The Perils of Getting Rid of Back Pain | Podcast Ep. 48

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmead. Happy Halloween out there. This should be being released on Halloween morning. So if you haven't gone trick or treating yet, have a good time and if you have subscribed, don't eat too much candy. But today we are not going to talk about sweets or diet or candy. What we are going to talk about is a very important study that came out from the spine journal in 2015 and it's going to tie together a piece of research that we had touched on earlier which talks about maintained chiropractic care or the journal article from Spine that supported the maintained use of spinal manipulation or chiropractic care for patients. And, and the study we're gonna talk about today is sort of the foundational component for where they went with those thoughts. The title of the study we're gonna touch on today, it is called Patients with Low Back Pain had a distinct clinical course pattern that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data. And this came out from a spine journal in 2015. And contrary to a title which sounds un, unbelievably boring, this study is exciting from a chiropractic perspective. And I'm gonna repeat the title one more time. You can find it in the show notes but I wanna make sure we get to every bit of that title. It is titled Patients with Low Back Pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A latent class analysis of longitudinal data. The spine journal in 2020 15. So every day in practice, and here's why, here's the application of this study and sort of what we touched on at the top of our episode today. Every day in practice we see patients who have come in before they've gone by the wayside, we haven't seen them. Whether that's a few weeks, a few months, sometimes even a few years and lo and behold they come back into our practice looking for care because something has cropped up more often than not it, it's the same thing they were dealing with before that has come back to bite them again. So repeat consultations for spine related complaints are common. They're common in chiropractic office, they're common in everybody's office. And at first this may seem like the initial treatment was not effective. So in a clinical research perspective it's important because sometimes we'll look at the longitudinal data of a patient that received a treatment choice or a treatment option, and that patient will be interviewed at one week, at six weeks, perhaps at six months or a year. And if the patient reports that their complaint or pain has come back and gotten at them again, sometimes that could be an indication that the treatment perhaps wasn't too effective, it wasn't permanent. Now, the challenge is in the real world, we know that many of the disease processes many of the challenges, complaints that a patient deals with specifically spine related. It's a process, it takes time. And even during care, never mind after discharge from active care, the patient's still under the weight of gravity, they are still going through micro traumas, they're staying active and there's propensity for injury as time goes on. And that really is what is shown in this study to be the true natural course. So let's talk about a few quotes from found in this study that frame a little bit more specifically what I'm getting at. The researchers found, however, most models identified a subgroup characterized by slow improvement, that is a gradual reduction in low back pain severity in days that occurred over approximately six months. I'll repeat that one more time. However, most models identified a subgroup characterized by slow improvement, that is a gradual reduction in low back pain severity and days that occurred over approximately six months. The researchers also found, in conclusion, the clinical course of low back pain is complex. Over a one year follow up period, most patients did not become pain free for a sustained period. But at the other end of the spectrum, only a small proportion were reported persistent severe pain. And finally, the researchers found, quote, the current implication for clinicians and researchers is to be aware that most low back pain does not simply go away. So all three of those quotes give a really great foundation to what we touched on at the top, which is patients that have spine related complaints, patients that have low back pain, they come in and out of our office. There's plenty of patients that we see that stay in our office. But many patients that come and go from time to time and the fact that they come back does not have any inkling or any indication that the care we gave was ineffective. It's a natural part of the process. Now, an unnatural part of the process is if a patient comes in in severe pain, receives no relief and continues on in severe pain, that is statistically unlikely. And, and it's an indication that something might be drastically askew. Of course, from a clinical perspective during our reevaluation, that's when we would identify it and refer the patient to the appropriate provider or obtain perhaps an MRI or additional imaging. But the typical progression is that there's ebbs and flows of a patient's recovery during their treatment, especially relative to low back pain. This is important for two reasons. We're going to make a fork in the road and go down both sides. One reason it's important is because we want to be able to accurately reflect and accurately communicate that to our patients when they come into our office that there might be ebb and flow, that it might not be the most consistent pattern, that they might start at the bottom of the pyramid. They're attempting to get to the top, but it may not be a linear bout to get from one to the other. There may be a few steps back in that process. So when a patient understand, and they understand that they could still have potentially a quote unquote bad day during their care, that's going to make them less likely to discontinue their care too early. So making sure that the patient understands that anytime there's a spine complaint, it's a process to get well is important. The other fork in this road is from a clinical or from a co management perspective. And just because a patient comes back into your office, it doesn't mean again that the care was ineffective. And furthermore, we can look back towards another Spine Journal article that highlighted sustained spinal manipulative therapy. Sustained chiropractic care can benefit patients long term by heading, so to speak, future episodes before they abruptly explode with severe pain. So both of these research articles really play well together and they that sustained chiropractic manipulation. Sustained chiropractic care article is a really hotbed topic. And every time I talk about it there's always certainly a bunch of comments pro and for one way or the other. But the research was very clear that Spine Journal had recommended that's a good thing for patients to do. Now, insurance wise, that's a different story. But as far as the clinical recommendations, it's very well supported. And this study that we touched on today really again gives the foundation of why essentially there are challenges, there are ebbs and flows and when a patient deals with a spine complaint, it is neither constant recovery nor constant pain, but there can be episodic variations in that pain throughout time. And in my opinion, there is no better, absolutely no better clinical treatment or clinical choice for a patient to make other than chiropractic care for that. So I hope you enjoyed today's paper. I love it. I think it's Very interesting. I'm gonna repeat the title one more time cause I know it's a long one. Patients with low back pain had distinct clinical course patterns that were typically neither complete recovery nor constant pain. A Latent class Analysis of Longitudinal Data Spine Journal 2015 before we wrap up today, I wanted to make if you did not have the opportunity to listen to last week's episode, I had Krista Burns from the American Posture Institute on talking about the new Postural Neurology program. If you haven't had the opportunity to listen, I would definitely check that out. She also gives a direct link to a free download of the top 20 research journal articles every brain based practitioner should be aware of. And that's a great paper and a fantastic resource that you should be sure to download. Also, if you have been listening, I thank you. There are over 2,500 roughly to at least over 2,000 every week. Chiropractors Listening research in the time it takes to get to your office. If you have not shared this with your friends or colleagues, take the opportunity to do so. And if you have a free second right after we finish this up, please go onto itunes and give us a rating. Give us a review that helps us reach more and more chiropractors and expand what we are able to talk about each and every week regarding the research. So have a great Halloween, have an awesome week in practice and I will talk to you soon.

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