Chiropractic Tied to Less Adverse Drug Events | Podcast 141

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are looking at a brand new study from JMPT titled association between utilization of Chiropractic services for the treatment of Low Back pain and risk of adverse drug events. With all of the talk regarding prescription medications, pain meds, opioids, this is an episode you do not want to miss. But before we get started, if you have not picked up your tickets for Rock Stock 2018, be sure to do so. It is coming up. It is the weekend of October 27th and 28th. It is going to be held in Miami, Florida. It's an awesome event. If you saw my recap from last year's, you know you want to be there for sure. So any questions regarding that, feel free to reach out to myself or check them out@rocktape.com it is going to be an event you do not want to miss and I will certainly be there. So as we said at the top, this week is about the association between the utilization of chiropractic and risk of adverse drug events. So over the last few years we have seen just a tremendous shift in the guidelines for treating spine pain, right? We've seen the American Geriatric Society, we've seen the Institute of Medicine, we've seen the American College of Physicians, the American American Pain Society even have all recommended what now would be considered a progressive evidence based, non pharmacologic approach to care, which is a distinctly different tract than anything that's been highlighted in the past. And for instance, just this week I posted an article on Harvard Health that also was emphasizing spinal manipulation, AKA an adjustment, the hallmark of what we do as one of the best options out there. And really saying, hey, this is at least as good as NSAIDs, if not better. But we'll get to that in a few moments. So what this research paper did is they looked and looked at the drug classes that are typically prescribed for low back pain, right? Your acetaminophens, your NSAIDs, and even I hate to say it, but you know, they're still prescribed from time to time opioids for spine related complaints. And of course all of those medications have an unbelievably high correlation with adverse drug events, right? We look at acetaminophen, NSAIDS and opioids. Opioids, tens of thousands of Deaths per year, NSAIDs, over 100,000 hospitalizations per year due to NSAIDs, the gastric issues typically associated with that. And acetaminophen has its own issues as well. So this is a class of drugs that while being prescribed, let's say for low back pain, for spine related complaints, typically results in side effects that drive people either to the er, to another doctor's visit, or unfortunately in some cases to death. So what this paper found was, you know, there was no causal relationship between chiropractic utilization and risk of an adverse drug event. The findings showcased a really a stunning reduction for those patients who had received chiropractic care within the previous 12 months. So it was anybody who'd received chiropractic care within the last 12 months, it was 51% less likely to have an adverse drug event. Well, you can see that there can't be a causation with that. But kind of the correlation or the association is, well, those who experience chiropractic care aren't taking care of those meds as often. So certainly there is a decrease, 51%, which is quite staggering, especially when we look at numbers. Adverse drug events that are in the hundreds of thousands per year. When you cut that in half, that is a significant life impact on a lot hundreds of thousands in this case of people, which is something that all of us should take very, very seriously. And when we go through with all of our members of the evidence based chiropractor training on MD meetings, we kind of talk through the process of a lot of medical doct. When you ask them what they're doing for their patients with spinal musculoskeletal complaints, they come back with one of three answers 99% of the time. And these aren't shocking physical therapy medications or referral to another specialist. So this paper highlights one of those aspects very, very distinctly when it's talking about the medications commonly associated. We talk through this all the time at the evidence based chiropractor and it's actually why we use this study as our August research brief. So if you want to check that out, visit us at the evidence based Chiropractor. But here a few important quotes from this paper that I think really frame and drive the message home. The researchers found, quote, many patients who are prescribed analgesic medications have low back pain. Among U.S. adults prescribed opioids, 59% have reported having back pain. That's pretty staggering. So if you took everybody that's taking opioids, over half of those individuals, 59% of them have had back pain. So that is a very high association. Consequently, the researchers also found chiropractic care of low back pain is both safe and effective. A recent systematic review and Meta analysis found that for a treatment of acute low back pain, spinal manipulation as performed by chiropractors provides a clinical benefit equivalent to that of NSAIDs with no evidence of serious harms. End quote. Lot to dive into on that quote. First they're just making a statement chiropractic care is safe and effective. And again this just adds to that research. Multitudes of papers now that's kind of a given at this point. So then they're looking at it and they're saying, hey, these adjustments a spinal manipulation is just as effective as an NSAID with none of the serious harms associated with that. Again, this is staggering. We're talking about NSAIDs being taken probably to the tune of hundreds of millions of times per year. That's an unbelievable stat to think about an adjustment being able to provide at least as much relief with none of that ancillary serious harm. This is important information that we need to get out to our community members and certainly when bridging the gap with other healthcare providers in our community. Finally, they found, quote, the adjusted likelihood of an adverse drug event occurring in an outpatient setting within 12 months was 51% lower amongst recipients of chiropractic services as compared to non recipients. And that tells the story right there. So within a 12 month time frame it was more, you were more than half as less likely. Wow, that was bad English. But you get what I'm saying. You're 51% less likely to have an adverse drug event if you had received chiropractic care in the last 12 months than if you had not. So all of this adds up to a paper and this paper also of course will be linked in the show notes if you want to click over to it on PubMed. But this is a paper that I knew we had to fast track for all of our members of the evidence based chiropractor because it's so congruent with the messaging, in my opinion that needs to go out to the other healthcare providers in our communities when we talk about bridging the gap with medical doctors and other healthcare professionals, specifically in the primary care setting. It's not that, in my opinion, it's not that they want to give more medication, it's that they just don't know what else to do. Their tools and resources are exceptionally limited and quite frankly they have absolutely, absolutely no concept about chiropractic care. They've resigned themselves to myth and conjecture. Maybe what they see online or heard somewhere, that's a big problem, but it's more of a Problem for the patients that they're treating and giving these medications to with harms that 100,000 people, NSAID going to the hospital, thousands of deaths per year, opioids, tens of thousands of deaths per year. These are big issues for the people in our community. And this is why I always really harp on the fact that the onus is on us as the leaders in conservative health care, as people who want to make a difference in our community to get out there and bridge the gap with these doctors and open their eyes to what we do. Many primary care doctors aren't going to see this paper, but when you can showcase it and frame it in a light that's easy for them to read, where there's consistency and follow up, where you're sending your case notes, where you're taking a meeting with them, it doesn't need to be expensive, it doesn't need to be challenging, you don't need to be overly extroverted. You just need to have a system and a process and to get this information out to those other physicians in your community. And as we've seen time and time again, the research just continues to add on to supporting what we do, supporting chiropractic care, supporting adjustments, and really supporting a progressive evidence based model of taking care of people with spine related complaints. And believe me, I strongly know that chiropractic care is very applicable for much more than low back pain. But if we break down just the serious facts of what's going on, 90% of individuals are experiencing low back pain in their life and 15% tops are utilizing chiropractic care. Maybe 1% of those people have red flags, but we have a lot of work to make up strictly on the back pain front before we dive into other things that we may be able to help with. And 20 years ago, I've said it before, but 20 years ago the literature like this out there supported just was not there. But we have the privilege of literally every single week practically seeing more and more papers coming out. But if those papers just go to PubMed and get dusty, it quite frankly does no good for us. Sharing this content online from the evidence based Chiropractor page would be fantastic or from another page is also great. Sharing this information online is fantastic. Getting it out to your community is awesome. That's what we do at the Smart Chiropractor. If you want social media content that's evidence, informed and evidence, check out the smartchiropractor.com or certainly if you want to bridge the gap and build relationships with other healthcare providers. Check out the evidence basedchiropractor.com I really appreciate everybody that's listened. We are still maintaining over nearly 11,000 listens per week, which is staggering. So thank you a ton. If you have a moment and want to leave some feedback or a review on itunes, that would be awesome. It helps more people find us. And if you have anything that you want me to address in the future, just shoot me a message. Jeff the Evidence Based Chiropractor I have some interviews in the can that are going to be coming up that are awesome. A couple topics that I have in mind, but if there's anything you want to hear about or think is important, don't hesitate to let me know. I hope you have a great week in practice and I will talk to you soon.

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