CF 195: Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain Today we’re going to talk about spinal manipulative therapy vs. opioid therapy for Medicare-aged patients and we’ll talk about young elite pitchers, their hips, and pain. Stick around.  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. 

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 


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You have found yourself smack dab in the middle of Episode #195 Now if you missed last week’s episode , we talked about Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we just got back from Washington DC. It was a go go go whirlwind kind of thing that every single American needs to experience. It’s powerful. The buildings were meant to inspire and awe and intimidate foreign leaders. So what do you think they do to regular ol commoners like me and you? Pretty impressive. Even if you dislike most politicians like I dislike most politicians. Day 1 was getting there.

We got up at 4:00 am to get to the 6 am flight. Got to DC by 1:30 . Hopped onto the metro and boom, we’re at the hotel. If you’ve never experienced the DC Metro, hell that is reason enough to go all by itself. It’s a work of art and I’m constantly fascinated by it. You can go just about anywhere you want easily and in no time with no traffic. That doesn’t mean there no walking involved though. Bring a pair of walking shoes my friends. The first full day we logged over nine miles. The second full day was about 8 and a half miles. Same on the third. Bout 5-6 miles on the fourth day.  Unless you’re doing the bus tours and all, you’re in fir walking. Plain and simple. I’m always good for 5-6 miles. 9-10 in a day is a bit more than I want. I can do it, but it’s damn sure extra. But, we saw the Lincoln Memorial, WWII memorial, Vietnam Wall, Washington monument, White House, Capitol, air and space museum, natural history museum, American history museum, national art gallery with this hemisphere’s only Da Vinci painting, Mt Vernon, Arlington National Cemetery and the changing of the guard, Old Town Alexandria, and much much more.

It was a go-cation and I’m glad to be back home so I can sleep and get some rest. It’s bad when going to work is a vacation from your vacation.

Professionally, just getting into the swing of things with our Nurse Practitioner. He’s catching on slowly but surely. It’s happening. Never fast enough. But I see it happening. We’re also getting into the swing of things with our Parker Intern.  He’s a good guy. Seems to be a smart guy and seems to click right along with everything we do so all’s well there. It’s been fun teaching him. So, I’m still playing catch-up from being gone so let’s hop in.

Item #1

This first one is called “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries”’ by Whedon et. al. (Whedon JM 2021) and published in Spine Journal on May 11 of 2021. Schiza!!! Es Caliente!  I just combined German and Spanish. Please make note. And recognize. 

Why They Did It

The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

How They Did It

• They combined elements of cohort and crossover-cohort design.


• They examined Medicare claims data spanning a five-year period. 


• They included older Medicare beneficiaries with an episode of cLBP beginning in 2013. 


• They analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.

What They Found

• SMT was associated with lower rates of escalation of care as compared to opioid Analgesic Therapy. 


• The adjusted rate of escalated care encounters was approximately 2.5 times higher fi the initial choice of care was opioid analgesic therapy vs. if the initial choice was SMT

Wrap It Up

Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy

Item #2

I want to thank my friends at ChiroUp for finding this one. They’re always on top of it at ChiroUp. Don’t forget to use my code, Williams15 if you want to sign up with them for a discount! Number 2 this week is called,