391- Back Pain Facts and the Biopsychosocial Model

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 Langme. This week we are back with research and it's actually a randomized trial study protocol. So the research has not happened yet, but the protocol came out. It looks awesome. And the background that they did is worth talking about. We're going to dive into this on today's episode. The title of it is Effectiveness of spinal Manipulation and and Biopsychosocial self Management compared to medical Care for Low Back pain. A randomized trial study protocol. Lots of great tidbits. When I was reading this study protocol it got me thinking. I have a lot of little clinical pearls, tips, facts, figures, high impact pieces of information for you to better communicate with your community and with your patients. And a couple things to think about as well. Before we get started, I wanna say a few words about patient pilot by the smart chiropractor. The money is in your list. You might be listening even on a device that you have access to your ehr on right now, listening to this podcast. If you have a list and you are not using that list with automated campaigns, you're missing opportunity. How much opportunity? It depends. But I can tell you this. The average doctor we work with utilizing our automated campaigns has a list size of 1,100 and we generate 26 click to call and click to schedule reactivations each month per 1,000. So that's 2.6 per 100 subscribers. If you are not getting those results on your own, schedule a demo. @the smartchiropractor.com we have a 3x ROI guarantee. You literally can't lose. How? Hop on over. Reactivate patients, have a system, have a process to do. So it's what we do. We work with over 300 practices, send over a million and a half emails per month doing exactly this. So based on your list size we can pretty much predict exactly what's gonna happen. And if you would like to generate more reactivations this year, then why wouldn't you head over to thesmartchiropractor.com and book a demo. But as I said at the top on today's episode, we're talking research. I'll drop a link down in the show notes. Again, it's a study protocol so we're gonna keep a couple keen eye out in the future. Gosh, I don't even want to guess how many years it's going to take, maybe before the actual study comes to fruition, but hopefully it's soon. And it's titled Effectiveness of Spinal Manipulation and Biopsychosocial Self Management Compared to Medical Care for Low Back Pain. And when I started reading the background on this study, my eyes lit up. Not all good news, but very interesting news and things that you and I need to be aware of. The literal first line in the background is the United States is in the midst of an unprecedented pain management crisis. That got my attention very, very quickly. We've talked about opioids in the past and it's worse than it ever was. Let's just call it exactly what it is. 100 change, people dying every single day is, is completely unacceptable and there's no accountability. So what does that mean? Do we get angry? Yeah, I think that's a rightful position to take. But we also need to be proactive and that is proactively educating people so they never go down that path. Because the more that we do that, the more silly the people who do those things. Not the patients who are hooked up in it, but the providers that are going about that as a treatment protocol. The more silly that they look, the more negligent they look as well, which is what they exactly are. So we are in the midst of an unprecedented, unprecedented pain management crisis. Guess what the cost of this is? 560 to $635 billion per year. That is absolutely outrageous. Why is that the case? Because low back pain is one of the most common if it's the number one cause of disability in the world. So here's the facts and figures that started to get my attention. Even more so than that approximately 20% of acute cases will become chronic. That means early detection, early care, early treatment is so, so important because one in five cases that are of low back pain become chronic over time. What's a great way to move from acute to chronic? Do things that don't work, take, you know, have no action whatsoever and become sensitized to medications. In my opinion, that is a fast track to that. What is the antidote to that? Being in it with a movement based healthcare professional like us, taking a proactive role. That is how you crunch the time down and stay acute instead of elongating that time out and becoming chronic. There's just very direct linear steps that can be taken. But one in five cases of acute low back pain become chronic. Shocking to me. And here's the even more shocking stat. 40% of chronic low back pain patients will experience high impact pain that significantly interferes with work, social activities, daily life. So sometimes I believe, you know, speak for myself. We kind of get this veil of low back pain being so boring. Is it the most exciting thing to treat on planet Earth? No. Is it necessary? Yes. Is there anybody that does it better than us as chiropractors? I haven't seen it. And the market is infinitely deep from a business perspective. So are you getting out there in communicating at the level you need to? There is no shortage. If you have anybody, if you have any space on your schedule, you can do a better job communicating. Because there is no shortage of individuals that are dealing with these issues. Tying back even a patient pilot at the top of this. Are you recommunicating with the people who have already no trust and like you, Are you staying top of mind with them? Absolutely. Important. Chronic low back pain. Sometimes we think of it as this ongoing thing and it's more of a nuisance. 40% of those people are going to have high impact pain that significantly interferes with work. We normally think of acute pain, that inflammatory state. That's when you're at the height of, of you know, a VAS score. It's more painful then and settles into chronic. Hey, 40% of people with chronic pain are going to have high impact pain. That is a big, big deal. And low back pain is complex. There's a lot of stuff that goes on with low back pain. It's one of the only. Spinal pain is one of the only types of pain. It's different than a hurt wrist, it's different than a hurt finger or ankle. It is complex. Our spine houses our central nervous system. Our spine is necessary for nearly everything we do in life. Therefore, when you have spinal pain there's such a great, it's hard to work around it. You have a hurt left finger, index finger, maybe you can use your right hand a little bit more. It's really difficult when you have spinal pain to be able to maintain a great quality of life. And that complexity goes from physical to psychological to social factors. All of these things come out ahead and they come out ahead really, really quickly. I have seen a couple friends go through some bouts of low back pain over the last few years and it seemed like that, I mean it was like lifting something. There's some radiculopathy going on. The change in the quality of life and the thoughts was fast and furious. So what does that mean for us? It means we need to be proactively talking about this, proactively putting out social content, proactively sending emails, communicating with people at scale about what to expect, tying back to last week's episode about what to expect so that you can meet and exceed those expectations, so that they can make a really good decision about what to do. And here's where we get into some of these other things here. So treatment for low back pain is quite frankly characterized by persistent use of, as they say, marginally effective and potentially harmful therapies that ignore the psychosocial component. That's not good. So we can help solve that. But again, it comes down to communication. For example, as they cite in the study or the protocol, the use of epidural injections, opioid prescriptions, surgeries for low back pain has increased at accelerating rates over the past few decades with little positive impact on patient outcomes. If you've seen me speak for one of the talks that I do, we overlay the cost of spinal issues, so to speak, as we talked about the beginning of the $500 billion, the cost of spinal issues with surgeries performed over the last like, per year, over the last 25 years. And I show the two graphs, then I overlay them. It is, you know, you think I'm showing the same graphs like management wants you to take a look at these two pictures. What's the difference? They're the same picture. It's literally directly linear. And I can say, working at orthopedic practices, in my opinion, about 90% of elective spine surgeries should not be performed today. That's my rough take on it. There's a lot of people that are checking the box for quote, unquote, exhausting conservative care in going towards surgical intervention. And the question is that has continued to pick up, are people healthier? Are we seeing less spine issues? No, we're seeing more than ever. But. And that's not a coincidence. So again, important, I'll just keep saying this. It's so much important for us to get out there to have these conversations. And of the biggest concern here is opioids, which are used by an estimated 30% of people with chronic low back pain. Take that in for one moment. 30% of people with chronic low back pain are taking opioid medications. Do we think there's an opportunity there? Absolutely. Imagine the change in somebody's life when you can help ease them off that through movement based care. I'm not saying it's easy. I'm not saying it's going to happen overnight. What I am saying is if there's anybody poised to do it, it's us. So there's growing evidence that physical and psychosocial risk factors can predict whether or not acute low back pain actually progresses to being chronic. That's what we're going to take a look at in this study. And to reduce chronic low back pain, they highlight the fact that patients should have greater to frontline care that addresses physical and psychosocial needs. Hey, I can't argue with that. And such approaches are designed to integrate psychosocial interventions with biologically based pain management approaches. Essentially biomechanics, right? And they say it right here. In this study. Physical therapists and chiropractors are the most common providers of non pharmacological treatment with an estimated 39% of low back pain patients seeking treatment from DCS and 34% from PTS. So I know there's some overlap there, but I always think about this from the standpoint and also just from a practice and business perspective. Just the people that are failing PT that have low back pain in your community is a whole market for you right there. Why? Is it because PT is ineffective? Absolutely not. But it is, in my opinion the fact that segmental biomechanics need to be addressed then regional, then whole body. So if you're going through and exercising but you have a joint that is fixated, you have a joint that's not moving great segmentally and that's the cause of the issue. You, you can do a lot of work regionally around it, you can do a lot of work whole body, but you need to just get the joint moving. Which is one of the reasons why we have such success as chiropractors. Because that adjustment, spinal manipulation, however you want to define it, is so important to the biomechanical component. Now you add on the ability to communicate from a psychological perspective, to set expectations. Again, tying back to last week's episode and, and then help people understand the progress and help inform how socially this might impact their life, but how they're gonna get back to those things and setting those realistic expectations. So, so critically important. So their long term objective in this study was to reduce, there's a big objective here, but is to reduce overall low back pain burden and prevent acute and subacute low back pain from progressing to severe chronic problem by targeting those people at higher risk. So they were looking at this through the lens of four interventions and I think this is a great way to go about it. Those people allocated toward spinal manipulative therapy, those allocated Toward supported self management, A combination of supported self management and spinal manipulation. And then separately medical care as the fourth one. So that's how they're breaking people up and allocating towards different groups in this study. I think it's a really great way to go about it. And they're going to look at three primary outcomes. One is average pain intensity over 12 months, average. Second one is average disability over 12 months. Third one is prevention of chronic low back pain. And then they're gonna have a whole bunch of secondary and tertiary measurements as well. My bottom line with this study, looking at it, was a lot of where we started with the background. People out there need to. They deserve to have better options. And the other thing I want to just bring up right now is as chiropractors, we become so blinded. I call it the. Is the curse of knowledge, as they would say, right? We have hung out with chiropractors, we went to chiropractic school. We were interested in the human body before we went to chiropractic school. We take care of people all day, every day. We become so blinded to the fact, well, why wouldn't somebody make this decision? They don't know what you know. And that is such an important component of what we call the curse of knowledge. How do you break that down? I think there's just a couple things. It's a process. It's not like you can break. Break it down immediately, but one, and these are things I try to remind myself of and I hope they're helpful for you. And that is think like a beginner. Think like a beginner. If you were somebody that knew nothing about the body, you're living your life and all of a sudden your back hurts, what would you do? What's the question that you would be asking? What are the people you'd be reaching out to? That is a really great way to think about what content you should be putting out. Because when you proactively answer the questions people have about their health, you win. And they win because you're able to communicate at a level that then goes to. My second point takes them from one step to the next. If you try to take somebody with zero knowledge and take them to step five from step one, it's never gonna happen. That's a conversion issue in a marketing lingo. But you wanna take people down the road one step at a time. If they knew nothing about the body, they had low back pain for the first time, what would be the first thing that they did? What would be the second thing that they did. What would be the third thing that they did? That's an important cascade to understand because the more that you understand that, the more you guide the conversation one step in front of the other. That is how you guide somebody. That's a patient journey. That is how you become the teacher, the educator, the doctor is by helping people make better decisions that they would be unable to make without you. That goes beyond the hands on care you deliver. That extends worldwide, nationwide. That extends to anybody you can touch with your message with the tools we have available today is so wide it's almost hard to comprehend, but it also goes back all the way back to the one on one conversations you're having with people in your practice. So bottom line with this, we are still in the midst of an unprecedented pain management crisis. That is a good opportunity for you and I to step up, to stand out and and for us to tell the truth about what's going on. To help take people one step at a time and to think like a beginner so that you can help more people get well without having to resort to advanced interventions which quite frankly aren't going to help them get well one way or the other most of the time. So as somebody listening to this, thank you so much for being a chiropractor. Thank you for being part of the solution. And I want to say a few words about Chiro Spring before we wrap up. Chirospring will hook you up with $100Amazon gift card just for taking a demo. Why? Because they know that their EHR was voted the best solution for chiropractors by chiropractors. They know that when they showcase to you the AI, the billing, the components that they have spent time on, you're going to see the difference, the Kiro Spring difference between what they do and what you currently have and use in your practice. So head over to kirospring.com offer kirospring.com offer I'll drop that link down in the show notes. Just for taking the demo, I got a feel the demo is gonna change the trajectory of your practice. But just for taking the demo they will hook you up with a hundred dollars Amazon gift card. And finally, Power Step Orthotics. They support this podcast, you should support them and they're willing to hook you up with a free sample pair. They are were designed by a podiatrist over 30 years ago and they're what I use. Personally, I cannot stand behind powerstep Orthotics enough. They have helped my dad tremendously. Who has had low back issues, neuropathy issues. Powerstep Orthotics are where it is at. Get a sample pair, try them out for yourselves. Pro.powerstep.com sample I'll drop that link down in the Show Notes Pro powerstep.com sample use the code EBC for evidence based Chiropractor. They'll hook you up with a free sample pair. And while you're at it, if you have not left us rating or review, I would greatly, greatly appreciate that. That helps more and more docs find out about this practice. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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