506- Chiropractic Care Reduces Pain for Older Adults

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 brand new research. This one came out of the Canadian Journal on Aging. I'm gonna drop a link down in the show notes. It's titled utilization of Chiropractic services among older adults with spine pain at a publicly funded Canadian Healthcare Facility. This one's a retrospective study. A lot of great information. Take home messages and and questions for the future before we get kickstarted into the research. Big shout out to Leander tables. If you are in the market for a new table, they're willing to hook you up with $1,000 off their series 950. I'll drop a link down in the show notes, connect with their team, have a conversation. These tables are really fantastic and again, if you are looking to not only save your back but also help as many people as possible in the most comfortable way possible, Flexion distraction tables from Leander are way up there on my list so be sure to check them out. But today we're talking research and we're diving into something really, really important. And I would say in the vein of what's discussed, this might be under discussed and that's an area of chiropractic research that deals with how older adults that might be not super novel in amongst itself but especially from underserved communities are, are utilizing chiropractic care and what kind of results that they are getting. Now in this study, over 240 patients between the ages wide birth here of 45 to 93 walked into a publicly funded community healthcare center in Canada with spine pain. Not only did they get chiropractic care, but a majority of them, we're gonna dive deeper into this. Walked out with really significant improvements in their pain levels. The kind of improvements that matter both keywords here clinically and statistically. Now if you've ever wondered whether chiropractic care really makes an impact on older populations, probably not because you probably see this all day, every single day. But more importantly, how our care stacks up in a tough real world setting where people have multiple health challenges, this episode really dives deep into specifically that. Again with some great talking points. I'm going to say four for all of your patients, even younger patients. So let's set the stage with a little bit of an overview on this study. As I said at the top, this is a retrospective study looking at chiropractic care provided at what's called the Mount Carmel Clinic in Winnipeg, Canada. And this is not your typical average private practice setting. This practice or clinic is located in a neighborhood with a few things going on. High poverty rates, indigenous populations, unemployment's high, substance abuse challenges. This is a place where access to good non surgical, non pharmaceutical, non medicine based care can make some of the biggest difference. There's just a lot of challenges. So when chiropractic care is input, so to speak, inside of a practice like this and it can help people avoid the cascade of advanced incidents, imaging, opioids, medication, elective surgeries, this can make a massive deal that makes a big deal for everybody, but especially in a practice deeply and rooted in the community like this. Now, this study pulled data from nearly a decade of chiropractic encounters between the years 2011 and 2020, and again focused on adults aged 45 and older who all came in with some degree of spinal issue. Spinal pain patients retract from baseline pain levels, so right at the beginning or all the way through discharge. So the researchers in this study could measure actual changes in reported pain, front to back. The goals were really twofold. Number one was to describe who these patients were and how they were managed in this setting, which is really important information for all of us to know. And two, what were the outcomes? What was achieved, especially across the different subsets of age groups within that pretty wide bracket. So let's talk numbers because this is where things start to get pretty, pretty exciting. As I said, 240 patients included the average age 57 and a half, oldest being 93 years old. It was interesting to ask chiropractors, what's the oldest patient you've seen? Right. So I just encourage you to think about that right now. It's always an interesting question, and who's the youngest patient you've seen? But in this, we're talking older adults. Now, a majority of patients in this study were female, 58% and just under half were classified as obese, with an average BMI of, of 30. Many, many of these people had comorbidities. They extended from things like osteoarthritis, hypertension, diabetes, depression, you name it. Now, a stat that was pulled out that really jumped out at me was that nearly 80% of middle aged adults and nearly 90% of older adults said their chiropractic care saved them from a visit to their primary care doctor. Think about that. Nine out of 10 seniors avoided a medical appointment simply because they received chiropractic care. And that's like a massive. What we'd call a substitution effect. And exactly what health systems are looking for in terms of cost savings and efficiency. If you follow this podcast, you know, I don't really place a high amount of value on cost savings. I'm not an insurance company and I'm not a hospital, so I'm not trying to save cost. What I'm always trying to look at is what's the best care somebody can receive. And in many cases, many of the times, those who pay pay attention. We have a saying of that. And you think about things, things that I'm thinking about right now, Full body mri, hyperbaric oxygen therapy, things that are proactive, very little to no coverage, but they're the best things for you. Taking supplements, I mean, just eating healthy, right? All of the things that we know. So cost savings are a nice benefit, especially when we're talking about a publicly funded facility. But it's not the north star of results. As far as I'm concerned. The north star of results goes to pain outcomes and pain outcomes. In this study, the results get even more interesting and even better. Across every spinal region and extremities. Every spinal region and extremities, patients improved by roughly 35% in pain scores from baseline to discharge. And these are complicated patients, and that's above the threshold for clinically meaningful difference. So again, key terms when we're looking into the research, Acute pain patients did have the biggest improvements. Probably no surprise there. The pain's been there a shorter amount of time. It's easier to get out, sometimes cutting the pain in half on those acute patients. Chronic pain patients also improved well with meaningful decreases in most regions. Key things to keep in mind here when we talk about chronic pain patients, again, standard definition three months. Chronic pain patients often have gone through much more care, so their neurophysiology, physiology, excuse me, has changed. The way that their brain is processing pain has literally changed. Whether we're talking about advanced fear avoidance behaviors, we could be talking about sensitivity thresholds that have pretty dramatically changed by the time we get into chronic pain. We're talking about deep psychological components for many of these patients. And remember what we talked about at the beginning. This could be stacked with depression, drug issues, drug seeking, behavior, unemployment. All of these factors make this type of patient very, very challenging. So when there's meaningful decreases in most regions related to pain, that is massive and without having to go through advanced interventions, without having to take medication that is eventually probably gonna lead to a place they don't wanna be, without having to go through elective spine procedures, which may or may not, as you've heard me say, I worked with a Johns Hopkins trained neurosurgeon, gentleman I respect tremendously who said to me, and he would say this publicly as well, which is 33% of my patients get better, 33% stay the same, 33% get worse after I do what I do. Now, all of us as chiropractors, we cringe when we hear that because our expectations probably are 75%, 85% get better meaningfully when we are delivering care. But it's not the case when we go into a traditional medical setting. So let's unpack this chronic pain a little bit further. Chronic pain dominated in both the middle age and older groups. Chronic pain was two to eight times more common than acute pain. A lot of people with chronic pain, depending upon the region. Now the lumbar spine was the number one complaint. 70% of middle aged and 30, 63% of older adults reported chronic low back pain. Now, treatment wise chiropractic in this study was not one size fits all. Patient received a very pragmatic, individualized approach, probably very equivalent to what you do in your practice. Spinal adjustments, 95% of patients received them. Mobilization, soft tissue therapy, extremely common. Older adults also had options to receive acupuncture. Younger adults were more likely to be prescribed exercise. And here's something to highlight with patients. Both age groups started off in quote unquote severe pain category, 7 plus out of 10 by discharge. Almost the groups when they were the numbers were, so to speak, added up and divided. They were all in the moderate pain range, 4 to 6 out of 10. So that is a meaningful shift in quality of life. Now why does this matter for you and your practice? Well, chiropractic works and it works in a very tough population and very much in the real world. These were not elite athletes with one complaint. These were patients with a lot of comorbidities, financial challenges, decades of chronic pain and they still were able to get meaningful improvements. This also reduced pressure on their healthcare system. So if you're somebody that's looking towards true integrative care in your community, this is something you can lean into. Nine out of 10 of the older patients avoided a primary care visit because they saw a chiropractor. So it's a demonstration of value and it reinforces guideline based practice that we have talked about to the nth degree here. Multiple international guidelines recommended what we do chiropractic adjustments, spinal adjustments and non pharmacological approaches as first line, first line treatments for back pain. This study confirms that those recommendations work even in underserved populations. So how do you communicate this to your patients? I think there's a variety of ways you can go with this, but you can use this in a variety of different conversations as well. But things like many people your age think pain is a part of getting older, but research shows chiropractic can make a big difference even if you're dealing with pain for years. That is just pragmatic conversation letting people know chiropractic care has helped older adults. It's cut their pain by nearly a third or better. And that's in patients that have really complex health issues, not just simple cases. These are really interesting ways you can use these conversations in your report of findings, in your marketing for your reactivations. It's gold for newsletters, community talks, in team training. Make sure that your CAS and front desk know about these talking points. So when a patient asks does this work for somebody like me? And that will happen when you're not standing there at the front desk or on the phone, they should be able to confidently answer yes based upon the knowledge that they have, not just because you said so. So the big takeaway is that chiropractic care provides meaningful, meaningful pain reduction and pain relief for older adults, even those with pretty significant complex health challenges. And it also helps can reduce the burden on a publicly funded healthcare system. So when chiropractic care is integrated into community health centers, patients benefit plus primary care gets relief, plus the system saves money, can be a plus in certain circumstances and that's really a win for everybody and it's something that you can be proud of. So I'm gonna drop a link down to this study down in the show notes, so if you wanna check it out, please feel free to do so. Also, if you're focused on checking out the cervical spine neckcare.com please head over there. The best piece of hardware and software that I have seen assessing the cervical spine in and as a listener to this podcast, they'll hook you up with 10% off your first year. So if you're interested in that, connect with them. I love, I love the product, I love the service, I love the assessments, I love what they do over there. So if cervical spine is a big part of what you do, be sure to check out neckcare.com also thank you to everybody who has left a rating or review for this podcast on Spotify or on Apple podcasts or even I've seen a few Google reviews as well. Really appreciate that. Thank you so much. I am still willing to honor that for the 500th episode. We've gone through that a few weeks ago but if you would leave a rating or review for this podcast and screen grab it, email it to me, send me your address, I will hook you up with a gift bag. We'll let that ride for another week or two. So thank you so much for tuning into this podcast. Thank you for being a chiropractor. I hope you have a fantastic week in practice and I will talk to you soon.

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