The Association Between Headache and Low Back Pain | Podcast Ep. 361

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today's episode, we're talking research, a relatively new study from 2019 talking about the association between headache and low back pain. This is a systematic review. It was in the Journal of Headache and and Pain. Lots of great clinical nuggets to take away and be informed about as you see patients in practice today, tomorrow and the next day. Before we get started, I want to say a few words about the smart chiropractor. It is almost 2023. If you are looking to automate in 2023, head over to the smart chiropractor.com, schedule a demo. We can help power your patient journey. That is new patients, better retention, more consistent react spending any money on paid advertising. It is what we do. And keep an eye out because over the coming weeks you're going to see some huge updates and upgrades that we've been working on all year that we are releasing. So now is the time to schedule a demo, see what's up, work with us in 2023, automate more of your practice and see more results, decrease that stress level. But as I said at the top on today's episode, we're focusing on research. This came out in 2019 in the journal of Headache and Pain. Again it is titled the association between Headache and Low Back Pain. A Systematic Review. So this is top tier. They're looking at tons of other peer reviewed journals, they're narrowing it down and saying what can we learn from this? I'm gonna drop a link down in the show notes if you wanna check it out yourself. Why is this a big deal? Well, if you take headache and low back pain, these are like literally probably make up like 80% of the reasons why people come into chiropractic practices to begin with, maybe 90%. So it is a huge deal. And the interesting part is, as they say in the title, they're really evaluating whether there's an association between the two. And sometimes, I know we are holistic providers, but sometimes, I'm gonna admit it, I see chiropractors out there getting really myopic. It's almost they're taking the clinicalness of things to the extreme where they're focusing on like practically down to a single level if possible, as opposed to really looking at the body. I always think about it the foundation, segmental, middle ground, regional motion, then whole body motion. You have to look at the neuromusculoskeletal system as a dynamic being and not Become super myopic to just, what's the pain, what's the complaint? Let me take care of that. Soon as they reach mmi, let me get them out of the practice. That's really not serving them in the best way possible. Why? Because of lifestyle. People are sitting way too much, they're not moving enough, they're stressed out, they're not eating right, you know, all of that. But, but really I see docs having a difficult time putting that meaningfully into their care plans and into practice. And that is a big, big fault and deficit of a lot of chiropractors out there. I'm just gonna call it the way it is. So I'm gonna encourage you as we talk about the association between headache and low back pain, two different ends of the body, to really think about this with your patients. Ensure that you're asking the right questions during your examination and evaluation. Ensure that, that you're going through an eval that takes into account what's going on systemically, what's going on with entire spinal motion, what's going on with entire extremity motion. How can you improve all of that? Because our bodies are such a dynamic system and it's one of those things where being out of school now and in practice probably close to 16, 17 years, it's like the more that I learn, the more I realize I don't know and how much the there is just such this dynamic interplay. So don't sleep on that. And this is a great study to sort of stimulate that and say, let me take a look. And there could be associations between things that might not seem associated. So when we talk about headaches, the most common types of headaches are migraines, tension headaches, and number three, yes, this is ridiculous that I'm saying it, medication overuse headaches. This is insanity. But yes, this is literally one of the top three reasons people have headaches. It's because they're taking medication to get rid of the top two forms of headaches. This is the world that we live in. It is why you need to get out there and tell your story and why I'm also gonna encourage you, of course, visit the evidence based chiropractor if you're trying to build referral relationships. Visit the smart chiropractor if you're looking to build better retention, more reactivations, better communication with your community. You can't do it on your own. Utilize the services, systems and processes that have helped other doctors. There's plenty of great ones out there. But man, When I see the number three reason for headaches are people taking medication for headaches and I see chiropractors out there that don't have full schedules, that is a problem. It's a communication issue to other providers, evidence based chiropractor to the public, smart chiropractor, we can help you solve those problems, but you have to take action to do so. So migraine and tension headaches feature two of the eight causes of chronic disease and injury and they affect more than 10% of the world's population. So you could break that down in your community. How many people live in your community? 50,000? 30,000 thousand? A million? If you're in a huge place, 10% of that, it could be patients of yours. Literally right now, just upon these, just upon headaches, forget about low back, forget about performance, forget about anything else. So is there opportunity out there? Yes. And if you're not full, it's a systems issue, more than likely, and a communication issue. So people with persistent low back pain and people with chronic headaches are typically managed by different clinical specialties in the medical world. So this is sort of the stark reality of what's going on in and for us this seems wild and crazy, right? Why would anybody go to two different doctors if they have a headache and they have low back pain? It is what happens. And that's the crazy part about it. You and I, as chiropractors, we do not live in the normal healthcare world. We live in an exceptional healthcare world and quite frankly, a better healthcare world. But people in your community, they do literally do not know better. So if somebody is not seeing you for both of these things, chances are, yes, they are literally going to an orthopedist for their low back issues and they are literally then going to a neurologist for their headache issue. This is how they receive subpar care. It is how they receive multiple medications, it is how they receive really no results is because everything's like split up, fractured and splintered and they're given terrible options, medications, et cetera, that caused more headaches. So yes, it seems like this is practically satire reading this study, but it is the truth. We need to be aware of that because the first step in being able to change things is being really aware of how things are today. So people with both headache disorders and low back pain, they are a neglected group because often outside of the chiropractic space, these two items are managed independently, which, yes, makes no sense, but, but is the way that it's happening around the world each and Every day, including right now in your town. So in this study, it was a systematic review. They took a look at a whole bunch of other studies. They identified over 5,000 relevant citations. And of course that number went down dramatically as I started excluding stuff. And ultimately they included 15 texts. In this review, they identified 46 studies that warranted scrutiny. And they chose 15. Said, these are the 15 we are going to go with and to really evaluate the questions of whether there's an association or not between headache and low back pain. Now, before we get into their results, I'm going to give my two cents on it, which is there probably is going to be an association. If you think about people, again, not moving well enough, being stressed out, poor ergonomics, this has the potential to play together and in a way that causes dysfunction at first and ultimately pain syndromes. We see it happen all the time. And when we know that 30% of the population is living in chronic pain, we can pretty much assume that these things are gonna play together just on the fact that, that many people are dealing with chronic pain. So if you're dealing with chronic pain in a musculoskeletal world, in terms of low back pain, chances are you gotta have a headache every now and again. That doesn't necessarily mean there's causation, but it means that there is correlation and, or association. Let's see what the research had to say. So they say overall there is a positive association in all studies with odds ratios estimating the relationship between primary headache and low back pain range from 1.55 and 8.0. So what does that mean? That means there is an association, there's no question about it. And as they cite here, treating chronic pain remains a challenge in the traditional medical system. And unfortunately, unrealistic expectations of short term pain control can lead to pharmacological over prescription. They say opioids in particular, and excess interventions including surgery or nerve blocks. And 90%, although 90% of people who consult their primary care provider for low back pain in the UK stop consulting within three months, most are still experiencing low back pain and disability one year after consultation. This suggests that those are limited in their help that they're receiving. And find another consultation or another provider. Wow, there is a lot to unpack there. None of it's particularly good, but all of it is opportunity for us. Here's what that says. It says people have really unrealistic expectations as far as short term pain control. They want to be out of pain right now, they want to be out of pain yesterday. And they want to be out of pain two minutes from now. Now what does the medical provider do? Often in that case they have the only thing that they can do which is prescribe a medication. And I just take a step back and I'm like, that's the only tool in so many of these people's tool belt. And it's not their fault. But how limited is that? It's insane we think about this scope of practice in terms of a medical provider being so wide. It's like a one trick pony for so many of these. It's like medication, medication, medication. And we know it doesn't work, we know it's dangerous, we know there's an opioid epidemic and still it is done all the time. Now if that's not done, what is done? Well, you've heard probably me rally, this is somebody I practiced within multiple multidisciplinary groups. So I've seen the inside of it. This is not speaking from a ignorant place. Surgical intervention is ridiculously overdone for elective spine surgery. Probably one tenth of it should be performed in. It is overdone and it drives an entire industry to the tune of billions of dollars per year. That is just the facts. And we see it here. It talks about excess interventions including surgery and nerve blocks. And it also, we look then here in this next sentence, 90% of people after three months aren't seeing their primary care doctor for low back pain in the UK and almost all of them are still experiencing pain a year later. So that tells the wonderful results that they're receiving when almost none of them are going back, they're taking their medication and running and then they're trying to figure out something else because they hit a dead end. And hopefully they didn't either get addicted to opioids in that process or be recommended and move towards surgery because they're in such pain and it's not the patient's fault. When you're in abject pain like that, you're looking to get out of pain. I can absolutely empathize with that. The healthcare system needs to be better, the medical doctors need to be better and they need to do better and need to look back at that Hippocratic oath of do no harm. So I don't mean to be negative on that, but I just want to give the the frank truth of what I've seen. And the chronic pain is a challenge because it can lead to a vicious cycle of changes. Psychological well being is aggravated pain, sensitization happens, worsening pain happens, they're not getting rewards, there's increased stress, there's fear, avoidance behavior. This starts to become a really, really challenging cycle. And they cite in this study that there's a genetic overlap between migraine and depressive illness. We know that there's a psychological component with low back pain. Drumroll. Here's where the association is coming into play. So a previous systematic review on low back pain has suggested that differences in gene expression could actually be implicated in the process of pain perception and signaling. And certain genetic mutations have been linked with differences in pain sensation. So it is possible that the neuromodulator CGRP is involved in the association between low back pain and muscle migraine. And this is a big deal because headache disorders, including migraine, may be associated with chronic pain disorders other than back pain as well. For example, they found people with fibromyalgia range from 18 to 36% of them had migraines as well. So there is a big time role in association between central sensitization in both disorders. And I think this spans the gamut from migraines to low back pain to fibromyalgia. And what can we do? We can encourage people that they are on the right path. We can help people with your movement based care and therapy, which is what everything recommends, which is non pharmacological, which is non invasive, which does not have any of the side effects and harms and is proven to be the best thing. We see that in the guidelines. It's just not being practiced appropriately in all of our communities around the world. So whose job is that to change it? It is. If you're listening to this, I got the answer for you. Why o u It is you and me to get out there to tell the story, to inspire people, to encourage people to give them the best advice to get well. So there's big top four clinical implications that they highlighted in the study. I'm gonna read them down. Low back pain and headache are significant causes of disability worldwide. People with both low back pain and headache disorders may constitute a neglected patient group that could have both conditions managed in combination rather than as separate entities. We identified a positive association between back pain and headache disorders and a combined approach to treating both conditions could reduce pill burden, medication overuse and provide a holistic treatment option for the two chronic pain syndromes. I wonder what that holistic treatment option could be. Well, I hate to give you a spoiler here, but in this study they did not talk about chiropractors at all, which is a shame and a missed Opportunity, for sure. But there will be more research papers to come. That is the great thing about research. It continues to roll on and the weight and momentum of research is behind who we are and what we do. We've seen those guideline changes take effect over the last few years. Now it is our job to push that into practical implementation in our communities and let people know the truth about their health, let people know the truth about healthcare and about how to make good decisions in a ridiculously complex and conflicted system. To me, that is the best thing we can do. And if you're listening to this podcast, you are an agent of change. If you're one of the 11,000, 12,000 Cairos that listen to this podcast each and every week, I wanna say thank you for tuning in. Thank you for caring about your patience. Thank you for caring about keeping up. Thank you for paying attention to my takes on things and what I have to say. My big ask for you is if you have not left a rating or review for this podcast, please, please do so. If you're on your phone, you could scroll on down, click how many stars you think this earned and or leave a kind word or two of text and that would be super, super appreciative. I do this upstairs in my office and you know, it's only when I got to events that I know anybody's listening. So feedback would be awesome. I would greatly, greatly appreciate it. And before we wrap, I'm gonna ask you also to support the people who Support this podcast. PowerStep supports this podcast. I'll ask you to support them. And what does that mean? You could pick up a free sample pair of orthotics. They're what I use, my father uses. I love them. They're developed by a podiatrist 30 years ago. Their team is awesome. You might have seen them out at some events, but you can grab a free sample pair. 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At least have a conversation with our team that does that all day, every single day. Chiromatchmakers.com Click the schedule a Call button. Schedule a Call. Drop the link down in the show notes if you're thinking about hiring in the next six to 12 months, it is never too soon to start collecting information. The more informed you are, the better decision you can make. Other than that, I hope you have a fantastic week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.