setting up the circumstance in your experience in your clinic for your patients to build up their resilience? That's a key question. And I would look at that and analyze that. From the front to the back end of your clinic, what does your website look like before a patient even steps in your door? Are you empowering them? Are you showcasing them? They have the ability to reach their health goals, that they have the ability to achieve a higher quality of life. And I mean this very directedly. If you've heard me before, you know I've rallied against the wellness awaits you headline on websites because I strongly believe nobody is searching how do I achieve wellness online? It makes no logical sense. But drill that statement down. Look at your website, drill down. What are the things that people are already coming into your pract? What are the things they're hoping to achieve? That's your audience, right? So take those benefits that you can give them. Take their goals, their dreams, their aspirations, get them onto your website in a way that starts that conversation. As you take your case history, don't just ask, where are you at? On a 0 to 10 pain scale, 9. And you see them walking in and you're rolling your eyes at them because you might not believe it's true. A friend of mine, Chaz Penza, chiropractic researcher, he described going through research and I think this is such a key point. As you take your case history, if somebody says they're in severe pain, 7, 8, 9 out of 10, it's a good opportunity to say, this sounds like it must be really affecting your life. Give them the empowerment that that's okay, you've heard that before. That's what that statement is saying back to them. If they say it's a 4, 5, 6 out of 10, huh? It sounds like this is probably affecting some aspects of your life. Tell me about that. If they're at a 1, 2 or 3, sounds like this might be beginning to affect some aspects of your life and understanding where they're coming from. What are the challenges they're dealing with? Why did they pick up the phone? Really? Not just the pain, but the change in their lifestyle. Why did they pick up the phone to come into your practice? That's the first step to understanding what buttons you can push to help them with their resilience. If they're looking to get back to certain activities, some of their lifestyle, their quality of life, that they report to you and say, hey, here's where I'm missing out. This is why I picked up the phone and called. Well, that might be a great opportunity in your active care, in your rehab, in your exercise, whether it's done in office or at home, to guide them with specific things that they can do that mirror, mimic or stepwise, get them back to the activities that they're missing out on because that starts to build resilience, right? People are like, oh, I can do this. Okay, one step at a time. But I'm starting to see that I can get there. Those are key aspects as you can build up their resilience, as you can build up, I hate to say, their tolerance to pain because I don't believe it's necessarily just about somebody toughen it out and having a high tolerance. It's about understanding that they're going to get through the process. And certainly somebody who's never had a big incident of pain before, it's shocking to them. It's scary. It's shocking. Talked about this just earlier this week on Research that Matters tv, which we host on our Facebook page about. You know, somebody gets back an MRI report or an imaging report, and they are scared out of their mind. You know, they're scared going in because they're like, oh, my gosh, I have, you know, I have this pain. I never felt it before. It's my spine. I'm nervous. And then they come back and they have degenerative changes at every single level. You are not. Your MRI report. Right, we've talked about that, and that'll be a separate episode. But my point of all this is when somebody experiences pain, it can be very, very scary. And for many people, if they've never experienced it before, I'm gonna venture to say they have a low resilience, naturally, because they're not accustomed to it. It's not an experience they are used to. So their ability to adapt to that circumstance might not be as refined as somebody who's been through multiple bouts of chronic pain and bounced back. Right? So take the steps in your office, your website, your history, your intake, the REH treatment, the adjustments that you're doing. Take every one of those opportunities, Think about it this week, and break down. Am I providing a fertile ground? Am I providing an environment for the people in my practice, in my clinic, to build up their resistance, to understand there is a better day ahead and to really take an active step each time they're in my practice towards their hopes, dreams, and goals? So that's the key message that I take away from this, because pain levels are going to be highly subjective, but people's ability to react and adapt to that pain can make a huge difference in the outcomes they receive in your practice. And I'm going to go one step farther with that. Always keep in mind, if you are not doing as good of a job as you could on the front end with that, a patient might leave your practice, quote, unquote, still in pain. And with those deficits. And where do they go but further down the intervention trail? Oh, well, I failed chiropractic. Time for injections. Time to get a surgical eval, now that I've checked those boxes off. So never underestimate the power of what you do on the front end, because what you do, how you empower your patients, how you build their resistance, their adaptance, and their resilience over time can make a huge difference in how they experience ultimately the rest of their lives. The health decisions that they make downstream and the choices or options that go on the table for them. So keep all of that's a lot to take in. Keep all that in mind. If you have any questions about that, feel free to shoot me an email. But as I said, I am pumped for Adjust yout Marketing this weekend here in Tampa, Florida. My maybe not hometown, but adopted hometown. And if you want to check out what we have going on for Adjust in the fall, let me know. Shoot me an email. Jeff the evidencebasedchiropractor.com I'll make sure you get all of the information. I hope you have a great week in practice and I will talk to you soon.

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Sam.