Chiropractic As A Complimentary Treatment

For PainMarc Nelson DC, ATC

Disclosure slide

•Owner and chiropractor at Cadence Chiropractic in American Fork Utah

Objectives

• Describe how chiropractic fits into an integrated model of health care for pain management.

• Summarize the current evidence on chiropractic and pain management, including safety

• Examine how chiropractic can be properly utilized for pain management

• Discuss case reports from a chiropractic prospective.

St Louis, Missouri

• 29.3% of the St Louis population is impoverished (1)

• 13% of Missouri is uninsured (1)

• 47.2% of St Louis is African American (2)

• Ranks 14th in the number of prescription pain killers at 95 prescriptions per 100 people. (3)

Myrtle Hilliard Davis Health Center

Logan Chiropractic Community Health

Center

• Sees 30,000 patients a year • Nearly 40% are taking prescription pain

medication• Preliminary data after year 1 has shown an

80% decreased dependency on medication of those under chiropractic care (1)

• Family Care Health Centers

• Started at 20 patients a week and quickly grew to over 100

Chiropractic

• 42 schools in 16 different countries

• Projected to grow by 17% (1)

• Accepted by all major insurance

Growing fast

One of the most widely used alternative treatments at the VA since 2005 (3)

• An estimated 35.5 million people saw a chiropractor in the last year

• Two thirds (66%) of patients that have received chiropractic care stated that it was very effective. Compared to 23% that said somewhat effective and just 10% who said it was not effective. (2)

Gallup-Palmer Poll

Chiropractic Education

• 4 year doctorate degree

• New residency programs at the Veteran Administration Hospitals

• Connecticut, 2 in New York, St Louis, and Los Angeles

• Under Utah law chiropractors can:

• Diagnose, create treatment plans, order and read imaging, perform acupuncture and more. (1)

Research

• The neurophysiological mechanism has been supported in recent research

• Central sensitization

• Systemic review of the literature by Lennard et al showed an increase in pain threshold by more than 15%.

• 3 of the studies also tested remote areas showing a systemic increase on the pain threshold. (1)

• JAMA systemic review and meta analysis

• 15 RCT showed moderate evidence that spinal manipulation showed a statistically significant decrease in pain

• Showed no adverse effects other then minor soreness out of 1711 patients. (2)

• Spinal manipulation and the placebo effect

• Published in the Journal of Pain

• Showed that the decrease in pain threshold was due to spinal manipulation therapy (SMT) and not just the expectation of receiving SMT. (3)

Safety

1 per 1 million adjustments (1)

Association of chiropractic and stroke is similar to the association

between primary care physicians and stroke. (2)

Early detection of potentially risky patients

is key

Risk of Stroke

What it takes to integrate care• Chiropractic doesn't take up much space or budget

• Referral and communication

• Clinical guideline Agency for Health Care Policy and Research recommend chiropractic care as first treatment for acute low back pain in adults (1)

• For acute low back pain (<4 weeks' duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat and spinal manipulation. (2)

• When coupled with other alternative therapies the effect is amplified.

• Chiropractic can help primary physicians focus their time on more complex patients

• Retrospective database review of Mount Carmel Clinic. (3)

Marc Nelson DC, ATC

drmarc@afcadence.com

801-678-8209

Cadence Chiropractic 456 E State Rd #500

American Fork, Ut 84003