The Surprising Link Between Low Back Pain and Headaches | Podcast Ep. 198

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week we are talking about an awesome piece of research that was just released that touches on the association between headache and low back pain. This is a big deal. We know that when you combine headache and low back pain, it's probably what drives upwards of 80% of people to visit a chiropractor for the first time. And any association between them is exceptionally important for your messaging and also for your clinical care and treatment. So we're gonna break this down, make it real and talk about how you can communicate this message with and for the people in your community and in your practice. Additionally, if you check out the evidence based chiropractor YouTube channel, you will soon be seeing some recaps from Rockstar. I know I met a ton of people who listen to the podcast out there. Thank you so much. But if you weren't able to make it out there, you can see what you missed and hopefully get your schedule straight for next year. Additionally, I'm going to be at Parker Seminars in Dallas. I guess it's next weekend when you're listening to this. So if you're going to be out there, I'll be speaking about marketing, which I'm super excited for. So come on, find me, give me a high five, all that fun stuff. I'm going to be out at Parker Dallas for their homecoming event talking marketing. But for today's episode, we are focusing on the research and we're talking about the association between headache and low back pain. This was a systematic review. It was released in the Journal of Headache and Pain just this year in 2019. And their goal was to systematically review studies quantifying the association between primary chronic headaches and persistent low back pain. So we all know low back pain and headache are leading causes of disability worldwide that's kind of been beaten to death in the literature. But what starts to get interesting is when we start to classify things and the most common types of headaches, migraines, tension type headaches, which obviously both of those we can help with tremendously with chiropractic. But the third most common form of a headache is a medication overuse headache, which is like smack your head territory, right? Because a lot of those are probably coming because people are taking medication to eliminate headaches. This is a conversation we've had within the smart chiropractor over the last few months. Medication taken for headaches. One of the biggest side effects of that medication are more headaches. So we could See that as it's literally the third most common type of headache is one that's induced by medication. So talk about a cyclical effect there. The other interesting thing is that migraine and tension headaches feature in two of the eight causes of chronic disease and injury, and each affect more than 10% of the world's population. So when we look at chronic headaches, it's severely disabling to about 3 to 4% of adults worldwide. Now, 3 to 4% might seem relatively low because it's not 70%, thank goodness, but 3 to 4% is a ton of people. We're talking about billions of people on planet Earth, Hundreds of millions, 350 million-plus in the United States. So we start to look at 3 to 4% of chronic headaches becoming severely disabling. This could equal 10 million plus individuals just in the United States alone. This becomes a very, very big deal, especially when we tailor this into what we've previously seen in the literature showcasing how chiropractic care, how an adjustment or a manipulation can decrease the intensity, severity and frequency of headaches. We can start to see where we're going with this as far as chiropractic being an exceptionally valuable piece of solving this puzzle. So what's a chronic headache defined as? It's always a good question. Defined as a headache occurring more than 15 days per month for more than three months straight. That's a lot, right? Think about that. More than half of the month is spent having a headache and it's gone on for more than three months. That can be a big, big burden, which starts to pitch back to say, hey, now I understand why this is a leading cause of disability. Because if you have a headache that often, you are definitely not going to be living your best life, to say the least. So the researchers were looking at this because their thought was, hey, people with headache disorders, chronic low back pain, chronic headache, they might be a neglected group that could have both conditions managed at the same time instead of individually. So I want to take that and break that down for one moment. In a chiropractic clinic practice such as yours and mine, often we look at the body holistically, right? So when we do our review of symptoms, when we're asking about chief complaints, we have no problem addressing, addressing multiple things with an individual. As a matter of fact, quite often it's almost never just one thing. There's always a compensation. There's always maybe the primary and then the tertiary or secondary effects. So we're constantly looking at that. But in the Medical world, historically, they break things down to single events. So when you go into physical therapy, for instance, a lot of people going for physical therapy are scripted for like one condition X amount of visits for only treating this condition. It's a neck condition. The therapist doesn't touch the low back. And you know, it might seem crazy to us, but that's the way a lot of things go. So the researchers were looking at from the standpoint of, hey, if they have one of these things going on, it might be a good idea to look and see if they have the other, which I think we all agree would be a good idea, but it's also where we have such an advantage. So what they found was a combined approach to treating both conditions and could reduce medication use. It could provide a holistic treatment option for both chronic pain syndromes. So that makes sense to me. They also found a previous large scale European study found moderate to severe chronic pain reported in 19% of adults. Now, interestingly, half of those individuals felt that their pain was inadequately managed. So almost 20% of this study, 20% of a very large European study found people had moderate to severe chronic pain, head or low back, and 20% and nearly half of those individuals did not believe that they were being managed adequately. You think there's a need for chiropractors in that equation? I think that is absolutely the case. So why is there so many failures? Well, they estimate, the researchers, that treating chronic pain remains a challenge for clinicians. And unfortunately, unrealistic expectations of short term pain control can lead to prescription overuse, opioids in particular, and even, even excess interventions, including surgery and nerve block. People get ants in their pants, right? Nobody wants to have pain. But again, they kind of looking back and saying, why are all these people failing in what's called the, what I'll call the traditional medical model? Well, chronic pain is challenging. There's a biopsychosocial component as we'll talk about in a moment. And if the person is looking for that magic drug, there are drugs strong enough out there that can eliminate pain, right? That's been proven. Problem is, most of the time those are called opioids and they are unbelievably addictive and they don't solve any of the issues that led to the pain syndrome. And additionally, they create a host of other issues for that individual. It could be addiction, it could ultimately mean death. And it doesn't change the biopsychosocial model. It doesn't change how they move their body, it doesn't change how they're thinking about their pain. It doesn't change any of that when you take the medication, which is what becomes so, so challenging. So recognizing the impact of the psychological processes on chronic pain, it's been recognized that, hey, non pharmacological ways to go about this are probably a good way. We've seen that with the American Headache Society, the American Pain Society, all of these guidelines, all of these organizations have stood up and stood behind to a certain extent what we do within the chiropractic space as hey, medication should not be a first line treatment. This needs to have more of a holistic approach. In papers like this that we're citing today, emphasize that point even more because they're saying there is correlation between these two items. And when we break that down, let's talk about a few key points that these researchers found and clinical implications. They found, quote, low back pain and headache are significant causes of disability worldwide. Well, we've well established that. They also found people with 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. I think that's a good idea. They found also we identified a positive association between low back pain and headache disorders. And finally they found a combined approach to treating both conditions could reduce pill burden, medication overuse and provide a holistic treatment approach for the two chronic pain syndromes. This paper is outstanding because it basically lays out the way we've been going about things probably in our practices since our first day of practice. Right? So having the research, having a brand new paper, 2019 the Journal of Headache and Pain, standing behind the fact of medications are not the best way to go when you're starting out. There is a correlation between people who have individuals who have chronic low back pain and individuals who have headache. Individual and treating both in unison, taking a holistic approach to healthcare is the best way to go. All of that sounds exactly eerily similar to probably what you and I talk about in some form each and every day in our practice. But it's also what we need to be talking about in our communities and with the other healthcare providers in our community. Remember, we saw 50% of people in the traditional medical management are failing. If I asked you what's your success rate in your practice for individuals with these complaints, I have a suspicion you'd say 80 to 90%. That's a huge cap. 50% of people being satisfied or 50% feeling like they're inadequately managed. And then in our practices, the people who think they're inadequately managed, I would guesstimate at less than 5 to 10%. This is a huge opportunity to talk about the latest research, to talk about how it applies to really specific health conditions that a lot of people are dealing with in your community and in bridging the gap, getting your name out there, building your brand and showcasing who you are and what you can do as a chiropractor. And that's really the takeaway message from today's podcast episode is this is about showcasing who you are and what you can do in practice. We've seen it time and time again. We'll continue to explore these papers on this podcast amongst others. But the bottom line is the research supports who you are and what you do. The research supports what we do as chiropractors, our treatment mechanisms, our philosophy of care, so to speak, in our desire to take care of people in a non pharmacological way, in a holistic way, in looking at their body through the lens of what can we do to improve function and structure while benefiting the patient and improving quality of life. That's what it's all about. Symptom reduction is a portion of that, but it is not where the story ends. So if you'd like help getting that message out to your community through social media, we have a whole system called the Smart Chiropractor at you can check out that. Or if you want to get this message out to the other healthcare providers in your community, which I think is a wonderful idea, you can check out the evidencebasedchiropractor.com I'd encourage you to become a member of one or the other. If you're focused on other healthcare providers, visit us at the Evidence basedchiropractor. If you're focused on your community, building your tribe and audience online and off, Visit us@thesmartchiropractor.com But I hope you have a great week in practice and I will talk to you soon.

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