Opioid Use Disorder, Physical Therapy, and Chiropractic & Neural Mobilization And Pain

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 356: Opioid Use Disorder, Physical Therapy, and Chiropractic & Neural Mobilization And Pain Today we’re going to talk about Opioid Use Disorder, Physical Therapy, and Chiropractic & Neural Mobilization 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 [e-mail] 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 excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s 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 #356 Now if you missed last week’s episode, we talked about Daily Water Intake & Curcumin Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Christmas is over now and this week we contend with New Year’s Day. What a pain in the butt, right? I enjoy a day off here and there just like anyone else but right in the middle of the week two weeks in a row starts to mess with business. So, last week I worked Monday, 1/2 of Tuesday, and 1/2 of Friday so basically two full days if you combine it all. We ended up with about 75 chiro patients for the Christmas week. That’s not great buut it’s better than nothing. Especially when you total the profit on 75 patients vs the total profit on zero patients had I chosen to take the full week off. Then, this week, we have New Years Day off and we’re slow becauuse it’s the damn holidays and, of course, insurance people renew on January 1st, so it’s looking bleak this week, folks. Typing out on a Monday, I have 78 or so for the whole damn week. Of course that will grow because Monday will re-book and then re-book again on Friday but that’s still bleak.

What I’ve discovered over my career that you may or may not agree with is that the last 2 weeks in December and December as a whole really…it starts to slow up. People are getting ready for Christmas, xmas parties, buying gifts, and things like that. Then the insurance plans re-set in January and it just takes some time to re-engage in healthcare for these folks. So we start to see February as a growth month and start to hit our full stride again in March. That’s my experience anyway.

I have 2 Airbnbs and I can attest that I’ve been booked at almost 100% capacity for months now but January and on are almost empty at the moment. It’s just that time of the year so, if you’ve slowed up like I have, you didn’t do anything wrong. It is what it is. Take this break to plan for 2025. Don’t have a plan? Get one. Use AI to give you ideas for growing your practice in 2025. At this point, its almost a crime to not be taking advantage of AI for purposes like these. OK, on to the research…

Item #1

Our first one this week is called, “Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis” by Moyo et al and published in The Journal of Pain in 2024….and it’s muy en Fuego!

Remember, the citations can be found at chiropracticforward.com under this episode.

Patience Moyo, Jessica S. Merlin, Miriam George, Theresa I. Shireman, Brandon D.L. Marshall, Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis, The Journal of Pain, Volume 25, Issue 3, 2024, Pages 742-754, ISSN 1526-5900, https://doi.org/10.1016/j.jpain.2023.10.003.

Why They Did It Nonpharmacologic approaches are recommended as first-line treatment for chronic pain, and their importance is heightened among individuals with co-occurring opioid use disorder (OUD), in whom opioid therapies may be particularly detrimental. Our objectives were to assess the receipt and trajectories of nonpharmacologic pain treatment and determine the association of opioid use disorder diagnosis with these trajectories.

How They Did It

• This retrospective cohort study used Medicare claims data from 2016 to 2018 and applied group-based trajectory models to identify distinct patterns of physical therapy (PT) or chiropractic care treatment over the 12 months following a new episode of chronic low back pain.
• We used logistic regression models to estimate the association of co-occurring opioid use disorder with group membership in PT and chiropractic trajectories.
• Our sample comprised 607,729 beneficiaries at least 18 years of age, of whom 11.4% had a diagnosis of opioid use disorder.
• The 12-month prevalence of PT and chiropractic treatment receipt was 24.7% and 27.1%, respectively, and lower among Medicare beneficiaries with co-occurring opioid use disorder (PT: 14.6%; chiropractic: 6.8%).

What They Found The final models identified 3 distinct trajectories each for PT, delayed and increasing use, and early and declining use; and chiropractic, early and declining use, and early and sustained use.

Wrap It Up People with opioid use disorder were more likely to belong in trajectories with little/no PT or chiropractic care as compared to other trajectories. The findings indicate that people with co-occurring chronic pain and opioid use disorder often do not receive early or any nonpharmacologic pain therapies as recommended by practice guidelines.

Item #2 The last one this week is called, “Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain – A Systematic Review with Meta-Analysis” by Baptista et al and published in Clinical Rehabilitation in November of 2023.

Baptista FM, Nery E, Cruz EB, Afreixo V, Silva AG. Effectiveness of Neural Mobilisation on Pain Intensity, Functional Status, and Physical Performance in Adults with Musculoskeletal Pain – A Systematic Review with Meta-Analysis. Clinical Rehabilitation. 2024;38(2):145-183. doi:10.1177/02692155231215216

Why They Did It To investigate up-to-date evidence of the effectiveness of neural mobilisation techniques compared with any type of comparator in improving pain, function, and physical performance in people with musculoskeletal pain.

How They Did It

• The following sources were consulted: PubMed, Web of Science, CENTRAL, CINAHL, Scopus, and PEDro databases; scientific repositories; and clinical trial registers. The last search was performed on 01/06/2023.
• Two reviewers independently assessed the studies for inclusion.
• We included randomised, quasi-randomised, and crossover trials on musculoskeletal pain in which at least one group received neural mobilisation (alone or as part of multimodal interventions).
• Meta-analyses were performed where possible.
• The RoB 2 and the Grading of Recommendations Assessment, Development and Evaluation tools were used to assess risk of bias and to rate the certainty of evidence, respectively.

What They Found

• Thirty-nine trials were identified.
• There was a significant effect favouring neural mobilisation for pain and function in people with low back pain, but not for flexibility.
• For neck pain, there was a significant effect favouring neural mobilisation as part of multimodal interventions for pain, but not for function and range of motion.
• Regarding other musculoskeletal conditions, it was not possible to conclude whether neural mobilisation is effective in improving pain and function.
• There was very low confidence for all effect estimates.

Wrap It Up Neural mobilisation as part of multimodal interventions appears to have a positive effect on pain for patients with low back pain and neck pain and on function in people with low back pain. For the other musculoskeletal conditions, results are inconclusive. As I once heard Dr. Brandon Steele say at a conference, if you have a patient suffering from radiculopathy and you can only give them one thing or do one thing for them, it’s nerve flossing.

I’ve seen it work wonders.

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.

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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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