The Evidence Based Chiropractor Blog

Hundreds of chiropractic marketing and research articles to help you grow.

Jeff Langmaid 5/15/14 Jeff Langmaid 5/15/14

The Dilemma of Spine Patients with Cardiac Conditions- by The Evidence Based Chiropractor

Most primary care physicians are utilizing one of three different "treatment" options for patients with spine complaints. They are treating in-house (aka- giving medication), referring to physical therapy, or referring to an orthopedist. The catch is that millions of Americans are currently taking medications for various cardiac conditions.

Did you know that patients who are taking cardiac medications are unable to take NSAID's?

While even the patients without contraindications generally should not be prescribed NSAID's (according to many guidelines) , the patients who are unable to take NSAID's most certainly should be a target of our outreach efforts. By taking care of these patients we provide value to the primary care office (they are unable to treat these patients themselves) while also offering a option (chiropractic care) which is recommended by numerous back pain guidelines and publications.

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 BRIEFS. 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.

Jeff Langmaid 4/28/14 Jeff Langmaid 4/28/14

New Warning Labels for Epidural Steroid Injections- by The Evidence Based Chiropractor

The FDA recently announced that injectable corticosteroids must carry an updated label which outlines the risks of severe side effects. These severe risks, while rare, are death, stroke, permanent blindness and paralysis.

After reviewing medical literature and their own adverse event database, the FDA decided the risks were great enough to cause an update to labeling.

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 BRIEFS. MEMBERSHIPS STARTS AT $25 WITH NO CONTRACT!

Jeff Langmaid 3/20/14 Jeff Langmaid 3/20/14

Statins for Every Man in America? - by The Evidence Based Chiropractor

A remarkable and frightening new set of guidelines were recently released by the American Heart Association and the American College of Cardiology. They have decided to expand the "treatment" of cholesterol by including an additional 13 million people who should be recommended statin "therapy".

Looking closely at the guidelines it appears that nearly 90% of men ages 60-75 years old will now be recommended to be prescribed statins. Women in this age group who qualify for statins under the new guidelines are over 50%. Eligibility will now be determined on a "10 year risk for cardiovascular disease" as opposed to being based on LDL/HDL levels.

Despite a lack of randomized controlled trials and grade 1 evidence these new guidelines have been adopted by the powerful organizations mentioned above. As these guidelines are adopted by Medicare, primary care physicians will undoubtedly be pressured into prescribing these medications. By not following the guidelines they may be placing themselves as risk for penalties. There is no doubt that these guidelines were heavily supported by the controlling pharmaceutical companies in the US.

The side effects of statin use are well documented. It is imperative that our patients, neighbors, and friends are well informed regarding cholesterol levels and the various treatment options available to them.

http://www.medscape.com/viewarticle/822210?src=wnl_edit_newsal&uac=193860MN#2

http://www.webmd.com/cholesterol-management/side-effects-of-statin-drugs

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.

Jeff Langmaid 3/17/14 Jeff Langmaid 3/17/14

Adult ADHD Prescription Rates Increase by Over 50%- by The Evidence Based Chiropractor

Research produced by Express Scripts (a pharmacy benefit management company) indicates that between 2008-2012 the prescription rates for adult ADHD medications increased by over 50%. While childhood prescriptions of ADHD medications tend to favor boys (2:1), the medications prescribed in adulthood tend to slightly favor women. This study looked at over 400,000 adults.

Joseph Austerman, DO, head of the Section of Child and Adolescent Psychiatry at Cleveland Clinic Children's Hospital, in Ohio, wrote "...the fact that there's been a substantial spike in medicating adults for ADHD does raise the same questions we've asked about appropriate use of these treatments in children: are we now over-diagnosing and overmedicating in the adult population?"

The overprescription of these medications is well documented. Additionally, the revenue generated from the sales/prescriptions of these medications is astounding. As non-prescribing physicians it is important for us to be aware of the trends in prescription/medication use. Many of our patients are presenting to our offices with a laundry list of prescribed medications. These medications inevitably effect their nervous system. As we evaluate our patients' , we must be aware of the challenges that may hinder the optimal progress of our care.

Jeff Langmaid 3/14/14 Jeff Langmaid 3/14/14

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

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.
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.
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.
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.
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!