495- How Chiropractic is Outpacing Opioids for Pain Relief

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 are back with more research. This is all around opioids versus non Pharmacologic treatments for adults in pain. This study ran from 2011 to 2019 and this is a topic that I am passionate about and I think you will be too if you're not already based upon what you learn on today's episode. Now before we get started, I want to give a big shout out to one of our new partners, Leander Tables, one of the best and oldest names in the business and they are hooking you up as a listener to this podcast. You can save $1,000 on their flexion, distraction and elevation. They call it the Series 950 table. You can connect with their team and or buy online using the code EBC 2025 and I'll drop a link of course down in the show notes. These are some of the best tables out there. Highly recommended. If you are in the market for a new table, have a conversation with them and save a thousand bucks in in the process. But as I said at the top of today's episode, we are talking research. This study is titled Trends in the use of opioids versus non pharmacologic treatments in adults with pain 2011-2019. Great study of course I'll drop a link down in the show notes so you can check it out and here's a quick overview. The goal of this study was to track the use of prescription opioids versus non pharmacological treatments like like chiropractic care over a multi year period. Specifically for this study they looked at 2011 to 2019. The data set had, get this, over 46,000 cancer free adults. Important that they were cancer free because there is a time and a place for opioids for I'm going to say cancer related care. But outside of that there is rarely if ever a time and a place. So these were not individual. This was a good selection, in other words of individuals who should not be receiving under practically any circumstance in my opinion these medications. They all had chronic or surgical pain and they were pulled from what's called the MEPs, the medical expenditure Panel Survey. This was focused on outpatient treatments by licensed healthcare providers and it was across the board, There were chiropractors, PTs, OTs, massage therapists, acupuncture, et cetera. And there were some really, really key trend in this study supporting what we do in chiropractic. And before we dive into some of the stats and data, we'll get deep with that in a moment. I just want to highlight how important this is. Opioids have ruined hundreds of millions of lives, cumulatively millions of deaths and hundreds of millions of people, family members, work associates, all this related to this. The fact that this is not a five alarm fire on the news every night and the fact that the providers prescribing these for years on end and many still providing them today are not held accountable is an absolute travesty within our medical and healthcare system. So I just wanna, I'm coming at this from a very specific point of view. I wanna everybody, I don't understand how anybody could come at it from a different point of view. Personally chiropractor, non chiropractor. But this is an important component and it's an important component of your practice because I can guarantee you there are people in your practice right now that are taking opioids for pain, I can guarantee you there are people in your practice right now taking opioids for pain that haven't told you they are. And I also can guarantee you beyond any reasonable doubt that there's a thick percentage of people that aren't in your practice but are in your community taking opioids every single day for pain. That's a massive problem. And many of them, not 1% or 2%, but a pretty sizable percentage of them are completely addicted to these medications in a down downward cascade. They might seem, as you might not know that speaking to them yet, but you will eventually. And anything that you and I can do to interject into that system to help somebody avoid that to me is one of the highest callings we can have. Yes. Can we do more than just pain relief as chiropractors? Of course we can. We're, we're where probably the world's leading experts in helping people live their best life in a holistic manner without the use of drugs and surgery. And occasionally those things are necessary, but for most people, most of the time they're not. And anything that you can do to live up to the Hippocratic oath of do no harm, of which many doctors in your community are not, by actually prescribing these, is a good day in the office, it's a good day for your community. So let's Take a look at some of the research they noticed. This is good news. Non pharmacological treatments are rising while opioid care is declining. Now, if you note the date of this study, this study did end in 2019. We do know now that what happened with the pandemic reversed almost, if not all, of the gains on what I'm about to say. But it's important to note that these gains were made so they can be made again. So for chronic pain, non pharmacologic use increased significantly. So that is really, really nice. At the same time, using no treatment at all dropped dramatically. We'll get into what that means in a moment. And by 2019, there were more adults with chronic pain using non pharmacological care than opioids, which is really, really good. Almost 44% of adults with chronic pain used some form of non pharmacologic care. And there were about 15 or about 16% on opioids. So the good news here is that the non pharmacologic care were four times, let's say three to four times as much as the opioids. The bad news was 15% of adults with chronic pain were on opioids. 30% of adults have chronic pain and 15% of those are on opioids. That's a lot of people. The good news, chiropractic was the most used non drug treatment and chiropractic care rose. In the chronic pain cohort, 25.6% of people saw a chiropractor in 2019, and that was up from 14% in 2011. That's a really big gain. And in the surgical pain cohort, about 9% saw a chiropractor in 2019. Now, we talk about the gap of opportunity here, and it's really important that you understand this. So 60% of chronic pain patients still received neither opioids nor non pharmacologic care. That's over 250 million people in this study period, who essentially went untreated or managed their pain on their own. That is a massive public health, I'm gonna say failure, and a really clear opportunity for your practice to proactively reach out, educate your community, and scream from the mountaintops. Tell everybody that you can, who you are and what you do. You're there for a reason. And most of the docs I see, they want to be busy all day long with patients. Why? Because that's how they light their fire. That's probably you. You want to see patients. You would love to have a successful practice and you understand that Having a successful practice comes by taking care of people. The more people you take care of, then the finances take care of themselves. So are you doing everything you can to get out there and tell this story? Tell your story. Let people know about the facts of what's going on in the research? I hope you are. And I hope you take what you learn each and every week on this podcast and utilize it in the conversations you have with your patients, across your social media platforms and of course, as you build relationships with other people in your community. You know us as chiropractors. We're not just, you know, fighting opioid overuse, as this showcases. There are hundreds of millions of people. We're fighting neglect. So chiropractic care and what you do can help bridge that gap. Gap. Now, paradoxically, in this study, those who reported the most severe pain were less likely to access non pharmacological care. For patients that reported, quote, unquote, extreme pain, the odds of using chiropractic PT massage dropped while opioid use surged. Now, this can be due to a few different things. One is that assumptions that severe pain needs medication, lack of referrals and awareness access barriers, all of those things can be true. What I've seen pragmatically is that many people and many doctors as well, and the doctors may not want to admit this, but when push comes to shove, they're very much influenced by the way the patient approaches things, which is the pain is really bad. Therefore, I'm beyond insert chiropractic PT conservative care. Oh, I'm beyond that. Why? Because I have a disc herniation. Over 50% of people believe a disc herniation means they shouldn't see a chiropractor. Not that they should. That's a massive problem. And the same thing goes for pain. Most people and many doctors believe, oh well, when they're in super extreme pain, well, they can't go get adjusted. Well, that patient might not receive a high velocity adjustment that day, but that doesn't mean that they're beyond the scope of conservative care. You probably have more than one technique in your tool belt that you can utilize. So, so this is another communication issue because many providers and people just equate you with simply and only the high velocity adjustment. Now, hey, I believe that's the most important thing we can do aside from communication, aside from guidance. However, it doesn't mean that it's the only thing we can do. So ensuring that the people in your community and other doctors know, hey, I have multiple techniques from low Impact to, to high velocity and everything in between. Whatever it is for you, really, really, really important. Now a few direct quotes from this study. Quote, Chiropractors and physical therapists were the most common licensed healthcare professionals providing non pharmacologic pain treatments. Another quote, the findings of this study suggest that non pharmacologic pain treatments are increasing. Good news in prevalence following government policy and practice guidelines. And another quote, the annual prevalence of non pharmacologic pain treatments increased and the prevalent use of neither opioids, non pharmacological or non pharmacological therapy decreased for both chronic and surgical pain cohorts. So what are some things that you should know out of this study? 1. Chronic pain affects 20 to 30% of US adults. It costs more than heart disease, cancer, diabetes, opioids, massively high risks as you're super well aware of falls, misuse, hospitalization, overdose deaths, you name it. Government action over the last 10 years has started to shift this care model. Guidelines pushing for non pharmacological care as a first line option. Rescheduling of some of these drugs to really where they should have been to start with have influenced this. But there's still a massive, massive long way for us to go. So what are some additional stats and talking points? Pain interference matters. We talk about this all the time. That life effect, right? The more pain disrupted daily life, the more likely patients were to be prescribed opioids and the less likely they were to get non pharmacologic care. That is crazy town, but it's what's happening. So I'm going to say that one more time and we'll dive into it. The more pain disrupted daily life, the less likely they are to be referred to you and the more likely they are to receive opioids. It's literally the inverse of what should be happening. But every time you hear that, hopefully that gets you excited and you say, man, this is also an opportunity. It's an opportunity for education, it's an opportunity for guidance. It's an opportunity to get out there. And let me be super clear, not everybody's gonna listen. Not everybody wants to listen, not everybody wants to hear the story. And many people don't want to hear the truth, but there are plenty that do. And your goal, your job, my job is to get out to those who do and are unaware. We're not trying to convert the unconvertible. What we're trying to do is connect with those people who don't know any better, who are excited to learn that there are other options who are interested in seeing the truth of what's out there and making the best decisions for them. So in 2019, opioids only. So the care that had opioids only about 12% of patients in chronic pain had that non drug care only about 23%. Both about 4% and neither still way too high at about 60%. Massive opportunity for you and your practice. So how can you use this? Well, we as chiropractors are already the most used non drug pain professionals. But as we've highlighted, there are tons of people out there that still are not getting your care and have no clue that you should be where they are at. So you can use studies like this to educate the other healthcare providers in your community to talk with your patients again through social whether they're on the table, wherever that might be. And if you're politically inclined, the policymakers in and around your community as well. Highlighting the fact that what you do as chiropractic is proven and it's growing and it's not going anywhere and that the guidelines in research continue to support who you are and what you do. This is a really great opportunity for you to use research like this to position your practice as being aligned actually already with these health goals, drug free, guideline aligned, evidence supported care, all of that. So this study, I'll call it a landmark study because I think it confirms what many of us have known for years, which is patients want and are using chiropractic more than ever. But man, we have only skimmed the service in terms of that opportunity. So the best thing you can do is continue to take care of the people in your community, continue to tell your story, continue to show up excited and continue to do that hard work necessary to help people overcome their challenges and ultimately live their best life without the use of drugs or surgery. Now, before we wrap up today's episode, I want to say a few words about turncloud. You've heard me talk about it. If you have not connected with their team, I don't know what you're doing. Click on down below and talk with them. They have created an intuitive EHR application where no one needs a user manual. How exciting is that? When's the last time you heard that they've stripped away everything that's not essential. You can connect with their team, get access to a special offer as an evidence based chiropractor listener by telling them and connecting with them@TurnCloud.com I will drop that link down in the show notes and I just want to thank you for tuning into this podcast. Thank you for listening. If you'd leave us a rating or review, that would be awesome. It helps more and more docs find out about this podcast. We are bearing down on episode 500 in just a few weeks time, which is going to be a special episode with massive giveaways for literally just about everybody. So please stay tuned, have a fantastic week in practice and I will talk to you soon.

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