CF 379: Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection
Today we’re going to talk about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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] Things you should do.
You have found yourself smack dab in the middle of Episode #379 Now if you missed last week’s episode, we talked about Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Now that the Fall is upon us, things are leveling out and getting mroe and more stable around here. Which means less travel and more living in my house like a regular normal person. Except, we stayed in my hometown last weekend for my 35th high school reunion. Which is weird as hell to say. But it is what it is. I have the gray hair to prove it.
Got to see a lot of folks I haven’t seen in a while and that’s always good. Some never go back. They didn’t have a good experience in high school so they care nothing about it. I get that. That wasn’t me though. I had an incredible experience. I won state in the discus and was a two-way starter and football captain, honor grad, and had a great circle of friends that I absolutely still stay in touch with and still enjoy texting and seeing every now and then. High school was somethign else for me and I wouldn’t trade it for anything. So we go back when it’s time.
Something I’ve been working on lately; through Facebook, a colleague reached out to me and said that with my ortho diplomate cert and my Forensics diplomate cert, that I should consider doing designated doctor work or medicolegal work out of state. She said she travels out of state once every 6-8 weeks and makes a gob of money doing so every year.
Well hell, you don’t have to tell me twice. There absolutely SHOULD be more benfits to having Diplomates so, if I got ‘em, miight as well use them.
So, I started down the path of getting licensed elsewhere and holy guacamole what a sincere time suck pain in the ass. Wow. Absolutely stupid the hoops you gotta jump through. I’ve been licensed in TX since 1998 but I have to do mental gymnastics to add a license somewhere else?? Insantiy. But, I’m getting there. Then, once licensed, I have to take a course that will prepare me for the Qualified Medical Examiner exam. Then I take that QME and pass it and Kablamo! I’m off to the races and adding an extra revenue source that can be maintained once I retire from actively treating patients every day.
Which, psssst…..between me and you….if you don’t want to die in yoru practice or sell it someday desperately for pennies on teh dollar, is exactly what we should all be doing. We should be acting as if there is an end game. Because there is and none of us are getting out alive. Why do you think I have the VoiceOver thing going? The Airbnbs thing? You think I post my paintings and my sculptures on social media so often so that I can brag? Hell no. I want a portfolio and people to know, like, and eventually buy my art. If myy paintints annd sculptures are news to you, go to www.riverhorseart.com and check it out. The point is; I’m trying to plan for the end game. I’m trying to do what I can to maximize my end game. You should be too.
Our first one this week is called Association of Opioid use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrspective Cohort Analysis by Moyo et al and published in Journal of General Internal Medicine in 2024. Remember, the citations can be found at chiropracticforward.com under this episode.
Moyo, P., Merlin, J.S., Gairola, R. et al. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. J GEN INTERN MED 39, 2097–2105 (2024). https://doi.org/10.1007/s11606-024-08799-3
Why They Did It They wanted to see if people with this opioid problem were treated differently for sudden back pain.
How They Did It The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date). Using multivariable logistic regressions, they assessed the following outcomes measured within 30 days of the index date:
Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin. Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date.
Doctors recommend starting with safer ways to treat pain (like exercises and Chiropractic therapy) instead of medicine—especially for people who’ve had problems with opioids before. But this study found that doctors often use medicines anyway, and not enough non-medicine treatments. Specifically, the authors said this, “Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.” Which means people with back pain aren’t going to a chiro or PT nearly often enough and to compound the matter, people in the medical castles are STILL prescribing too many opioids and gabapentin whihc means they’re acting in a non-evidence-based way.
Item #2 Our last one this week is called, “Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study” by Saracoglu et al and published in Pain Medicine in August of 2025 and is muy cliente me amigos.
Tuba Tanyel Saraçoğlu, Burak Erken, Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study, Pain Medicine, Volume 26, Issue 8, August 2025, Pages 440–450, https://doi.org/10.1093/pm/pnaf040
Why They Did It To evaluate the effects of transforaminal epidural steroid injection on pain and disability across different lumbar disc morphologies using the Michigan State University (MSU) classification system.
Transforaminal epidural steroid injection effectively reduces pain and disability across varying disc morphologies. At the 1-month mark, pain relief was more pronounced in group 1B compared to 2A and 2AB groups, whereas at the 3-month mark, the results were similar between subgroups. So, these groups know that these injections are short-term relief only but they’re recommending larger studies with longer follo-up to improve patient selection and optimze the tx strategies. Instead of looking at the American College of Physician’s recommended hierarchy of treatment. While I was messing with Perplexity AI, the best research-leaning AI that I’m aware of, I asked Perplexity the following: “Qaseem et al published in the Annals of Internal Medicine by the American College of Physicians suggests a hierarchy of treatment with things like spinal manipulative therapy, exercise, massage, acupuncture, low-level laser, yoga, tai chi, mindfulness, cognitive behavioral therapy, and heat being first-line recommended therapies.
These recommendations come from the largest medical group in the world.
Why are these not more widely recommended by AI and by primary care providers as well as surgeons?” Perplexity returned with this response which, I thought, was fairly accurate minus the part where many chiropractors are causing the issue as well.
The AI engine responded with, “Reasons First-Line Therapies Are Underused
Why Noninvasive Therapies Should Come First
In summary, while the largest medical group in the world encourage starting with non-drug therapies, they’re not always widely recommended because of habits, system pressures, patient expectations, and insurance rules—even though science backs their effectiveness and safety as first-line care.” 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/
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
The post Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection appeared first on Chiropractic Forward.
