Chiropractic Care Supported by the American Pain Society and American College of Physicians - by The Evidence Based Chiropractor

A variety of clinical guidelines support and encourage the use of chiropractic care due to its safety and efficacy.  In 2007, the Annals of Internal Medicine released a series of clinical guidelines.  The clinical guidelines for the treatment of low back pain were supported by the American Pain Society and the American College of Physicians.  

These guidelines reveal some interesting data.  They report 65% of primary care physicians recommend massage, 55% recommended ultrasound, and 22% recommended (of performed) spinal manipulation.  They also found that only 2 treatment options show strong efficacy for the management/treatment of acute (<4 weeks duration) low back pain.  These treatment options were spinal manipulation and heat.  For sub-acute and chronic low back pain the researchers still found spinal manipulation to be a valuable treatment option.

When we look at this study we can draw a few conclusions.  First, only a small minority (22%) of physicians are recommending spinal manipulation to their patients.  Second, spinal manipulation is a recommended treatment option.  

The discrepancy in the recommendations from the clinical guidelines and the recommendations by the physicians is no surprise.  Other studies have shown that primary care physicians recommendations for low back pain are "high discordant" with current research.  Without a profession wide marketing and outreach campaign for the promotion of this research, the task falls to us, as individual providers to build referral relationships. 

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.

Top 5 Pain Interventions to Avoid- by The Evidence Based Chiropractor

The top 5 pain inventions to avoid by the ASA touch on a variety of spine related conditions.  This list was created because many medical doctors are commonly performing these procedures in spite of the fact that evidence based guidelines suggest they shouldn't.  

At the top of the list is a recommendation to avoid prescribing opioid analgesics for non cancer pain.  These are commonly prescribed even though there is an extremely high addiction rate and virtually no benefit in terms of outcomes.  

As you look through the list, you will find a array of procedures/interventions which are probably being performed on your current patients.  As evidence based practitioners it is imperative that we stay up to date on these topics and keep our patients informed regarding their health care choices.  

The following five recommendations were made-

http://www.medscape.com/viewarticle/819517

1. Don't prescribe opioid analgesics as first-line therapy to treat chronic noncancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti-inflammatory drugs, or anticonvulsants, before starting opioids.

2. Don't prescribe opioid analgesics as long-term therapy to treat chronic noncancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient's responsibilities (eg, urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in coprescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen.

3. Avoid imaging tests, such as MRI, computed tomography, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after pain begins if there are no specific clinical indications (eg, history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn't require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.

4. Don't use intravenous sedation, such as propofol, midazolam, or ultra-short-acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain-relieving effects of the procedure and the potential for false-positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.

5. Avoid irreversible interventions for noncancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long-term risks of weakness, numbness, or increased pain.

JOIN US BY THE END OF THE MONTH AND RECEIVE ZIP CODE EXCLUSIVITY AND A 30 MINUTE IMPLEMENTATION CALL IN ADDITION TO IMMEDIATE ACCESS TO OUR MEMBERS VAULT AND YOUR CUSTOMIZED MONTHLY MD RESEARCH BRIEF.  MEMBERSHIPS STARTS AT $25 WITH NO CONTRACT!

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.

Adding Chiropractic to Standard Medical Care Provides Astounding Results- by The Evidence Based Chiropractor

Adding chiropractic care to standard medical care provides SIGNIFICANTLY better results for low back pain than standard medical care alone.  This 2013 study from SPINE found that, "“The results of this trial suggest that Chiropractic Manipulative Therapy in conjunction with standard medial care offer a significant advantage for decreasing pain and improving physical functioning when compared to standard care alone, for men and women between the ages of 18-35 with acute low back pain".  

The global improvement questionnaires show that the chiropractic patients had greater improvements and only a few reported worsening conditions.  However, the standard medical group saw only a few people get better, with most of the patients getting worse.  This study clearly shows that patients receiving a combination of medical care and chiropractic care have superior improvements when compared to those only receiving medical care.  

View fullsize

 

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together.

Opioid and Benzodiazepine Prescription Rates Are Out of Control- by The Evidence Based Chiropractor

New research shows a stark increase in the prescription rates of benzodiazepine and opioids by primary care physicians.  Over 12% of the visits to primary care physicians offices between 2002 and 2009 involved a prescription of one, if not both, of the aforementioned drugs.  Researchers evaluated and analyzed over 3 billion primary care physician visits.  

This news is especially startling because as Dr. Ming-Chih Kao reports, "[Statistics show] that from 1999 to 2006, there was a 250% increase in fatal overdoses in the US involving opioid medications. More than half of the overdoses involved more than one type of drug — most commonly benzodiazepine."  

The interaction between these commonly prescribed drugs are directly responsible for the deaths of thousands of people per year.  The researchers concluded that some of the opioid medications are being prescribed at higher rates because physicians have felt the pressure of reduced physical therapy coverages.  This is in spite of the fact that ALL evidence based practice guidelines caution against the prescription of opioids and/or narcotics for spine complaints.  Additionally, research continues to show that chiropractic care is superior to physical therapy when treating musculoskeletal complaints.  

Reaching out, educating, and availing yourself as a conservative treatment option to your local primary care physicians is imperative.  

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world.  Our service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together

http://www.medscape.com/viewarticle/821836#2

Unnecessary Spinal Fusions Costing Billions of Dollars - by The Evidence Based Chiropractor

In October 2013, the Washington Post wrote a scathing article on spinal fusion surgeries being performed in Florida (and throughout the US).  In part, they found that more than 50% of the 465,000 fusions performed in 2011 did have have adequate documentation to necessitate the surgery.  

Over the past 20 years the rate of spinal fusion surgery has increased six fold.  Yet, nearly all long term outcome assessments show we are not adequately treating spine related complaints. 

In the past, extensive and expensive lobbying efforts have succeeded in suppressing the advancement of clinical guidelines.  At this time, there are no accepted models of when a spinal fusion is truly necessary.  The Post found, "...at a broader level, the rapid rise of spinal fusions in the United States, especially for diagnoses that generally don't require the procedure, has raised questions from experts about whether, amid medical uncertainty, the financial rewards are spurring the boom.".  

At the very least, barring an emergency/red flag presentation, patients should be encouraged to explore ALL conservative options available to them prior to entertaining the idea of fusion surgery.  Research continues to show chiropractic as the best first line treatment option.  If unsuccessful, then physical therapy, medication, and/or injections may be considered.  This article does not even begin to touch on the adjacent segment disease which affects the vertebral segments surrounding the surgical fusion site.  

With significant complication rates, sky high prices, and potentially un-ethical decision making from the physicians and hospital systems; it is more imperative than ever to promote the safety and efficacy of conservative care. 

JOIN US BY THE END OF THE MONTH AND RECEIVE ZIP CODE EXCLUSIVITY AND A 30 MINUTE IMPLEMENTATION CALL IN ADDITION TO IMMEDIATE ACCESS TO OUR MEMBERS VAULT AND YOUR CUSTOMIZED MONTHLY MD RESEARCH BRIEF.  MEMBERSHIPS STARTS AT $25 WITH NO CONTRACT!

-The Evidence Based Chiropractor is the fastest growing chiropractic outreach group in the profession.  The service is dedicated to increasing chiropractic utilization by showcasing research.  Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals.  Join us.  Lets grow chiropractic together