CF 361: Healthcare Expenditures & Sleep And Pain Today we’re going to talk about Healthcare Expenditures & Sleep And Pain But first, here’s that sweet sweet bumper music  

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #361 Now if you missed last week’s episode, we talked about Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Sorry I missed last week’s episode. I have a trip to Atlanta for the big VOAtlanta voice over conference. If you’ve listened for some time, then you know that I moonlight as a voice actor. It started during covid and basically turned into a full time job on top of my full time job. It’s something that can be done in a robe in my basement. No overhead. No employees. Just a microphone, agents, managers, and clients if you can get ‘em! So, considering the money that can be made in VoiceOver, it’s worth chasing and exploring. I’d be a fool not to. I’m not in my 5th year of vo and have reached the level that a lot voice actors strive for. I have a national agent out of Beverly Hills and I have a management company out of New York City. Both are achievements that any vo is hungry for so I am super grateful and have been blessed beyond description.  In addition to these, I have accumulated around 10 regional agencies as well. On top of that, I’m on several rosters for producers and marketing agencies across the country. 

You can probably feel that this isn’t really a hobby. It’s a thing and it’s a thing that keeps growing so it’s pretty exciting. To the point that I have auditions coming in as I type this right now!  VOAtlanta is the country’s largest gathering each year of voice talent from across the world. Not just the USA. There were folks from Ireland, England, New Zealand, Venezuela and more. All over. There are typically around 1,000 or more vo folks at the Atlanta show.  As you might imagine, there are a lot of regular ol’ folks like me there but there are also what you would picture Los Angeles, Hollywood, eccentric creatives to be. It’s a mish mash of folks from all walks and you what? It’s pretty cool.

Of course I hang out with folks more like me the most but I’ve made friends from all walks of the world and it’s a pretty cool thing overall. 

So yeah, that was last week and this week is a chiro conference in Lubbock, TX. In the words of Ferris Bueller, life moves pretty fast my friends, if you don’t stop and look around, you might miss it.  I’ve been very active in the Texas Chiropractic Association for years and years now.

Probably since about 2008. So, about 16 years now. I’ve served on the Board, as the PI chair, as the chair for fundraising, and as the Director of Dept of Scientific Affairs. Which is all cool and all very useful but what I got out of it and still get out of it, is far beyond anything put into it.  I have friends that I call family from all over the State of Texas. Some are in pretty influential positions in our industry. Any time I have an issue, I have a network of plugged-in friends that can help guide me and advise me and you can’t beat that with a big ol’ stick, my friends. That means something. 

Also, I misspoke last episode when I mentioned bringing in a private equity partner.

They technically are NOT a private equity partner. They are a true partner that invests in the clinic and helps you grow it in size, capability, and finances.  We have been doing weekly 1 hour transition calls to get ready for the sale and all that goes with it. We are excited. It’s going to be work but, once the work is put in for the first few months, then we should be hitting the cruise control and watching things grow as some of the responsibility is gradually taken off of my shoulders.  Maybe I’ll start to breathe and sleep better. Won’t that be nice?? I’ll keep you updated as we go through the process. 

Item #1

Our first one this week is called, “Fatigue, sleep disturbance, and pain interference in children and adolescents with chronic pain: a longitudinal study” by Roman-Juan et al and published in Pain in April 2025…..hell that so en fuego, it hasn’t even happed yet!! Remember, the citations can be found at chiropracticforward.com under this episode. 

Roman-Juan, Josepa,b; Ceniza-Bordallo, Guillermoc; Sánchez-Rodríguez, Elisabeta,b; Jensen, Mark P.d; Miró, Jordia,b,*. Fatigue, sleep disturbance, and pain interference in children and adolescents with chronic pain: a longitudinal study. PAIN 166(4):p 927-935, April 2025. | DOI: 10.1097/j.pain.0000000000003432

Why They Did It

How They Did It

What They Found

Findings revealed that sleep disturbance, pain intensity, and pain interference co-occurred at both time points.  Higher levels of sleep disturbance, pain intensity, and pain interference at first assessment predicted higher levels of sleep disturbance, pain intensity, and pain interference at follow-up, respectively.  Higher levels of pain interference at first assessment predicted higher levels of sleep disturbance at follow-up while controlling for initial levels of sleep disturbance.  Furthermore, fatigue was found to mediate the association between first assessment and follow-up sleep disturbance, the association between first assessment and follow-up pain interference, and the association between first assessment pain interference and follow-up sleep disturbance.

Wrap It Up Basically, this study used a fancy math model to look at how sleep problems, pain levels, and the way pain affects daily life are connected over time.  They checked these things at two different points and found that if you had more sleep issues, stronger pain, or bigger problems because of pain at the first check, you’d likely have more of those same issues later on.  Also, if pain was messing up your life a lot at first, it could make your sleep worse later, even if you account for how bad your sleep was to begin with.  On top of that, feeling tired seemed to play a role in linking these problems together—so it helped explain why early sleep or pain issues led to worse sleep or pain problems later. In the ortho diplomate I went through, it was very clear in the curricula and in the research that a big component of pain, regardless of age, is a lack of sleep and if one were to engage in more sleep, they tend to suffer less pain. Ideal sleep was somewhere around 7-8 hours for adults. More around 9+ hours for kiddos if I recall correctly.  So, turn the phone and the TV off and get some damn sleep people! 

Item #2 Our second and last one this week is called, “Comparative Analysis of Individuals With and Without Chiropractic Coverage Patient Characteristics, Utilization, and Costs” by Legorreta et al and published in JAMA Internal Medicine in October of 2004. Not hot but definitely worth covering.  Legorreta AP, Metz MD, Nelson CF, Ray S, Chernicoff HO, DiNubile NA. Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs. Arch Intern Med. 2004;164(18):1985–1992. doi:10.1001/archinte.164.18.1985

Why They Did It Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations.  This study explores the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system.

How They Did It A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit.

What They Found Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year).  Having chiropractic coverage was associated with a 1.6% decrease in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs, low back surgery, hospitalizations, and MRIs.  Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode–related costs ($289 vs $399).

Wrap It Up Access to managed chiropractic care may reduce overall health care expenditures through several effects, including 

Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs. Tis study was led by an MD and this study was published in 2004. Later, in about 2016/17, in Qaseem et al, the American College of Physicians published their recommendations for first line therapies for back pain, both acute and chronic. They included SMT, exercise, massage, acupuncture, and low level laser. All things that are encompassed by chiropractic care.  Why is the wheel turning so damn slowly? They say it takes 15 years for research to come out and for it to trickle down to the PCPs and it to become regularly and widely implemented. Well, that was 20 years ago. And here we are.

Still struggling like that squirrel trying to get a nut. It’s exhausting isn’t it? Still, it’s better in 2024 than it was in 2004. No doubt. Progress moves slowly. Especially when you have a loud, obnoxious factions of your profession trying desperately to hold you back in 1897.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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 preventatively 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. Website http://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

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