Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 207: Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

Today we’re going to talk about….Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration 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 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. If you haven’t yet I have a few things you should do.

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You have found yourself smack dab in the middle of Episode #207 Now if you missed last week’s episode, we talked about how Vertebral Dysfunction Alters Neuro Function & The Gender Of Your Provider May Matter. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

It’s a bit hectic around here this week being the week after Thanksgiving as of this recording. Being off for 4 days straight was a very welcome respite from the normal day-to-day. Nothing too crazy around here this week. We are missing our intern who left last week. We’re just re-acclimating to life as it was before we had an extra hand here in the office. But we’re getting there. We’re stretched a little thin because we added the nurse practitioner.

Well, when he has a procedure, he needs an extra set of hands so that takes up one of our CAs. That leaves us short on this end of the business. But, the NP is not busy enough consistently enough for us to need to hire another set of hands full time. So, we’re in a growth period and growth can stretch you. And it’s stretching us.

But that’s OK. I know it’ll all be worth it eventually. We started our integrated journey back on August 1st and here we are at almost December 1st. So that’s about 4 months in. We are averaging around 18-20 visits per week for the medical services and just trying to build build build. Our most common services would probably be trigger point injections, primary visits, and maybe the hormone pellets or IV therapy. It’s a slow grow thing as with any new venture. It takes time to get your message out. And we’re working on it. We start radio ads next week. Other than that, outside of chiropractic, we are setting up a short term rental/Airbnb, VRBO type of house.

It is a brand new flip so we’re stepping into a basically new place and it’s ready to go. We’ve been buying all of the stuff to outfit it, getting all wireless stuff so we can manage it ourselves remotely, hiring a contractor to build a deck on the back, and are getting our AirBNB and VRBO listings in order and all that good stuff. It’s a mess for about a month but once you get it set up, it should only take us about 15-30 minutes per week to manage it from an hour and a half away. And, according to AirDNA which is an analysis software for short term rentals, we stand to profit around $30,000+ per year on the thing. That’s pretty exciting.

I always talk about the exit strategy. This is part of it. Getting more stuff in line outside of your day to day. 30 minutes a week is not completely passive work but it’s damn near passive and gives us a good raise through the year. And $30k is a nice down payment on another house. Especially when you combine it with what I’m doing in voice over industry currently. Now, if I can just get a rock star associate to come in and take some of the heat off of me on the day to day hands-on chiropractic treatment. THEN….then we might be on our way. Enough of that, let’s get to it.

Item #1

The first one this week is called “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study” by Jenkins et. al. (Jenkins 2021)and published in Chiropractic and Manual Therapies on November 23rd of 2021, aye chi Wawa….it’s so hot.

Why They Did It

Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.

How They Did It

• A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark.
• Data were collected from November 2016 to December 2019.
• Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit.
• Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation.
• Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks.
• 2162 patients were included, with 24.1% referred for imaging.

What They Found

Participants referred for imaging had slightly higher back pain intensity at two-weeks and one-year, and disability at two-weeks, but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed.

Wrap It Up

Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice. I know some of you will say “I found so and so on a person that would have never been found, etc.” I get it. And some of you just feel better if you’ve seen what’s going on underneath. I get it and I don’t fault that. I really don’t BUT….you MUST acknowledge that the vast majority of your x-rays that you insist on taking on every patient that walks through your doors, ultimately, weren’t absolutely necessary and didn’t change a thing about how you would be treating them. That is of course unless you’re a technique philosophy wonk and you think you find listings on x-rays. A strategy that I’ve seen little research that can support. If you follow Choosing Wisely, you are typically in safe and calm waters.

Item #2

The second one is called “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review” by Cheng et. al. (Zhangrong Cheng 2021) and published in Ageing Research Reviews in September of 2021

Why They Did It

They start by setting the stage here. Low back pain (LBP) is the leading cause of years lived with disability in the world population, which has increased by over 50 % in the past 20 years, mainly due to population ageing Intervertebral disc degeneration (IDD) is a common degenerative disease of the musculoskeletal system that develops with age. It is regarded as the main cause of chronic low back pain in the elderly. IDD has various causes, including ageing, mechanical overloading, and nutritional deficiency.

Melatonin is a pleiotropic indole hormone secreted by the pineal gland and plays an important role in resisting various degenerative diseases. The serum levels of melatonin decline with age and are reported to be negatively correlated with the symptomatic and histopathological scores of IDD. In vivo studies have shown that exogenous administration of melatonin could maintain the structural integrity of the intervertebral disc and inhibit the development of IDD. Mechanistically, by interacting with its membrane or intracellular receptors, melatonin can promote autophagic flux, scavenge free radicals, inhibit the release of pro-inflammatory factors, and block apoptotic pathways, thereby enhancing anti-stress abilities and matrix anabolism in different types of disc cells. Several studies have explored the effects of melatonin on IDD.

This was first discovered when surgical removal of the pineal gland in chickens depleted their serum melatonin levels and accelerated IDD onset Therefore, melatonin supplementation may be a promising therapeutic strategy for IDD. This review aimed to summarize the latest findings regarding the therapeutic potential of melatonin in IDD.

Wrap It Up

From the perspective of therapeutic strategies for IDD, the benefits of melatonin are comprehensive. The existing evidence supports melatonin as a potential therapy for the prevention and treatment of IDD 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 Bibliography Jenkins, H. J., Kongsted, A., French, S.D (2021). “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study.” Chiropr Man Therap 29(46). Zhangrong Cheng, Q. X., Juntan Wang, Yukun Zhang, (2021). “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review.” Ageing Research Reviews 70.

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