323- Chiropractic Usage in the VA for Chronic Pain

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we're back at it with the research, looking at a fantastic new study that just came out, 2022, and it looks at non pharmacological treatment for chronic pain for US Veterans in the VA system. This is a great study. And as they highlight in this study, this is a lot of information that can be applicable across really any system, network, country, insurance carrier. And using the VA system as a baseline to understand what's going on with chronic pain and how it's being treated and taken care of is a great microcosm. It gives a great example for what's going on out there and lessons that we can apply throughout all of the patient populations that we see in practice. So, lot of great info on today's episode. We'll dive in in just a moment. But before we get started, say a few words about the smart chiropractor. The smart chiropractor can power your patient journey, provide you with more qualified leads, more new patients, better patient retention, more consistent reactivations without spending any money on advertising. We do that through social, through in office patient education, through email marketing, pretty much all of it done for you. And we give you some tools if you want to be active, to go out there and get the best results possible in the content game. So if you're interested in generating more of your ideal patients and keeping your schedule full, head over to the smart chirofractor. That's. But as I said at the top of today's episode, we're talking about a study that came out just last month and it is titled non Pharmacological Treatment for Chronic Pain in US Veterans Treated within the Veterans Health Administration Implications for Expansion in US Healthcare System. So as you can see, they're kind of teasing. Well, here's what the data shows in the VA system and here's what could happen if, if we apply some of this knowledge, some of this background and data into expansion of other systems. And this is there's gonna be a lot of stats coming out in this episode, but this is, I'm gonna say, a very important study, if not a landmark study. And why do I say that? Well, let's set the stage, then we can get into the details. Chronic Pain defined as three months or more. It affects up to 1/3 of US adults. That's a lot. And the economic cost of this is estimated to be over half a trillion dollars each and every year. So sometimes when I hear that, it's almost difficult. It's numbers are so big it's hard to even grasp. But here's the thing. You take three adults, one of them probably is dealing with chronic pain. You have 10 adults in a room, three or four of them are dealing with chronic pain. That's a big deal. And why is it a big deal? Pain stinks, but it's associated with disability, things like cognitive impairment, cardiovascular disease, psychiatric issues, substance abuse issues. And this starts to become the compounding challenge when we look at chronic pain. It's not just the pain itself, it's everything that's ancillary, everything that sits out tertiary around the chronic pain challenges that start to compound things. You end up in that cycle and quality of life diminishes. And this is where there's, it can ultimately lead to an early death. So chronic pain is particularly prevalent, you know, amongst us veterans. People going out there and they're serving our country with their heart, with their mind, with their body. You know, they come back, many of them having some form of chronic pain. And almost one third of veterans are dealing with chronic pain. So it is a real issue. And here's what happened a few years back. Opioids were the go to, right? And opioid prescribing in the VA increased from 17% to 24% between 2001 and 2009. I look back at these numbers and I hate to say it's criminal, but it's like, how did anybody look at this and think this was a good idea? It just makes no sense to me whatsoever. But the facts are the facts. 24% between 2001 and 2009. What were the results of that? Well, hospitalizations, overdoses, self inflicted injuries, these were all of the side effects of that. And these harms were the greatest among veterans with depressive and anxiety disorders, which are more prevalent in the veteran population than in the general population. So this is a big, big challenge affecting a lot, a lot of people. And it needs to be taken really seriously moving forward because these people are putting their life on the line, their family's life on the line to serve our country. They're coming back and getting subpar care. Historically has definitely been the case. I think as we'll see in this study, a lot of positive gains have been made. But trying to make up for what's happened in the past is going to be a tall order. So the VA system is the largest. When we look at this from a research perspective, it's beautiful because it's the largest integrative health care system in the United States, provides va, provides healthcare to over five and a half million veterans and chronic pain services. And they don't need outside referral or prior authorization. They can go in and get the care. And that's an important component of this now, 17%. An important thing to keep in mind is that 17%, almost 20% of veterans who are enrolled in the VA use it as their only source of care. So a million people, right? Five and a half million people utilizing the VA annually, about 20% of those. So million people out there use the VA as really their only source of health care, their primary and only source of health care. So the decision making that's happening in the va, between these patients and the providers there are a big deal. And it's going to really drive how they're taking care of acute pain, how they're taking care of chronic pain, musculoskeletal, neuromusculoskeletal, you name it. They're really receiving the totality of their care within this system. And again, we look back and we don't have the data. I hope that the data in the health in the VA system is different than the general population. But we look back over the last year and every gain in the opioid battle was lost, meaning all opioids are being prescribed over the last year at practically a higher level than they ever had in the past because of the isolation and because of the challenges seeing people. And quite frankly, I think a little bit of a lack of oversight and taking our eye off the ball. And I say our, I mean the healthcare system, you know, at large. So I hope that's not occurred within the VA system. But important to keep in mind when we're taking these stats and putting it into action that any of your patients that come in, whether they're in acute pain or they're in chronic pain, and, and if you've been listening to this podcast, you know this. We've looked at the stats each and every week, you see that there's still just such a high prescription rate. It's mind blowing. But it's important to keep in mind as you're dealing with your patients. And I'll go off a little bit on a story here because I was talking with a doc the other day about a Few patients that he had seen that had chronic pain that were taking opioids. And just the mental, the psychiatric toll that these took on the patients. And, and once they were off of the opioids, they were just different people. They were back to themselves, they were back to being engaged, they were back to being, quite frankly, a lot nicer than when they were on the medication. And they were just a pill, no pun intended, to deal with in practice. They were like the problem. There's a big psychological component not only from an addictive component, not only from, it's changing how you perceive pain in your sensitization, which if that's not big enough of a deal, I don't know know what is. But there is significant personality changes that can occur as well. Now the good thing is quite often when you get off of these medications, your personality goes back to normal. You start to become an engaged person. This stuff is just toxic, yet it still is prescribed at a much higher rate than it should be. So what were some of the people in this study? What did they look like, what was their ages, all of that. So in this study, overwhelming majority were male, were male. Most were non Hispanic and white with at least some college education. And about 50% were age 65 years or older. So we see that baby boomer population getting up there. So nearly 33% of veterans had chronic pain, as we talked about in this study, and 19.1% had high impact chronic pain. So yeah, you look at the docs and with a limited tool set, with an overloaded schedule that you can see and the marketing behind it, you can see how they're scripting some of these medications at a fevered rate because there's just a lot of people dealing with a lot of pain. I mean, nearly 20% had high impact chronic pain. That's a big deal. Now when you looked at the veteran population, they said, how many people are using opioids? And let's get to the good news. How many people are using non pharmacological care? About 15% use prescriptive opioids. I have a feeling it's a bit higher than that, but that's what the study showed. 43% used some form of non pharmacological care and 16% used multimodal non pharmacological care. And the most common non pharmacological care for pain was physical therapy, about 20% usage, massage, about 15%, relaxation strategies, about 13% and Cairo around 11%. So I think Cairo's gaining steam. This is not a necessarily retrospective study to be able to see what those trends, trend line look like. However, yeah, you look back 20 years ago, there might not have been a chiropractor in the VA system. So it probably would have been zero. Right. And now to see it get up to 11%. We know that the veterans have higher incidences of chronic pain and high impact chronic pain than the general population. So you'd like to see the chiropractic care utilization be higher than in the general population. You'd like to see that sneaking up to 15%, 20, 25%. I think that would be a number where it would be a lot better for those patients. So among veterans with chronic pain, those who were in the VA system were more likely than those who were not in the VA system to use non pharmacological care. So that's a good thing. Including chiropractic, psychotherapy, educational classes, multimodal treatment. And the results suggest that the VA is an important resource and facilitator of, of non pharmacological care. If the more that they offer it, the more that it's utilized, that's powerful. You need to have access. I know access can become so challenging when dealing with the va, but this showcases the fact that access does matter. The ease of being able to see a provider, see them in a timely manner, get the care. That might not be the easiest of scripting. As you know, the veterans I used to work with would say vitamin M meaning Motrin, right? It's like vitamin M for everything. Take a Motrin, you know, you know, not taking the pills, not taking the medications. But getting ease of access into a multimodal program or specifically into a chiropractor as well, I think could be incredibly powerful. So when we look at those engaged in the VA system, so there's, you know, when you look at veterans, there's two populations here. One population is are those that are in the veterans health system for healthcare. The others are veterans who don't utilize the system. Those who utilized the system over 45% had chronic pain and 25% had high impact chronic pain. So those in the veterans healthcare system had a higher incidence of chronic pain and high impact chronic pain than the veterans, not in the system and way higher than in the general population. And the complicating factor involved with this is VA patients were also disproportionately affected by, by psychiatric symptoms and challenges. So this is, you know, this is a challenging patient population to treat and take care of. There's a lot of multifactor issues going on related to chronic pain. You know, in the best of circumstances, chronic pain can be difficult to treat and take care of because you're dealing with almost every aspect of a dynamic human being. You're dealing with the physical aspects of the pain, you're dealing with the psychological aspects of the pain. You're dealing with the psychological baggage of having the pain. Right. The longer that this chronic pain goes on, people, your mindset shifts. And I think we've all seen it with some, maybe people in our family, some patients that we've seen, you know, it takes a heavy toll mentally on individuals. Beyond biochemical changes, beyond physiological changes, there can be deep, deep seated psychological changes that occur as a result of chronic pain. Now here is the good news and this study showcases it, that when people have access to non pharmacological care, they tend to utilize it. Here's the other great part. When people have access to multimodal or non pharmacological options, they typically get good results in those individuals that really have the support and guidance through a team of healthcare professionals, including chiropractors, that can help, help them understand, help them get over the hump, help them take one small step at a time each and every day. It can make a world of difference in their lives. And I don't think, you know, there's anything that we could be more proud of as a profession, as individual chiropractors, as a profession, as a whole than literally helping a single person, helping that one individual overcome their challenges. And sometimes we could become sensitized to it because, you know, we see, you know, just another day of miracles in our practice. Right. You know, you look at, you know, somebody has a natural childbirth, somebody gets back to, you know, this activity they haven't done in five or 10 years. Somebody comes in with a hot disk bent over in half, and they walk out standing up tall and it's like, okay, just another day in my practice. That's not the case in most healthcare, you know, practices and places and facilities. It's small steps. And in chronic pain, I think we need to appreciate the fact that, that quite often it's not gonna be the person's bent over in half in acute pain, walking out, standing up straight and right back to their activities. It's gonna take a little time. There's gonna be a process. There might be other healthcare providers involved. There's nothing wrong with that. And celebrating those small wins along the way is so, so important. And here's the scoop. What's the other side? The other side of the Equation is a surgery. Well, they might not need surgery. Is it an injection? Well, you can only get three per year and it deteriorates tissues over time. Further medication that they're having to take more of or jump between or stack medications. We've seen how that story plays out. So the most important thing I think we can do as chiropractors brass tacks level with this study is understand that chronic pain is a real issue, number one. Number two, understand that it's going to be a process to help people find relief and to guide that and to celebrate those small wins along the way. And that individuals that have chronic pain are quite often very interested in utilizing the care that we can provide if we make it as easy as possible for them to understand what that care is and easy as possible to access that care. So those are the big take home messages for today. If you have any questions, comments, you can always hit me up Jeff, the evidencebasedchiropractor.com Also, if you have not left a rating or review for this podcast, please do so. It helps more and more people find out. We have over 11,000 listeners each and every week, which is awesome. I can't believe it. And it's, I'd love to continue to grow that. So if you're listening on your iPhone, you can literally scroll down a little bit, tap the amount of stars, leave a comment, leave some feedback. We'd super, super appreciate that. And before we wrap up, if you're building or growing your team this year, head over to Chiro Matchmakers. If you're looking to bring on a chiropractic assistant or a an associate doctor, please check out Chiro Matchmakers. Also, we have chiropractic coverage services. So if you want to provide any of those services, if you want to be an associate looking for a new opportunity, you want to provide coverage work, we're always looking for fantastic talent. Or if you are a doc looking to build, grow and expand your team. We know staffing, high turnover, these are some of the biggest challenges we face as chiropractors, as healthcare providers. And that is why with Chiral matchmakers, we have an advantage because going through team assessments, going through cultural assessments, doing all these things that really huge businesses have access to but you would never be able to do on your own, ensures that you reduce turnover, have a great fit and, and ultimately have super productive long term relationships with the people you build onto your team. So I hope you have a fantastic week in practice and I will talk to you soon.

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