511- How Patient Expectations Shape Chiropractic 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 Lingmaid. On today's episode, we have more brand new research, fantastic study around chiropractic adjustments, changes in cortisol levels and short term pain relief. This is a randomized clinical trial, brand new, hot off the press. We're gonna dive into it and highlight some of the key stats and factors, takeaway messages and how you can apply this to your patient conversations. Now, before we get started, I have a special shout out to Leander Tables. They're gonna hook you up with $1,000 off their Series 950 just for being a listener of this podcast. I'm gonna drop a link down in the show notes or you can connect with them directly on their website or via phone, let them know you're a listener. And on their Series 950, awesome Table, they will hook you up with $1,000 off. But as I said at the top, today's episode is all around research. This study we're going to touch on is titled Research Relative Contribution of Real Sham Spinal Manipulation Performance Changes in Cortisol Levels and Patient Expectations and Fear Behaviors in Modulating Short Term Pain Relief in People with Neck Pain. A Secondary Analysis of a Randomized Clinical trial. Man, that title is a mouthful. As always, I will drop a link down in the show notes so you can go over there and check it out. But really, this gets down to, I'm going to say a very simple question and that's thinking to yourself, have you ever had a patient who felt better almost before you even laid your hands on them? You lay your hands on their neck, you set up the adjustment and they say, wow, that feels better already. Now the question is, was that the adjustment or was that really all taking place in their central nervous system and brain? And the answer is going to be probably. There's a combination of factors going on, but there is no question. And this is a little bit outside this research, but there's no question how you're positioning yourself. The content you're putting out online, if you're running paid ads, what do they look like? What's the offer when somebody calls your practice, are they getting a warm receptionist, a fantastic AI agent, or are they getting somebody that's cold and disconnected when they show up in your practice? And I Mean literally from outside, are the windows clean? Does the pavement look nice? Is your sign clean? When they open the door, does everything work appropriately? Or is it like creaky and kind of like, I don't know, this place could use a vacuum. Right? These are massively meaningful things that really do set up your ability to get the best results possible. When they check in, what is that experience like? Are you providing yourself? And I saw this when I was working in the orthopedic groups. They would spend literally millions upon millions, let me put it that way, ensuring that the patient experience was completely dialed in. Now, why would they do that? They would do that because it bluntly lightened the load on the clinical and sales team. And every time you're exchanging value for service fee for service, it's a sales process, make no mistake about that. However, it doesn't need to be a sales Z process, but it is a sales process. So. So you want to set yourself up for success. And this comes at this from the standpoint of if somebody's showing up in your practice based upon the fact that they think you can help, then you should give them every opportunity to say yes. As long as they qualify for your care, as long as there's nothing that would lead them or you to make a different decision. So many times people and I saw this in the surgery centers because they would be massive buildings that were really nice and people would walk in and like, breathe a sigh of relief and just because they were like, you can help me. And the question is, is your practice setting up that expectation? When somebody rolls up to your building, when they engage with your team, are they like, man, this is the place I've been looking for, or are they coming in skeptical? Cause I can guarantee you, if they're coming in believing that you're already the right place for them, you are setting yourself up for success and them up for success, which is the most important thing. So today we're going to dive into some really fascinating new research that looked basically at this question. What really drives short term pain relief after an adjustment? Is it the adjustment itself? Is it stress hormone changes? Is it patient expectations? Or on the other side, is it fear of an adjustment? And I think the answers to this might surprise you, and they definitely will change the way you think about the words and communication styles that you use in your practice with your patients. So this study was a secondary analysis of a randomized clinical trial. And how about 60 some odd patients with chronic neck pain? Now, in this study, they compared real cervical adjustments with Sham adjustments. And they layered in expectation setting. So some patients were told positive things like this will help your pain. Others were told neutral messages. And some were even given negative suggestions like this might make your pain worse. And on top of that, the researchers also measured sam salivary cortisol levels, our body's stress hormone. And they looked at whether patients fear of adjustments influenced the outcomes. And then they ran a regression model to figure out what factors contributed the most to changes in pain. So this is a really cool study with it's a really interesting study design. Title's a little bit a lot to take. But the study design is really nice because it lays out very systematically how does what you say influence what happens. So here's a quick rundown of some of the key findings and this is going to be no surprise. The first one, expectations were paramount. Positive expectations had the largest effect on pain reduction by far. That is meaningful. We're going to come back around to it. The adjustment also mattered. Real adjustments outperformed sham adjustments. But the effect size was actually smaller than compared to the expectations. Cortisol levels didn't really move the needle. Changes in stress hormone levels were not significant predictors of pain relief in this study. And fear did not significantly impact pain relief either. So patients who were fearful didn't necessarily get worse results. A little bit surprising, at least in this study. So when we look at the numbers, expectations alone explained and accounted for over 50% of the variance in pain relief. The adjustment itself explained about 20 to 25%. And the cortisol and fear levels were pretty much statistically irrelevant in this trial. So let's go one level deeper and start breaking this down. So the patients who received and got real adjustments, they did have significantly greater immediate pain relief than those who got the sham adjustment. And that's really reassuring you. We've highlighted this time and time again, an adjustment is not placebo effect. Now if you go on X, if you go on YouTube and you start looking at comments, that's like the first skeptics thing. It's placebo effect. When somebody says that, they're showing you their knowledge level and I'm going to spoiler alert, it's not high. You know, placebo effect with what we do has been ruled out for I think 15 or 20 years through randomized clinical trials in, in very prestigious journals. So we're so far beyond that. So it's such a basic statement when somebody says that. And it's very clear that they have no clue what they're talking about. But this study Reinforced it, which I think is great. But where it gets interesting is if you gave an adjustment with a positive expectation, hey, this is a really safe and effective way to help reduce your pain. Patients had a much bigger reduction in pain. Now, negative expectations, on the other hand, reduced that benefit. Patients who were told this could make your pain worse, they sometimes actually reported more pain. And again, cortisol levels, researchers checked before and after, and the changes really didn't correlate with pain relief. But this is important. And I think a lot of us, we get into a mode of one of two things. One of them is, I'm go with the. The most common first one of them is we're kind of going through the motions. I don't mean that in a negative way, but you're seeing patients each and every day. You have a nice practice, it's scaling, it's building and growing, and you can get into a little bit of a rut in terms of what you are saying or not saying. And that's really the key part. Speaking through your care. I'll say that again. Speaking through your care is such an important part of. Of a great doctor patient interaction. That's from examination that what starts at intake, through examination, through care and treatment. When you're doing your exam, are you talking through it with the patient? All right, let's have you look to the right. Right cervical range of motion decreased by 10%. Saying those things out loud, critically important. Many times the patient might not know exactly what you're saying in the moment, but you're planting those seeds. You're establishing trust and you're highlighting what's going on. So as you reference it later, it's going to just make more sense to somebody. When you're delivering your care, are you. What would be the reason not to is the question. Right. And what I say, what would be the reason not to? What I'm referencing is saying positive things. All right, now let's get in there and help get you feeling better today. All right, You're a little restricted on the right side. This adjustment should loosen that up. Okay. You have some pain going down your arm. What our goal is is to maximize the space with this adjustment in that foraminal canal and reduce the inflammation so you can feel better. I'm probably already talking a little more technical than I probably would coach on, but ultimately that is the mode you want to be in. It's not in risk mitigation mode at this point. It is, you know, basically saying an informed consent while you're delivering Care, don't do it. Make sure that you are saying positive things each and every time you are engaging with your patients. It's not only meaningful in terms of just really nice as a patient experience. Yes. There's a side benefit of quote unquote sales that go into that. I love the word sales, by the way. I do not believe that's a dirty word. So there's a component of that as that, but it's also driving the best recovery and best results possible. Why wouldn't you do that? So I think it's an important checkpoint on today's episode to say, what am I actually verbally saying? What am I saying during a patient engagement, whether it's care, treatment or examination. And you know, so the question is probably pretty obvious at this point. It's like, what does this mean for your practice? It means that the adjustments you deliver work, there's no doubt about that. But what you say, how you frame it, and the expectations you set can actually make as big or bigger of a difference than the adjustment itself. And that's massive. Again, simple positive statement. The adjustment today is designed to help relieve the tension in your neck. And most people feel less lighter and better right away. That could literally double the benefit that your patient experiences. So let's go through a few examples. We've highlighted a few, but here are some just basic talking points, some easy talking points you can utilize in your practice. Hey, adjustments have been shown to be safe and effective and this should calm down that pain and tension that you're feeling. Hey, many people notice their pain drops very quickly after this type of an adjustment. Yet we'll keep it comfortable and effective for you. And I'm fully expecting you're gonna find some relief pretty quickly. Highlighting those things, really, they're simple, they're positive, they're encouraging. You're not over promising, you're just setting a really helpful expectation. And you can apply this in your report of findings by framing out your adjustments and what the care plan is. Using research to remind your patients about the benefits of what they can expect. You can use this in your reactivation campaigns. Again, email and texting. We do this with Patient Pilot. It's kind of built into the messaging that we do, but really consumer friendly, proactive messaging to make people know that they're welcome back in your practice and that benefits are waiting for them. And also in team training, ensure that your team is up to date on these types of things. So your staff and your team can use expectation shaping up front so when outcomes improve, you Know it. Your retention improves, your referrals improve, your reputation improves. So doing everything you can to improve outcomes is a really, really good idea. So big takeaways on today's episode are the adjustments that you deliver work, but the words that you deliver can work even harder. And by setting positive expectations, you can amplify the relief that your patients are receiving and negative expectations undermine that. So this study is a great reminder that chiropractic care, yes, it's about neurophysiology, yes, it's about biomechanics, but it's also about psychology. And patients bring their own baggage, right? They bring their own beliefs, their own fears, their own expectations with them each and every time. And those factors can shape outcomes just as much as your hands. So you want to make sure that you are framing things, pre framing things and post framing things in the best way possible. You're not just delivering an adjustment, you are delivering a patient experience. And that experience starts and continues on with the words that you choose each and every day in your practice. So as we wrap that up, this was about neck pain. And if you take care of people with cervical spine issues, I'm gonna encourage you to check out Neckcare. As a listener, they're gonna hook you up with 10% off. I think the best a cervical assessment tool out there. The tech is awesome. The hardware, software combination, it works. It's like Apple that this, the reports are awesome. They're easy to give you the depth you need as a clinician and they're easy to understand. So you can give this as a massive benefit in your practice to and for your patients. So netcare.com, i'll drop that link down in the show notes. Other than that, if you have not left a rating or review for this podcast, I would definitely deeply appreciated if you would take one moment and do so. That helps out tremendously with more and more people being able to find out about this podcast. So if you want to scroll on down, tap so many stars, leave a sentence or two, that would be absolutely fantastic. And thank you so much for tuning in. 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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