Reducing Chronic Pain Risks: The Power of Non-Pharmacological Treatments | Podcast Ep. 288

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we're back at the research and we are talking all about non pharmacological treatment of army service members with chronic pain and its potential association with fewer adverse outcomes after transitioning to to the VA or the Veterans Health Administration. So there's a lot of people out there dealing with chronic pain. Our service members are a big part of that population and exposing them, offering the opportunity for non pharmacological care is exquisitely important. We're gonna go through what the research says and how this may play a role in fewer adverse outcomes, which is always a good thing. In today's episode, before we get started, Axis Event is happening. Axis is our online clinical chiropractic summit. It is, and yes, there will be a replay. You can grab a ticket right now@axisonline event.com we have a host of fantastic speakers. This is a day devoted to improving your patient outcomes. We have Allison from Fringe speaking. We have Jason Sonners from Hyperbaric Chambers speaking. We have Dr. John Schultz, an interventional doc, speaking. Dr. Josh Satterley on clinic gem hybrids, Dr. John Rosa on opioids and his role in the administration at the highest levels of government. Dr. Kevin Christie, Dr. Lisa Thompson, Dr. Michael Longear, Dr. Tara Giroux, Dr. Sam Wang, Dr. Ren Burton and more, all at Axis. It's all happening July 10th. It's an online event and you can register for free right now@accessonline event.com and I'll drop that link down in the show notes as well. This is something we've been putting together through the smart chiropractor. You're not gonna wanna miss out on it. And, and we are super pumped and excited at what we are able to offer. So be sure to check out Axis, pick up your registration, pick up your ticket today, axisonline event.com but as I said at the top on today's episode, we're breaking down research and this study is new. It just came out in 2020. And the title, as you'll see in the episode show notes, is non pharmacological treatment of army service members with chronic pain is associated with fewer adverse outcomes after transition and to the Veterans Health Administration. So maybe this title kind of gives away some of the findings and results here, but I think it's really important to go through the specifics. So you may ask, well, how many people did they look at? Over almost 150,000 individuals. So this was a Longitudinal cohort study of active duty army service members. And it was 142,000 individuals were sort of tracked or traced for this study. So huge sample size over a long period of time from 2000, 2008 to 2014. So this is a real study, meaning it's got a lot of data and a lot of interesting pieces to it. So some of the background on this study is they found that deployment to conflict zones, you know, places an increased risk of chronic pain, which often persists after these service members leave military service. And I think we've all seen this in our practice. We've all seen, you know, veterans who are no longer in active service, who are dealing with a lot of health issues. It is not uncommon, but it is something that, because of that, because these people are, you know, really taking the mantle for our country, because these people are really putting their life on the line, this is something you really need to take a hard look at. How are we taking care of these individuals not only while they're active duty military, but also afterward as well. Now, the background on this, again is 29% to 44% of active duty service military members report chronic pain after deployment to conflict zones. And up to 60% of veterans health Administration people who are not no longer in active service report chronic pain. So this is a big deal. It's almost half of individuals that are active duty have chronic pain, and it's more than half of individuals after they get out of the military have chronic pain. So this is a really big population of people who really deserve our time and attention and clearly deserve the best care possible. Now, if we're talking about chronic pain, it might seem like, okay, chronic pain pain, we see that so often as physicians. But I really want to hone in on why this is so important. Chronic pain has been and continues to be a really well established risk factor for suicide ideation, for suicide attempts, for opioid use disorders, for overdoses with opioids. These are the risk factors. These go right along with chronic pain. So any impact we could potentially make with decreasing chronic pain stands to reason that we're gonna be making impact on some of these other really, really adverse outcomes long term. So non pharmacological treatment options have been promoted. They continue to be promoted, but the implementation of them, I'm gonna say, continues to be weak. So what do we include in non pharmacological treatments? We include things or these individuals in the study included things like exercise therapy, chiropractic care, spinal manipulation. Those were really the big ones. And Then they had what they call less common treatments, stuff like yoga, massage and acup. And they point out right from the beginning there's compelling evidence for a moderate effect on clinical outcomes for exercise and spinal manipulation for chronic low back pain. So right off the bat, we have a win. You know, this study's really staking its claim and saying, hey, it's well established and well known that there's good clinical evidence to support exercise, movement and spinal manipulation, which is the hallmark chiropractic care. And they also go further to say recent research in active duty service members showed that early pharmacological care, non pharmacological care, excuse me, was associated with a lower risk of military duty limitations in facilities where this non pharmacological care was more common were less likely to initiate long term opioid treatments. So super, super important, number one, helps people stay active. They are active duty military, they very likely, many people want to stay active. So providing non pharmacological care helps them help support them in what they're trying to do. And it helps, you know, reduce the limitations that they have, which I think is really important. And secondarily, I'm gonna say even more important is it's been shown to reduce the likelihood of long term opioid treatment. Critically important. We all have heard everything, we've talked about this on the podcast, but we've heard so much about the opioid epidemic, the devastation it's caused, over 140 deaths each and every day. And quite frankly, all the progress that had taken place in 2017, 2018, going into 2019, all, all of that was wiped out over the last year. So really with the pandemic that we've dealt with, it's really changed how all the progress that we've made on combating the opioid epidemic and a lot more to be said about that as time goes on. But non pharmacological care is key and it can be used to manage chronic pain. It can be used in addition or ideally instead of opioids. And this can have an effect not only on pain and functional status, but also because of the benefits there. It can reduce the likelihood of adverse outcomes that are associated with chronic pain and the adverse outcomes that are associated with opioid use, such as substance use disorders, drug overdoses, and even self inflicted injuries. And they say the potential long term protective effect of non pharmacological treatment against adverse outcomes has not been examined to date, which is why they dug in with this study. And I think we're all gonna be Very glad that they did. So. The median age of the individual that was in this study was 26 years. These are, let's frame this again. We just said that 50% up to 50% of active duty are dealing with chronic pain and 60% afterward. And this is not necessarily people who are in their 50s and 60s active duty. The median age of 150,000 people practically in this study was only 26 years old. That is super early to have chronic pain. And that leads to challenges when you're dealing with chronic pain this early on in life. And when you don't get those best care, best treatment strategies, best practices, you have a long life ahead of you. And if that chronic pain compounds and we see this with medication, the sensitization over time where more medication yields less benefit in terms of just straight pain relief. Now you're increasing medication, now you're jumping medications, now you're doubling up on medications. We've all seen this in our practices. We all probably know people in our family, extended family that have gone through these things. It's a big deal. And statistics showed that 26,000 9.5% of active duty service members with chronic pain received non pharmacological therapy before they were diagnosed with chronic pain. So again, I think that 10% receiving that non pharmacological. There's a long way to go, especially in light of the benefits that are showcased in this study. So they say it's well known that ICD codes are for suicide ideation. Suicide attempts and other self inflicted injuries are underreported as well. So for all the what we hear about this, it's still underreported overall and that's scary. Now what did they find with this study? I want to break in a little bit on how many people received each modality. Exercise, physical therapy, chiropractic. But the take home message on this study and really where the researchers found the benefit they found, quote, our results suggest that non pharmacological care provided to active duty service members with chronic pain may reduce their odds of long term adverse outcomes. Given known associations of these adverse outcomes with morbidity and mortality, providing non pharmacological care to service members with chronic pain could potentially save lives. Our results provide further support for the role of non pharmacological care as a risk mitigation strategy when long term opioid therapy is initiated, which is only briefly mentioned in the clinical practice guideline for opioid therapy for chronic pain. So wow, talk about a lot to dive into right there. I mean they literally are putting it out there in black and white, so to speak, that this has the potential to save lives. And again, I think this is really important for us as providers to frame appropriately in our minds and understand really the impact that we can make as we get out there with our hands. As we get out there providing the care that doesn't require the medications. The need for this is probably greater than you and I imagine. And I'm going to say the impact we can make is definitively greater than you and I can imagine. Because even though we see patients, we feel like we know what they're going through. I'm going to say if you take care of enough of these individuals, there's going to be some that might have been really teetering, may have been on the border of really making a life altering decision that if you're out there providing the care, if you're able to help them function at a higher level, if you're able to reduce their pain, if they're able to improve their quality of life and avoid a lot of these medications, man, you can truly save a life. And it's not just that individual's life, it's everybody around that individual, as we know, that can be impacted. So I want you to take this to heart. It's a little bit of a heavy study, I realize that. But it's really important to understand the impact that we can all make and especially when we're taking care of those individuals with chronic pain, whether they're a service member or whether they're somebody who's been dealing with chronic pain for another reason, all things hold true, which is chronic pain treated with medication, you're in quicksand. It's an uphill battle at best, and most of the time you're sliding downhill. And when you're able to get in there with non pharmacological care, which is guideline recommended, which papers like this support, and you're able to change a life. Man, what higher calling can we have as doctors and physicians? So if we look at what was done with these individuals, what sort of care they received, here's some of the rates which I think are interesting. In closing, 100,000 people received exercise therapy, right? We talked about 150,000, 142,000 in this study, 100,000 did receive exercise therapy. So that's a great move in the right direction. Other physical therapy was about 40,000 individuals. Chiropractic care came up third with 27,000 individuals. And then it goes down from there. So a couple things that I Take, you know, to with this and kind of keep in mind, yeah, a lot of people received exercise therapy, which is good, although somewhat undefined. In this study, other physical therapy was about 38,000. If we combined exercise and other physical therapy, that's a good chunk of the individuals that were in this study received those two modalities. But only 27,000 received the offering or did receive chiropractic care throughout those years. And that's a missed opportunity. I know the VA system has evolved, they've changed, they've added on chiropractors, but man, even those docs I hear and talk to in the system, there is a backlog, there is a backup and there is such a tremendous need and opportunity. So you know, keep on getting out there, keep on telling your story as a chiropractor. Look for those opportunities in your town, in your community where you can help because the help is needed. You could very well change lives and man, reducing these long term adverse outcomes. I don't think there's anything more important than that besides the day to day improvements in quality of life, in reduction in pain and improvement of function that you can offer. So thanks for being a chiropractor. Thank you for listening. If you are looking for chiropractic office coverage, I'm going to encourage you to see us at chiro matchmakers@chiromatchmakers.com if you're taking time out of the office and shutting down your clinic and shutting down your practice, you are missing out on an opportunity to help people and to generate revenue for your practice. You need to use a locum doc, you need to use a coverage doc. We can help you with that. And if you're listening to this and you're saying, man, I might want to be a locum or a coverage doc, I'm looking for my next career opportunity. Visit us@chiromatchmakers.com we have over 100 open permanent jobs and we have tons of opportunities to provide coverage as well@chiromatchmakers.com so have a fantastic week in practice. Be sure to sign up for access online clinical events to improve your patient outcomes. That's happening July 10th and yes, there will be a replay. Have a fantastic week in practice and I will talk to you soon.

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