The Link Between Urinary TNF and Low Back Pain Relief | Podcast Ep. 397

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we have more research and it is an awesome study that is brand new and it's all around low back pain. How well it identifies, are there biomarkers and or are there predictive ways that we can analyze whether somebody is or is likely to struggle with low back pain? That's what this study is all about. It's exciting, it's brand new. We're gonna break it down and highlight some of the clinical pearls gems and where this might be the start of a lot of new research in the future. That and more on today's episode. Before we get started, I'll say a few words about the smart chiropractor. The smart chiropractor. Send emails, get reactivations. That is what we do with a 3x ROI guarantee. So if you have an email list that you are not touching, so to speak, that you're not messaging with consistency, you're probably ghosting your patients and you're leaving a lot of reactivations on the table. We can automate the entire process for you and help you generate fantastic results. Schedule a demo@thesmartchiropractor.com Again that is thesmartchiropractor.com but as I said at the top on today's episode, we're talking research. The title of this study is Urinary TNF Tumor necrosis factor as a potential biological biomarker for chronic primary low back pain. This is hot off the press. It is brand new and I will drop a link down to this study in the show. Notes, how big of a deal is low back pain? Well, we talk about it all the time. It is a really big deal. And it's estimated that over half a billion people will suffer from low back pain at any point in time. That means there are a lot of people in your town, in your community, in your city, in your state, state, in your region and in your country that are dealing with low back pain right now. Additionally, we know that 1 to 2/3 of people seeking care for acute low back pain will eventually experience recurrent or persistent symptoms. And we've talked about this transition from acute to chronic pain in the past. And quite frankly, how when I look on the outside in, it looks like a lot of times traditional interventions almost facilitate, literally facilitate that transition from acute to low back pain. That is why who we are as chiropractors, what we do with movement based care is so important because when we are able to slow down, stop or reverse acute back pain. It never gets chronic, which is absolutely critical. This study, they looked at patients and these patients were recruited for a treatment session 24 to 48 hours after the initial examination. Now, interestingly, even though it doesn't say it in the title, this actually ties directly in because all of these patients were adjusted twice a week for a total of four weeks. That was sort of the treatment modality, so to speak. So let me highlight the patient group with. We'll highlight the control group, then we'll get into some of the exciting results. So the patient group, on their first visit, there was a recruitment session. They did a case history and a physical exam and they did baseline clinical outcomes. About 24 hours later, they did a baseline urine sample. And that's when treatment began. The treatment protocol, as we just highlighted four weeks, which were eight sessions of chiropractic adjustment, spinal inhibitive therapy. 24 hours after that last session, they had a follow up in which they had a second urine sample, clinical outcomes, and the treatment concluded. And then there was data analysis. Now, on the other side of the coin was the control group. The control group was pain free. So this was pain free, people feeling great. First visit, pain free recruitment. 24 hours later, they did a urine sample. There was no treatment, of course, but four weeks elapsed, they let the same amount of time elapse. At the end of that, 24 hours later, they did a secondary urine sample and then they did a data analysis. So that is how this was put together. And 39 patients were recruited, 24 met the selection criteria and were ultimately included in this study. Now, sidebar, 14 of these patients had comorbid conditions. That wasn't surprising to me, but here's what they listed as the comorbidities. Some which were obvious and some which were actually pretty surprising. Cardiovascular disease, neck pain, depression, full spine pain, headaches, diabetes, anxiety, carpal tunnel syndrome and plantar fasciitis, of all things. So those were described as comorbidities in this study. I hadn't thought of quite a few of those as comorbidities when taking care of people with low back pain. So that was interesting to me and I wanted to highlight it to you as well. And it makes sense in people that have more than one area of challenge or complaint. I'm probably going to oversimplify this a little bit, but here's how I think about it. For individuals that are coming into your practice and they have, of course, cardiovascular disease is a comorbidity but let's say they have low back pain and neck pain. They have low back pain and anxiety, plantar fasciitis, carpal tunnel syndrome, even. These are factors that might, I'm going to say, challenge their ability to get well because they have more than. Is there something larger going on? Are these two totally separate injuries or are they combined? Is this an indication that of either how this person moves or lives? The answer's probably yes most of the time, but I never really thought about it through that lens until I saw them listed here as comorbidities. Now let's get into some of the discussion on the findings because this is where things get really, really interesting. This study corroborated previous research that elevated TNF in both serum and urine samples of patients with chronic low back pain is happening. Furthermore, for the patients in this study, not the control, urine concentrations of this cytokine TNF treatment necrosis factor were reduced after spinal manipulative therapy compared to values in the matched pain free controls. So I'll highlight that a separate way. After an adjustment, pro inflammatory cytokines D decreased. That is what they found in this study. That should make you really excited if you're a chiropractor listening to this. So in the absence of inflammation, both serum and urinary levels of TNF were just about zero. There was minimum fluctuations, but they were pretty much zero. But the baseline values differed significantly among patients with different pain trajectories. This is where things also get interesting, specifically with those that had ongoing pain as they defined it, quote, unquote ongoing pain versus quote unquote episodic pain. And patients were characterized as ongoing. Those people had higher urinary levels of tumor necrosis factor than patients with fluctuating or episodic pain. How much of a difference? 6.6 in ongoing pain to 2.7 in fluctuating. Nearly double the amount, so to speak, of tumor necrosis factor. Now, people with episodic chronic low back pain had undetectable levels of of this cytokine and that means they were basically the same as healthy individuals. So people had episodic chronic low back pain. All of this tumor necrosis factor was pretty much zero. They were just about the same as somebody that had no pain whatsoever. What does this say? Well, it certainly seems like there's different mechanisms under each pain trajectory. So if you had acute pain that was fluctuating, you had a good amount of tumor necrosis factor going on. If you had acute pain that was ongoing, not yet chronic. They talk about thin lines here. That was a very high tumor necrosis factor. And if you had episodic chronic low back pain, you were just about the same from a TNF perspective as somebody who had no pain at all. Really interesting. So in general, higher levels of TNF are linked to more severe chronic low back pain, restricted radicular pain and disability. Now, the findings of this study were similar and compatible with urinary TNF being a biomarker to assess clinical recovery for chronic low back pain patients. Why? Because if it was super high and then you were able to deliver an adjustment, a manipulation, and you saw it drop down substantially, those individuals were very likely to see the significant recovery. However, if you had a lot of pain, you had no tumor necrosis factor because of the trajectory of your pain. There wasn't much. If you want to think about it this way, room for an adjustment to make difference, Right? If you're already at zero, how much lower can you go? Tumorous necrosis factor. Not much. So that is really, really interesting. Now, can an adjustment through the mechanism of action do a lot more than influence tumor necrosis factor from a urinary sample? Absolutely. This only touches a small fraction, but it touches an importantly small fraction. Why? Because a lot of people have low back pain. Two, analyzing urine samples is not particularly complex or challenging. Now we probably don't do that every day in our practices, but that doesn't mean that it's not relatively available and pretty darn affordable. And the other component is, the third component which really ties it together is we see that what we do with an adjustment really can make a substantial impact in the amount of TNF in a urinary sample. And that correlates to a clinical recovery pattern that is absolutely powerful. I've never seen, they highlight some previous research, but I've never seen it put together in this fashion. And I think it's a really, really. I highlighted this at the beginning. This is where research may go in the future. I can guarantee you there's going to be follow up studies on the data in this study. And I think that that's fantastic because anytime that we have the opportunity to better understand how we can, I like to say predictive analytics, how we can look at a piece of data, how we can look at whether it's a movement assessment, whether it's a blood marker, whether it's a urinary marker, whatever it might be, whether it's through motion and hands on, whether it's through a JTAC device and we're looking at motion, whatever it might be, Anytime that we can better identify who is more likely to see substantial gains in results with their care. I think that that's fantastic. That doesn't mean if you're less likely to give up on them, by the way, just as an aside, but it means, man, we can really start to identify who are those individuals that are going to get an awesome result with, with what we do. And how can we speak into that? That doesn't mean we ignore the people that might be less likely, but it means we can really speak into and really set the expectations from the get go with a high amount of certainty for those individuals that we think are gonna respond very well. So some of what they found in this study was quote, higher baseline TNF was associated with better clinical recovery, suggesting that SMT spinal manipulative therapy may be more effective for a subgroup of patients with elevated TNF levels. This is congruent with literature suggesting that SMT may act by modulating mechanisms related to central sensitization. This is also an important factor is the different types of pain. There's neuropathic pain, there's central sensitization, there are different types of pain. And this has been really, really difficult to discriminate between those pain mechanisms. Predominantly these three. Nociceptive pain, neuropathic pain, and central sensitization pain. There's no consensus clinically being able to discriminate between those pain mechanisms. But it is really nice when we can see that for people that have central sensitization that are going to more likely than not have high TNF when they have pain, the act of what we do can make a significant impact in that. And I love that for a variety of different reasons talk about impacting the central nervous system. We're literally talking about central sensitization. So when we can impact from the outside in with our hands, we're putting our hands on somebody delivering an adjustment and we're literally impacting biomarkers in their blood and urine that are relative to decreasing inflammation, decreasing pain and helping them improve. How powerful is that medications hope to achieve these sort of influences? And that's directly taken with direct chemical interaction with the acts and the adjustments that we are able to perform with our hands, we are able to make that big of influence on individuals. Now we see it, and I know many people get bored in the conversation of back pain because it's like, yeah, back pain, back pain, back. And we do so much more than that. We do, but do not sleep on the fact that there are half a billion people out there today, tomorrow, the next day, the next day struggling with low back pain. And the more that we can accurately describe how we help people doesn't mean everybody's gonna wanna hear about TNF factors and urinary biomarkers by any stretch of the imagination. Most people won't. But wow, it just informs our ability to show up with confidence, with clarity, with certainty, and the ability, when asked, to really drill in and describe the benefits of the care that we're providing. And for that, I absolutely love this study. Again, I'll drop the link down in the show notes if you want to check it out. And before we wrap up, I want to say a few words about orthotics and specifically power step orthotics. This is what I use. They're what I personally recommend. They support this podcast. You should support them and they will hook you up with a free sample pair pro.powerstep.com sample use the code EBC I'll drop the link below pro.powerstep.com sample Use the code EBC and they will hook you up with a free sample pair of their orthotics. And finally they'll if you are thinking about building and growing your team this year, whether it's hiring a virtual chiropractic assistant, virtual CA A in Office CA or an associate chiropractor, do not go it alone. This is the most important decision you will make for the growth of your business. Getting this right can dramatically accelerate your ability to hit your financial goals, giving you more time, freedom, giving you more revenue. Getting this wrong will set you back back. Team turnover is one of the biggest killers. So if you are thinking about building and growing your team, have a conversation with kyro matchmakers kairo matchmakers.com Again that is kairomatchmakers.com I'll drop that link down in the show notes Their team can help answer questions, guide and direct you. And if you'd like the whole process done to make your life a heck of a lot easier, we are happy to do it for you@cairo matchmakers.com Other than that, thank you for being a chiropractor. Thank you for tuning into this podcast. Leave a rating or review if you have not. Have a fantastic week in practice and I will talk to you soon.

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