Quality of Life Improvements in Chronic Pain: Chiropractic Care's Impact | Podcast Ep. 234

Foreign welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmay. Thank you for tuning in this week. We have a great piece of research that we are going to review. It came out just last year in 2019 in Spine, one of the top journals in the world and it is titled Group and Individual Level Change on Health Related Quality of Life in Chiropractic Patients with Chronic Low Back and Neck Pain. We're gonna dive into this. This is a really cool study that has some big takeaways that I know you'll be able to utilize with the conversations and communications that you're having in your practice. Before we get started, I am going to have a big ask of you listening to this podcast. Please give us a rating or a feedback or however you want to define that within itunes. If you're listening to this on your mobile device then you can just scroll down and hit the button right there. Super easy to do. It helps more and more docs find out about this podcast. So if you've been enjoying it I would love to have a review and or any feedback whatsoever from you. You can do that directly on your phone if you're listening there. Additionally, be sure to check out the Smart Chiropractor Facebook group that's been where I've been hanging out a lot. We've been diving into a bunch of really cool topics around marketing so you can just search the Smart Chiropractor and there is a Facebook group I would be happy to connect with you in there. Breakdown Marketing. We're doing sort of a bunch of different polls, video trainings, you name it, it's all available in there. So head over if you haven't. I would love to see you in that group. But as I talked about at the top today we are breaking down a really cool piece of research titled Group and Individual Level Change on Health Related Quality of Life in Chiropractic Patients with Chronic Low Back and Neck pain. So of course we are looking at a patient population that has chronic low back and or neck pain. Typically that says more than three months duration and a little bit of latitude with that. But when we're talking about chronic just that's kind of to framework things out. And also this is a really interesting study, right? I mentioned earlier that it was published in Spine, yet it's really specifically chiropractic patients with chronic low back or neck pain. So this is cool. There's not a ton of studies that really focus on specifically chiropractic patients by name. So that's really interesting. And additionally, as we dive into the title, group and individual level change on health related quality of life. Quality of life. Now, it's hard to say that you can have a high, this is a little bit subjective, but it's hard to say that you have a unbelievably high quality of life if you are living in chronic pain. Right? So part of having an improvement in quality of life certainly can be in many instances pain reduction, but it also takes on a broader classification. And that's where things start to get really, really interesting when we examine how people under chiropractic care find the benefit. Right, because pain relief is a part of it, but it's not the whole pie. So let's take a look at what some of the data says, what some of this research says, some quotes, we can break it down, make it actionable for you in your practice. So the goal of this study was really to evaluate group level and individual level change in health related quality of life among people with chronic low back and neck pain receiving chiropractic care in the United States. This was a US focused study. Now the researchers, basically, I'll kind of give you the preemptive spoiler alert here. They found that chiropractic care was associated with a significant improvement in health related quality of life over time, especially in pain. Now how did they get to that conclusion? Let's talk about that. Bottom line is we all know this, we talk about it. Nearly every single paper starts out with it. But musculoskeletal, neuromusculoskeletal disorders are some of the most prevalent health problems in the world. And they're either the leading or the second leading cause of disability. Low back pain itself. Prevalence in the United States around 20%. And estimated cost in 2010, almost a decade ago was 30 billion. I don't even want to guess how much that is at this point in time. I would say that that's accelerated dramatically over the last 10 years. It could be $100 billion at this point. But really the take home message, there is 20% prevalence. I've seen it anywhere between 20 to 30%. And when we talk prevalence, you have to remember that is essentially analyzing how many people at this moment in time amongst a certain population have the condition. So 20 to 30% of people in the United States, in this case adults in the United States, have low back pain at any given point in time. Right now. Right now. Right. You can, any given point in time, 20 to 30% of people. Now this is an interesting part of this study, you know, this is, this gets a little. I'm not sure, but they report that more than 50% of U.S. adults have sought chiropractic care for. From a chiropractor. Sought care from a chiropractor, excuse me. And about 30% of those with spinal pain in the US have utilized chiropractic care. That is a little incongruent when I've seen utilization rates at 15%, 10%. But again, this is when we talk about utilization, when they talk about adults having sought care, those percentages can go up and down dramatically depending upon how the criteria is built and, and what exact population they're looking at. But the good news is this certainly showcases that a lot of people are at least open to chiropractic care. Now in this paper, they basically looked at a three month change in the PROMIS profile measure. So what does this do? P R O M I S. This was the technique that they used to analyze the data and it measures or assesses pain intensity and seven health domains functioning. Fatigue, pain interference, depressive symptoms, anxiety, the ability to participate in social roles and activities, and sleep disturbances, utilizing four items in each of those domains. So that's sort of the study tool that they looked at. And what they ultimately discovered was that chiropractic care was associated with significant improvements on all PROMIS measures except emotional distress in this sample of patients with chronic low back pain or neck pain. So that's really, really crazy. That's awesome. So significant improvements across all PROMIS measures except for emotional distress. And if we kind of re back things up, what does that include? That includes significant improvements in physical functioning. That would include significant improvements in fatigue, in pain, interference in anxiety, in their ability to participate in social activities in sleep. That is really, really great. And icing on the cake is of course a significant decrease in pain. So that starts to become really, really compelling. Because as we think about this from a conversation perspective, it's all about tying what's going on with that patient to the life effect. That is what people will live in pain. But when they start seeing a decrease in their ability to do the things they want to do, AKA what we might call the life effect, that's when they start to take action. We see it all the time. Right? You talk to a patient, how long has it been going on? Years. Well, what precipitated? Well, when I went out, I couldn't really play golf with my friends. I couldn't pick up my grandchild. Those classic examples that are true, people will live in Pain, but it's when the pain starts to affect their quality of life, which is why this study's so cool. That's when things start to take a different, you know, go to a different level. So if your messaging and communication can proactively address those life effects now you start to have a really compelling value proposition. You start to answer the question in their mind, is this chiropractor right for me? Is this doctor right for me? If you are putting out content consistently that answers that question preemptively for them, and they're and you are in their sphere of influence or vice versa, then you have a great opportunity. You don't need to compete with, like, discount ads. You don't need to do any of that. You can build the no trust and like factor by answering their question preemptively, by leading you to be yourself. The obvious choice, by showcasing the quality of life benefits and life effect benefits that your patients are getting. So in this study, pulling it back to the research, they found the largest mean improvements were observed for pain and sleep disturbance. That's really cool. And pain, obviously you have to get rid of that or at least minimize that in order to have a high quality life for many people. Everything kind of stems from that in many cases. Second aspect is sleep, right? If you have crazy disturbances in your sleep, that's rest and recovery, recovery being key, you're not gonna be able to recover very well. And we've seen sleep disturbance, the intersection of sleep disturbance and pain, it can span the gamut. Those rhythms ultimately affect how our nervous system functions. We've seen that shown in the literature time and time again, so very, very important from that perspective. And, and finally, the researchers have found, quote, we used the coefficient of repeatability in the study to show that for the scales that showed statistically significant mean improvement from 13% to 30% could be classified as responders. So kind of taking that, putting that back into context, you know, they said, well, how do we determine who really responded to this care outside of, let's say, clinical significance on benefit? If we're thinking about this in terms of sort of previous research that we've looked at maintenance care, et cetera, that says, hey, if you responded well, what does respond well mean? And they're saying that from 13% physical functioning to 30% could be classified as responders. So that's, you know, that's very realistic to see improvements of 13 to 30% in many of your patients, many of us, you know, or our patients outperform that dramatically. So important to Keep in mind, also speaking with a doctor the other day, a chiropractor on the phone, and you know, we were just talking about, you know, how in many cases, you know, chiropractors, I think we are so hard on ourselves. We're like, gosh, if we don't get like 80 or 90% improvement, oh boy, did I do a good enough job. Can I share many surgical surgeries and surgeons that I talk to, if they have like a 30% improvement, they're jazzed, like they are psyched, they feel like it, quote, unquote worked. And chiropractors, I feel like sometimes if we get like 50% improvement, we're sort of hard on ourselves or, gosh, do we want, do I want to share that? I don't know. I don't know if that's enough improvement for a majority of our patients. We are getting improvement that is far better than they can get in other places and far less dangerous, the treatment, far less risky in terms of what they go through. Right. Chiropractic, unbelievably safe, unbelievably effective. But we sometimes have to see those stats to remember that. So these researchers found their conclusions were the results of this study contribute to literature by providing evidence that chiropractic care is associated with improvements in functioning and well being among individuals with chronic low back or neck pain. The study findings provide empirical verification of why some chronic pain patients utilize chiropractic care on a regular basis. It supports the use of chiropractic care as one option for improving functioning and well being of patients with chronic low back or neck pain. That's powerful. When you see that type of quote come from spine, that is something that you can and should lean into in your practice. The final quote that I'll bring out is they found quote, spinal manipulation is designed to relieve pain and improve physical functioning. Studies of the biomechanics indicate that spinal manipulation produces reflex responses and movements of vertebral bodies in the paraphysiological zone. So those are things that will probably are not new to you, but just more emphasis to get out there, have positive conversations. We talked about the updates on maintenance care just a week or two ago on this podcast and a lot of this research, again, research. All these papers try to answer one specific question. It's when you look at it in the totality that you start to see trends. You start to see how these things mix together. You start to see how one paper references another. Hopefully you're getting that data and that information by tuning into this podcast each and every week. And if you are, I'm gonna ask one more time. Head over and give us some ratings and or feedback on itunes. That helps more and more docs. Find out about it. But have a great week in practice. Stay safe out there and I will talk to you soon.

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