333- Spinal Manipulation or Medication for Chronic Low Back 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.

How do you hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today's episode we have an awesome piece of research ton of clinical pearls clinical takeaways. This is an award winning study and it is pitting head to head spinal manipulation adjustments versus prescription drug therapy. And this is one you're going to want to pay attention to. Tons of information, lots of great clinical tips pearls, you name it, this study has it. And again, it's an award winning study. We'll dive in in just a moment. Before we get started, I want to say a few words about the smart Chiropractor. The smart chiropractor can power your patient journey to provide you with more qualified leads, more new patients, better retention, more consistent reactivations without spending any money on advertising. You can learn more. Check it all out. The smartchiropractor.com Again that is the smartchiropractor.com Also while you're over there, check out the blog. We have hundreds of blog posts about business skills, marketing strategies, clinical tips. We spend a lot of time, effort and energy over there. So head over the smart chiropractor.com click around. I am sure you will find something that can improve your practice. But as I said at the top on today's episode, we're talking research and we're going to talk about a study that was in acc rack award winning paper. This puppy was just released this this year in 2022 in JMPT and it is titled Spinal Manipulation versus Prescription Drug Therapy for Chronic Low Back Pain Beliefs, Satisfaction with Care and Quality of Life among Older Medicare Beneficiaries. Title pretty much says it all. But let's dive in. Why is this important? Yes, we all know that low back pain is the greatest source of disability worldwide. But something I found interesting is was in 2012 and I'm sure this has only gone up since then. But in 2012 the National Health Interview Survey Interesting found that nearly 20% of people 65 years and older had low back pain over a three month period. That's substantial. You think about 20% 1 in 5 people over 65 years old have had low back pain not ever within the last 90 days. And that is continuous. That is very, very impactful. And again to me it shows how much of an opportunity we have as chiropractors, we're the best answer. There's no question about it. We'll see it in this study. Yet our utilization hovers 10, 15%. There's so many docs out there that don't have full schedules of patients to see. A lot of that comes down to communication. Now part of that's communication with other healthcare providers. That's what we focus on, of course, with the evidence based chiropractor. Part of it is the communication with the public in your community. That's what we focus on within the smart chiropractor. But super, super important. So spinal manipulation, I love this. They just come at it right off the bat. They say, quote, spinal manipulation therapy most commonly provided by chiropractors has been established as an effective non pharmacological treatment for low back pain. Fact. End of the story right there. And I could not agree more. Additionally, they highlight that several clinical practice guidelines support the use of spinal manipulation for low back pain. And I know sometimes this might sound a little samesy. You hear these things introing on a lot of studies. It's very, very important because 10 years ago this was not how studies began. They began by saying, basically saying, we don't know if spinal manipulation or adjustments are any good whatsoever. And then the rest of the study goes on paraphrasing, of course. But when they're outlining, this is what the guidelines say, this is what we know. The more studies and papers have that there's not one paper to rule them all. One study ideally leads to five more studies. This is a journey. So the fact that this is being embedded in d, dozens, if not hundreds, maybe even thousands of studies at this point, it does matter. Now it takes time for that to trickle down to clinical practice, but it does matter. So opioids, we know the epidemic is back. It's worse than ever before. I don't know how there's a single physician out there prescribing these things for low back issues. That's a conversation for another day and maybe privately. But in this study they highlight the fact that opioids perform poorly in regard to patient satisfaction and health related quality of life. Well, poorly in health related quality of life. No kidding. It's caused hundreds of thousands of deaths, millions of lives, absolutely shattered. So there is no question about that. And they were essentially fraudulently brought to market. So patients, including the older Medicare beneficiaries, which in The United States, 65 years old or older, Medicare is our government program, if you're listening, overseas receiving various treatments for chronic low back pain have reported a higher satisfaction with chiropractic than with medical care. That's impactful as well. Why is that? Well, we'll go into it in the study a bit, but it's important to know people want it. And here. Well, and let me rephrase that. Actually, there's probably less people that want chiropractic care than people that are satisfied with chiropractic care. Here's what I mean by that. We know utilization is overall pretty low, 10 to 15%. We also know that there's about 50,000 really actively practicing chiropractors. Yeah, there might be close to 100,000 licenses, but there's probably about 50,000 chiros in real active practice. And we know that all of them do not have full schedules. So what's going on there? It seems as though based upon what we see in the research and the fact that we know just with back pain alone, we could do so much more performance care, sports care, rehab care, but just with spinal issues alone, that pretty much every single chiropractor could be full if utilization were higher. So what do we know? Well, we know that's a fact. We also know that once somebody sees a chiropractor, it is a high likelihood that they're going to have a very high satisfaction. So it's really just that exposure. So for us as chiropractors, we just need to look at that and reverse engineer and say, how do we communicate our message in a way that makes sense? Because clearly it's not translating very well. How do we communicate in a way that makes sense? How do we communicate in a way where we can stay consistent and we can build trust and rapport over time? Because quite frankly, we've also seen studies where the trust factor, if somebody has not experienced chiropractic, the trust factor is really low. So the question to you, doc, is what are you doing to proactively change that in your community? It's not gonna happen magically and it's not gonna happen through a state association. It's not gonna happen through a national association. It's gonna happen at your practice level. So that's why I'm so passionate about with evidence based chiropractor, building referral relationships. Why? We've done it for 10 years. I'm looking back now, I'm saying, gosh, 10 years, I feel really old. But we've been doing it for 10 years and we've impacted hundreds of thousands of patients lives, probably well over a thousand chiropractors practices Building those relationships. And also on the smart chiropractor side, actively we service docs around the world, helping them get out there and bridge the gap of communication. And there's no bigger gap out there. So anyhow, back to the study. All participants in this study received long term management of chronic low back pain with either spinal manipulation or prescription drug therapy. They basically had four different cohorts. They had those that received spinal manipulation, they had those that received prescription drugs, and then they had what? They had two crossover audiences, those that started with spinal manipulation and went to drug therapy and those that started with drug therapy and then went to spinal manipulation. So those are really the four audiences. The outcome measures. There's a couple different outcome measures. They were measuring overall satin satisfaction, beliefs of treatment received, health related, quality of life, amongst a few other things as well. So here is the juice, here's what they found. 84% of people in the spinal manipulation group reported being very satisfied with spinal manipulation compared to only 50% of the respondents in the prescription drug cohort. That's a substantial difference. That's very substantial. Not only in the fact of. Let's break down these numbers a little bit. If you were a prescription drug individual, it's 50% that were very satisfied. So half the people were very satisfied, half the people weren't crapshoot. I mean, I won't say placebo effect. Some of these medications are so strong, it's so far beyond placebo. But it's a coin toss whether you're happy or not happy if you're taking prescription drugs. Coin toss. 84% of people receiving spinal manipulation. That is incredibly high. That is, I want to take a second and just acknowledge that 84% is incredibly high in any research study to be very satisfied. Not, not just kind of satisfied, not meh. But very satisfied. That is substantial. That is a showstopper right there. They also found 60% of the respondents in the spinal manipulation crossover group being very satisfied with spinal manipulation compared to 80% in the prescription drug crossover. So these are named almost backwards. So let's, let's talk about that for a second. Those that moved over to prescription drug therapy, 60% were very satisfied with spinal manipulation. Those that moved over to spinal manipulation, 80% were very satisfied with spinal manipulation. So again, a lot of times individuals, when they have a choice, when they're able to experience, I guess in this case when they were able to experience both, it was more likely that if they started receiving spinal manipulation that they were going to be pretty darn happy with it. And that's just the reality of what's going on in so many practices. I think it's wrong, but many people are going in and still receiving medications as a first line treatment from primary care doctors, internal medicine doctors. Of course there's exceptions doing the right thing. But the rule, quite frankly, are people not following the guidelines, people being guideline discordant and patients suffering for it. And to me that's inexcusable. And that's a different side of the equation. We need to focus on what we can control, stay positive with what we can do in our communities. That's all about communication. So researchers also found 96% taking or having spinal manipulation for low back pain makes a lot of sense. This was the beliefs section. 96% of people agreed with that versus 35% in the prescription drug therapy cohort. So does spinal ambition make a lot of sense? Well, 96% of the individuals receiving it thought it did. And again, that showcases to me, ties in with satisfaction. People that have the experience, it makes sense, they like what's going on. They just need to have the opportunity to experience what we do with our hands. Healing comes through motion. Healing is not found in a pill, it's not found in an elixir. It's found through motion. It's found through enabling the body to heal on its own to the best of its ability and to mitigate around its shortcomings. This is the power of what we do, in essence. And it's not a mask, it's not a temporary relief. We don't become sensitized to it in the same way that happens with medications. And there can be long term lifestyle changes. This ties back to. Some of you out there will cringe when I say this, but it ties back to thoughts, traumas and toxins. If we can, as chiropractors, address how people think, how people move and how people eat, we can make such a substantial impact in their lives. And if you are listening and you pride yourself as being an evidence informed chiropractor, don't get so myopic, please, with your care, that you're only focused on the area of pain, that you're only focused on the hands on care and trying to get them out and trying to. I have the lowest pva. That's great. Do what's right for the patient, but understand that habits take a long time to change. If they change ever. People don't change their hobbies, their jobs particularly often. They might change the employer, but they're not probably not gonna change their line of work. So these are things that require, while you might help get them out of pain in one to two visits, these are things that require maintenance. Quite frankly, and especially when we look at Medicare, people have been under gravity, you know, 65 years or longer, they've had injuries, they've been under the stress of gravity, they've done all these things. They've been on the planet in many, many years, many, many decades. That takes its toll. So just as people live on medications, they live on three, you know, injections per year for whatever their issue is. But esis I'm referring to. It's nuts to me that sometimes us as chiropractors take a stance of not wanting to do that when we're the best thing they can have because if they don't, they're gonna rely on NSAIDs or worse. And we know that there is great harm in that. The number one thing about being a doc, do no harm. Right. So these results suggest, the researchers found, quote, these results suggest that SMT cohort self reported significantly higher rates on the belief items pertaining to SMT than the PDT prescription drug therapy cohort did. So were people super satisfied when they received chiropractic care? Yes. What were some of the final findings? Couple of things here. The researchers also found, quote, the results support the hypothesis that among older Medicare beneficiaries with chronic low back pain, long term recipients of spinal manipulative therapy have higher self reported rates of satisfaction with care received than do long term recipients of prescription drugs drug therapy, which is consistent with prior work. Very, very important stuff. Significantly higher scores for the spinal manipulation group on both mental and physical components of the SF12 indicate those who received spinal manipulation on average had clinically meaningful, clinically meaningful higher self reported physical and mental quality of life. You want to talk about improving quality of life as somebody gets older? Help them move and stay active. Drugs do nothing for that. If anything, they build reliance in many cases, they build addiction in some cases and they build sensitization in nearly all cases. We as chiropractors can make impacts far beyond that. And I'm not trying to supremely dog that. There is a time and a place in abject breakthrough acute pain where you need to get this stuff under control. But that should be the exception, not the rule. And we need to rethink about this, reframe it. And us as chiropractors need to figure out how to, how we can communicate at a better, at a better clip, at a higher level, in a more meaningful way to those people in Our community. So they had a couple practical application bullet points here. I want to read. One is, among older Medicare beneficiaries, long term recipients of spinal manipulative therapy had greater satisfaction with it than did long term recipients of prescription drug therapy. Probably no surprise there, but I think it's important just to see it in black and white in the research. Number two, among older Medicare beneficiaries with chronic low back pain, long term recipients of spinal manipulative therapy had higher self reported rates of health related quality of life than did long term recipients of prescription drug therapy. Big takeaways there. If drug therapy fixed the problem, people would probably be pretty happy with it and it just is not the case. So people want results, right? They're not coming in because they want to receive an adjustment. In many cases they want the benefits associated with that. They want the. Of course, the same thing with drugs. Many people don't want to take drugs. They want the result of taking the drug or the pharmaceutical. So when we're delivering results, we see it be reflected in these types of research studies and also when we communicate with patients, when we're able to have a patient experience who we are and what we do and have the opportunity to explain it, it goes a long way because people are super, super satisfied. So get out there, keep up the great work, utilize some of these clinical pearls in your practice. Either there are people in your practice right now, it doesn't matter where you are listening in the world, you have people out there right now probably gonna see in practice. If you're listening to this on Monday morning, maybe Tuesday morning, you have people that you're gonna see today that are deciding between whether or not they're gonna go medication route or chiropractic route. What are you doing to help influence their decision in a positive way? Critically, critically important. Couple things before we wrap up today's episode. I wanna give a shout out to powerstep. Powerstep are the orthotics that my father uses. He is a guy who has had consistent long term low back issues, foot issues, you name it. Powerstep insoles have done wonders for his ability to get up and get around. And power Step, as a sponsor of the evidence based chiropractor podcast is offering you, yes you, a free sample. So head on over. There's no reason not to do this. Pro.powerstep.com sample pro.powerstep.com sample I'll drop that link down below. Pick up a pair. I have a pair about five feet away from me right Now I love them. My father who has had issues loves them. These are the real deal. They were developed by a podiatrist over 30 years ago. Please check it out. Additionally, if you are hiring in your practice this year, visit Chiro Matchmakers. We would be happy to have a conversation. See if we can help really find the ideal person, not just a warm body showing up in your practice. Whether it's a chiropractic assistant or whether it is an associate doctor. If you are looking to hire, you know hiring the right person can generate seven figures for your business. Hiring the wrong person, six figure or more mistake. Head over to the Chiromatchmakers.com or if you're looking for that next career opportunity, we have over a hundred positions available right now. You can check out our job map showcasing what things look like across the world right now. And if you're an associate doctor, you are in a power position. There are a lot of fantastic opportunities paying really, really well. So head over to chiromatchmakers.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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