CF 122: Chiropractic In Primary Prevention, TENS For Migraine, Acupuncture For Chronic Pain

Today we’re going to talk about Chiropractic In Primary Prevention, TENS For Migraine, Acupuncture For Chronic Pain

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #122

Now if you missed last week’s episode, we talked about Chiropractic vs. PT, Nutrition & Chronic Pain, HVLA and the T/L Junction. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

Well, it’s been a ride and the ride continues. Aren’t we getting so tired of it all? Well, absolutely we are. We’re all going insane. Myself included.

I have unintentionally and unfortunately been included in a few Facebook fussing over the last week and I have to just say…..people need to settle the hell down. 

When you take a pandemic, people are crazy stressed. Couped up and feeling a loss of freedoms, scared, and worried….it’s all understandable. I’ve experienced all of those emotions myself. I’m no better than anyone else.

But then you throw in the craziness of human nature and human interaction and it takes all of those feelings to the next level. 

When you have Billy DeMoss seemingly losing every bit of any brain he may have once had and saying things like they’re going to come to get your kids and take them to a concentration camp, or that this is a play for mandated vaccines to kill us all, or that they’re trying to chip us…..well now that’s a whole new level of what I perceive as complete idiocy. 

Look, it’s clear some people buy into that and I’ll just say, I will still fight for your rights and advocate for chiropractic but just keep it to yourself. Those opinions are from outliers. I promise. If you hold those, you’re of the 1 or 2%.

There’s a feeling amongst some that we need to all pull together and support each other and lift each other up. I don’t disagree with that at all. I think that sounds like a worthwhile pursuit.

I’ll also say that times of great stress like this are often the impetus for flushing out the crazies. We are seeing them all over the Internet now. From buy and drink a boatload if tonic water to 5G to chilling and concerts toon camps….. I’m sorry folks, I’m not supporting them. We aren’t going to hold hands and sing kumbaya. No way no how. 

If we insist on being too afraid to police ourselves then we have acted irresponsibly in my opinion and we damn well deserve what we get. 

If a chiropractor has sensible, educated thoughts, and videos, and writings……I got your back. I’m your advocate. Let’s do this. We’re going to be OK, my friend.

The crazies; sorry. You get called out and hopefully policed.

I’m also reasonably sure that those with those beliefs aren’t listening to an evidence-based podcast to begin with.

I think everyone’s crazy because we’ve lost the middle ground in this world these days. It’s all or nothing. Like a light switch or something. I have news for them; life rarely works in absolutes.  This pandemic is no exception.

Especially here in America, we have the republicans and the democrats on polar opposites of each and every topic. If a Democrat says the ground is under our feet, the republicans will immediately argue that it’s above our heads and if a Republican says the sky is blue, a Democrat will bitch about how it’s more lilac.

It’s beyond frustrating. On this thing, I don’t agree with either absolute. Democrats are going to have to understand that we can leave the house, begin to re-open safely and in a smart way, and try to salvage our economy.

Republicans are going to have to wrap their heads around the fact that the country isn’t going to completely reopen tomorrow. It just isn’t. We can slowly reopen and attempt to save as many lives as possible in the process of saving our economy. 

The answer, in my opinion, is in the middle ground. It’s not a one size fits all solution. What is good for rural Wyoming is not hoot for congested public transit-dependent New York City. Common sense.

The let er rip and if they die they die people are simply wrong. Consider your elderly family, friends, and your elderly patients and your immunocompromised friends and family before supporting the let er rip policy. 

The complete lockdown people are simply wrong.

What is it about society today that everyone thinks they’re better experts than the actual experts? Would you listen to a rocket scientist tell you how jet propulsion works and then you sit back and freaking argue with them about what has been their life’s work and what they’ve studied day in and day out for 30 plus years? Hell no we don’t do that.

So why is it OK to act like experts above and beyond those doing their best to keep us safe right now? They are in the middle ground. They don’t want to kill the economy but they also want to keep us safe. It’s my opinion that we let them.

This is week two of me being open for emergency patients. I have gloves for now. I have a handful of N95 masks from my woodworking hobby. At the advice of a Nurse Prac friend, I sterilize the one I used each night with either barbosol or parvosol.

Then there are all of the other mitigation techniques like waiting in the car, screening questions, temperature checks outside, before being allowed in, cleaning, no family attending the appointment, no waiting room, new patients intake on the phone to reduce time in the office, only one or two patients in the office at a time., fans put in every room to move the air….and on and on. I am looking at air filters for each room as well since there are no openable windows in my office rooms.

Maybe we’re going overboard. Time will tell. But I’ll never be accused of not doing everything I can do to still treat while being as safe as I can possibly be.

I hope you are all doing well. I hope you are staying safe and doing what you can to keep your family, friends, staff, and patients safe too. 

Keep the faith. There’s new info that it is likely Not as deadly as initially suspected. There are reasons for optimism.

If we can just keep from losing our minds in the meantime.

Item #1

Let’s get to the first one here. It’s called “Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach” by Goncalves, et. al(Goncalves G 2018). and published in Chiropractic and Manual Therapies in 2018. It’s new enough to be warm but not hot off the presses. 

Why They Did It

The chiropractic vitalistic approach to the concept of ‘subluxation’ as a cause of disease lacks both biological plausibility and possibly proof of validity. Nonetheless, some chiropractors purport to prevent disease in general through the use of chiropractic care. Evidence of its effect is needed to be allowed to continue this practice. The objective of this systematic review was, therefore, to investigate if there is any evidence that spinal manipulations/chiropractic care can be used in primary prevention (PP) and/or early secondary prevention in diseases other than musculoskeletal conditions.

Well that’s a lofty goal now, isn’t it?

How They Did It

• As the title gives away, it’s a systematic review so dependable information. Systematic reviews lie at the top of the research pyramid if you recall. 
• They searched PubMed, Embase, Index to Chiropractic Literature, and specialized chiropractic journals from inception all the way up to October 2017 
• For the search, they used terms like chiropractic, subluxation, prevention, wellness, spinal manipulation, and mortality. 
• They included anything mentioning the study of the clinical preventative effect or benefit from manipulative therapy or chiropractic treatment in relation to primary prevention or the treatment of physical disease in general. Anything other than musculoskeletal disorders. 
• Population studies were also eligible
• Checklists were designed in relation to the description of the reviewed articles and some basic quality criteria. 

What They Found

• Of the 13.099 titles scrutinized, 13 articles were included (eight clinical studies and five population studies). 
• These studies dealt with various disorders of public health importance such as diastolic blood pressure, blood test immunological markers, and mortality. 
• Only two clinical studies could be used for data synthesis. None showed any effect of spinal manipulation/chiropractic treatment.

Wrap It Up

The authors concluded by saying, “We found no evidence in the literature of an effect of chiropractic treatment in the scope of PP or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.”

Alright, this is something I refuse to get too deeply into and it’s because, as healthcare practitioners, we should all be responsible enough, no matter what dogma was forced down our throats in school, we should all be responsible enough to recognize how the world works. Certainly the world of responsible evidence-based healthcare. 

If you say you are an immune-boosting chiropractor, you are not being honest. You are only following anecdotal experiences you’ve noticed in passing. A patient tells you they don’t get sick anymore. So what? Who cares? It means nothing outside of your clinic and outside of that patient. 

To say it means anything beyond that is irresponsible. If that upsets you, all I can say is I’m sorry you’re upset. Then I’d tell you to speak to your state associations and your state governing bodies because most, if not all of them, take the stance I take on it. Then I’d direct you to the ACA. After that, I’d direct you to the World Federation of Chiropractic……I know, I know….many of you don’t recognize those entities and that all ties into the fact that you don’t agree with them. And it’s usually this issue that you don’t agree with. 

But understand, you have some small little studies and maybe some case studies and a pile of anecdotal thoughts. And an enormous capacity to believe things while these other entities are standing on research and evidence. 

So, here you go; you don’t like those groups? You don’t like people telling you that you’re wrong? Then fund some research. There are plenty of people out there that want you to be right. Hell, I want you to be right? Do you understand that? I want you to be right. I’m not a denier because I want to be contrary and piss people off. I still love my friends that are on the philosophy, faith-based path. I respect them. I don’t want to fight and fuss with them. I don’t want them to look at me like I’m on the other side. I want us to walk the path together. Fighting the fight together. 

Hell no I don’t want to be disagreeable on this. I hope you’re right. But until there is convincing evidence, and contrary to some beliefs, there is not convincing evidence, until then, you’ll never hear me tell someone to come in and get their life-saving adjustment or that they need that adjustment to get that immune system boosted. Never. 

I see a lot of you pointing to Heidi Haavlick as one of the researchers showing that chiropractors can do these amazing things. Well, friends, I hate to break the news to you but she came out just a couple of weeks ago and stated very clearly that there is no clinical evidence of immune-boosting powers on behalf of the chiropractic community. She said “As a scientist, I must be clear on this. We do not have clinical evidence yet because no clinical trial has been done.. So, we still need to answer these clinical questions by doing such clinical trials.”

So there you have it. Put your money where your mouth is. Break open that wallet, spend some money. It’s so easy these days with online payments and things like that. You want to promote it, then help pay for the proof. 

I hope you’re right. I’d love to be able to tell my patients that it is now evidence-based to tell them good news about adjustments and the immune system. I’ll make a brochure for you all to purchase from me, and we’ll be the happiest of happys. 

Until then, it is not evidence-based to say such things. 

Before we get started, I did a thing

Marketing Evidence-Based Chiropractic

I’ve always wanted to help others with their message and how they’re getting it out there. Keeping that in mind, during this lull in business due to the pandemic, I decided to try something different and invest my time instead of waste it. I’ve certainly had the time to invest as have most of us.

I did two episodes on marketing an evidence-based practice a few months ago and both of those episodes are among our most listened to, most popular episodes so I know there is value there and I know there’s an interest in the topic. 

Over the years, if I wanted to learn more about excel, I’d take a course over at udemy.com. If I wanted to learn more about marketing, udemy proved to be a valuable resource. If you’re not familiar with sites like Udemy or Teachable, you should go check it out. 

I haven’t really looked into what other chiropractors are using it for but I thought, if I wanted to offer a course, Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested. If it’s not, it will be live in only a day or two. 

If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like. 

Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. See what you think. It’s my first online course to create so any feedback is appreciated. Over time, I’ll be updating the content and adding graphics, and things like that as I finish the initial bulk of the work and am able to revisit and re-work parts that could use it. Plus, I plan on responding to feedback and make any needed changes from there as well.

Marketing Evidence-Based Chiropractic

Item #2

Alright, Item 2 is kind of a fun one I think. It’s called “Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial” by Hokenek et. al(Hokenek NM 2020). and published in the American Journal of Emergency Medicine in January of 2020. Now THAT’S a hot one folks back up a bit. 

Why They Did It

The primary purpose of this trial is to evaluate the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) therapy application in the emergency department.

How They Did It

• The patients were divided into 2 groups: a sham group, and a verum group. 
• Patients in the verum group include those who use the device for the first time. 
• Both groups were connected to visually indistinguishable devices. 
• Both groups underwent therapy for a total of 20 min. 
• Using the Visual Analog Scale (VAS), the patients’ perceived changes in pain intensity were recorded at the 20th and 120th minutes after initiation therapy. 
• After the 120th minute, patients’ individual needs for additional treatment were assessed. 
• Additionally, their self-reported well-being was assessed using a Likert-type verbal scale.

What They Found

151 patients were admitted to the emergency ward and were assessed, 

39 patients were assigned to each from this pool. 

Thirty patients (76.92%) in the sham group and 1 (2%) in the verum group had additional analgesic requirement after 120 min.

Wrap It Up

The authors concluded, “TENS therapy is a fast-acting, effective therapy for the treatment of acute migraine in the emergency department”

Item #3

Our last one this week is called “Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis” by Vickers et. al(Vickers AJ 2018). published in Journal of Pain in May of 2018. Warm….not hot though. Dangit

Why They Did It

Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for 4 chronic pain conditions

How They Did It

• They searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. 
• They included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. 
• Trials were only included if allocation concealment was unambiguously determined to be adequate. 
• Raw data were obtained from study authors and entered into an individual patient data meta-analysis. 
• The main outcome measures were pain and function. 
• An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials

What They Found

• Acupuncture was superior to sham as well as no acupuncture control for each pain condition
• They also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year

Wrap It Up

The authors wrap it by concluding, “Acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. Although factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain after acupuncture cannot be explained solely in terms of placebo effects”

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com. 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Goncalves G, L. S., Leboeuf-Yde, (2018). “Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach.” Chiropr Man Therap.

Hokenek NM, E. M., Hokenek UD, (2020). “Treatment of migraine attacks by transcutaneous electrical nerve stimulation in emergency department: A randomize controlled trial.” Am J Emerg Med S0735-6757(20): 30024-30023.

Vickers AJ, V. E., Lewith G, (2018). “Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.” J Pain 19(5): 455-474.

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