Chiropractic or Pain Management for Back Pain | Podcast Ep. 150

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are talking about a head to head study that showcased chiropractic care against pain management. They measured disability, they measured reduction in pain. We're going to talk about what the findings were, how relevant to your practice and conversations that you can have around research like this on today's episode. Also, I am about to hop in my car and head down to beautiful Miami Beach, Florida for Rock stock. So if you're listening to this, it is over. But make sure that you put it on your calendar for 2019 and I'm sure that I'm going to see a few listeners there. So I'm looking forward to it for sure. So this week's episode the the title of the research paper is A Comparison between Chiropractic Management and Pain Clinic Management for Chronic Low Back Pain in a National Health Service Outpatient Clinic. So again, direct comparison Chiropractic Management and Pain Clinic Management for Chronic Low Back Pain. This came out in the Journal of Alternative and complementary medicine in 2008. This was one that I thought was really, really intriguing from a title sen but also the data that it per that they found was also just really good. It's interesting, it's pragmatic and it's actually we utilize this paper for members of the Evidence Based Chiropractor. In October we highlighted it as part of the monthly research brief that they get each and every month to be able to build the bridge with people in their community. So it's a powerful piece of literature and the findings I think you are going to like for sure. Also, while I'm thinking of it, if it is easier to listen to this podcast on Spotify, we are now available there. So itunes, Stitcher, whatever the case may be, you can find it on the website theevnspacecarbager.com, but also available on Spotify. If that's something you want to check out or is easier for you, we are now available there as well. So diving into the research itself, we know studies have shown that up to 33% of people suffering from low back pain are at risk of developing chronic recurrent bouts of pain throughout their lifetime. So historically what we've seen with LBP or low back pain is it's very rarely complete remission. So there's sort of a roller coaster as I think of a yo yo effect where you know recurrent bouts of low back pain, once you have one bout, it is much more likely that you'll have recurrent bouts throughout your life. Now, not all of them need to be disabling bouts, but there is rarely a cycle of complete remission. Now, the good news of it on the other side is, is rarely is it consistently at a high pain level for a long period of time. So back pain tends to ebb and flow. That's an awkward way of saying back pain tends to ebb and flow. And when it does ebb and flow after the initial bout, there's about 33% likelihood up to 33% of people will experience recurring chronic bouts throughout their lifetime. So how does this happen? Well, there's a couple things that we can identify that certainly contribute to it, right? Degenerative changes, the effects of gravity. Big one, the lack of adequate flexibility. Our bodies love a balance of strength and flexibility, and that goes into poor core stability. But when you have either poor core stability or a lack of adequate flexibility, you're putting yourself in a tough biomechanical predicament when you start moving around and living dynamically and you topple on degenerative changes on top of that. And all of those can play a very important role in the biomechanical aspects of low back pain. And what we've seen in literature, you know, we talk about it each and every week. Chiropractic care has been well established for way over a decade at this point as part of a complete multidisciplinary approach to care. And why is that? It's because of what we offer with a variety of things, but the hallmark being chiropractic adjustment, a spinal manipulation. So we are in a very unique position as providers to impact both the structure and the function of a person's body. So when we look at the structure, you know, when you give an adjustment, the facets, gap, adhesion, synovial folds can reduce in that area. We open the intervertebral foramen. When you go through a range of motion, we get into the paraphysiological space, those vertebral foramen open up a bit. And that certainly is something that's structural right now, functional. There's mechanoreceptive input. You make an adjustment, there's a big time spike in mechanoreceptive input, which gates pain and gates nociceptive input. So all of these things we're still learning and still discovering, but we have the unique ability to touch again on the structure and the function. So that is really, in my opinion, where a lot of times we see in the literature chiropractic care just blowing away Other modalities is because we're able to touch on more than one aspect of it. And that's really what these researchers found as well. They found, quote, the results, however, still revealed that chiropractic treatment produced highly significant improvements in disability scores in this cohort compared with the treatment administered by the pain clinic during the same period of treatment. So basically, what they're saying there, man, it's so interesting how they write research studies. Sometimes I look at it and I'm like, is that good grammar? I'm not one to speak about grammar. But at any rate, they showcased decrease in disability scores with chiropractic care were highly significant and again, significant, clinically significant, statistically significant. These are words we're always on the lookout for in papers because they don't give those words away. So you really need to hit a nice threshold to be able to get those. Second, they found, quote, current theories and evidence suggest that multidisciplinary methods of treatment are most beneficial. Okay, this paper was written in 2008, and we've seen that only compounding over the last decade or so, where there is no question at this point that a multidisciplinary approach can yield the best results, touching on multiple aspects of the individual's pain, what's causing them, the dysfunction, and really addressing that through a variety of techniques typically has shown to be best. They also found, quote, this preliminary study suggests that chiropractic management appears to offer some benefit to patients suffering from chronic low back pain with an apparent biomechanical component. This benefit consists of reduction of both perceived pain and disability. So diving into that, they looked at numerical ratings, scale, they looked at an NRS pain scale, and they found, I mean, quite frankly, the lines are just divergent. The people going through chiropractic care, the line goes down. People going in a pain management office, the line stays steady, if not ticks up a bit. They're literally. It's like they start in the same pot, the same point, and then diverge as soon as treatment begins. So these are all of the reasons why I really took a look at this paper, and I think it's a powerful piece because if we think about it from a really pragmatic context, if you're reaching out to primary care physicians in your community, sports med docs, internal medicine physicians, a lot of these individuals are making a decision. A patient presents to their office with low back pain, with neck pain, some neuromusculoskeletal issue. Let's say, you know, 1% of those individuals have red flags, but 99% probably don't. And those are people that very well might be the perfect patients to come into our practices. So there's a lot there. And what we've also seen is in a primary care doctor's office, 30% of their daily volume is relative to musculoskeletal care. And with only 1% of those having red flags, thankfully, that's a lot of people that could potentially be going into your office. But quite frankly a lot of primary cares. And you guys see this, a lot of primary care doctors are making a decision to send patients to pain management if they don't respond well to a course of NSAIDS to begin with. Not only is that what we've seen to be guideline discordant, not only is it probably not really true patient centric care, but it's something that when put head to head, this is the type of research that brings us closer to where we want to be. Meaning this. There can be a lot of excuses for why you may not send to a chiropractor, but when research is published that puts us head to head with a direct other treatment option that is usually made by these primary care doctors, it starts to become a very compelling argument. Now one research paper doesn't do it all on its own. Obviously this came out a couple of years back, but it starts to add to the foundation. And when you can get this information out to those people in your community, it adds just that, that drip, that trickle, that bit of information more than they had before. Now if you start showcasing through your case notes that you're co managing with these docs that people are getting well now if you're highlighting again this type of research monthly and showcasing it to them, they're seeing that, that drip, that marketing, that consistency, your name, your logo in a professional sense. Now you're taking those rare occasions when you have the opportunity to meet them face to face to build a little bit of trust and rapport. That way you can see how case notes do one thing, they showcase co management and great results. Patient centric model, the research does another thing. It's your marketing, it's your consistency, it's keeping them updated, adding value to their day and shining a great light on your practice. And your meetings are building that face to face trust and rapport. When you can have all three of those working in concert, which as you can imagine is exactly what we teach at the evidence based chiropractor, you start to create a very, very interesting dynamic where you're touching These physicians in multiple fashions, they're seeing your name in multiple different contexts. And it starts to become a very powerful tool to stimulate those referrals, which I think we should be getting much, much more of. Because as I've touched on in the past, we've seen in the literature, 90 plus percent of primary cares are being asked about chiropractic, yet 11%, only 11% are making a formalized referral. The gap in between those two numbers is your opportunity to get out there. It's your opportunity to, to get more patients into your practice, to make a higher level of influence in your community. And ultimately, let's just talk brass tacks. Somebody that goes to their primary care doctor, takes a medication that doesn't work, gets sent for a microdiscectomy because their arm is hurting them and they have a disc pressing on the nerve and they're never experienced chiropractic care before. Going from drugs to surgery is not something that is in the patient's best interest. In lieu of red flags, these individuals, these people in our communities, they need exposure to chiropractic care. They need exposure to great docs like you. But we need to get out there and build those bridges and bridge those gaps to make sure it happens. So I hope you have a great week in practice. I hope you utilize this paper to start those conversations in your community. Of course, if you're interested in what we're doing at the Evidence Based Chiropractor and becoming a member, check us out@the evidencebasedchiropractor.com I hope you have a fantastic week in practice and I will talk to you soon. We appreciate you joining us for this episode of the Evidence Based Chiropractor. Learn more tips for explosive practice development@the evidencebasedchiropractor.com youm can also join the Premier MD monthly membership, enabling you to use what you just heard to maximize results in your office.