Author: Dr. Robert Speirs DC

Chiropractic as THE alternative to Opioids.

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In 2015, two million Americans had a substance abuse disorder involving prescription pain relievers; with more than 20,000 overdose deaths related to these drugs. In the past decade, death rates and substance use rates quadrupled in parallel to sales of prescription pain relievers.

Chronic LBP is a primary generator for opioid prescriptions. This year, both JAMA and Annals of Internal Medicine have published and supported new clinical practice guidelines that recommend prescribing spinal manipulation over medication for LBP patients.

“For acute, subacute, or chronic low back pain, physicians and patients initially utilize spinal manipulation and delay pharmacologic management.”

Research shows that low back pain patients who undergo chiropractic care have improved outcomes with lower rates of opioid use, surgery, and overall healthcare costs.

Not surprisingly, various governing bodies, including the FDA, CDC, and 37 State Attorney General’s, have concurred that physicians and healthcare decision makers should consider non- pharmacologic therapy for LBP patients. In fact, the 2018 Joint Commission guidelines mandate that hospitals include conservative options for chronic musculoskeletal pain management, specifically naming chiropractic as a potential option.

Chiropractic care is not a replacement for traditional medical treatment of LBP, rather a complementary tool to integrate within your current management paradigm. We hope that you will continue to consider our office for those cases that may be favorably served by conservative manual therapy. We are grateful for your confidence and will work hard to maintain your trust.

Do I Need an MRI?

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Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!
Patients will often bring in a CD that has an MRI of their lower back to a doctor of chiropractic and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!
Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!
This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.
Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!
Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain!  So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs.  If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Preventing Fibromyalgia?

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​Fibromyalgia (FM) is a common cause for chronic pain (pain that lasts three or more months) and afflicts 4% of the general population in the United States! FM commonly affects the muscles and soft tissues – not the joints (like arthritis); however, many FM sufferers are mistakenly diagnosed with arthritis, so it may take years before they get an accurate diagnosis. There are NO known accurate diagnostic tests for FM, which is another reason for a delayed diagnosis.

In order to answer the question, “Can fibromyalgia be prevented?” we must first find the cause of FM. There are two types of FM: PRIMARY and SECONDARY. Primary FM occurs for no known reason, while secondary FM can be triggered by a physical event such as a trauma (e.g., car accident), an emotional event or a stressful situation (e.g., loss of a child), and/or a medical event such as a condition like irritable bowel syndrome, rheumatoid arthritis, or systemic lupus erythymatosis (SLE). Any condition that carries chronic or long-lasting symptoms can trigger FM, and some argue that the lack of being able to get into the deep sleep stage may be at the core of triggering FM since sleep disorders are a common finding in FM sufferers!

The “KEY” to managing FM has consistently been and probably always will be EXERCISE and SLEEP. So, if FM is preventable, daily exercise and getting the “right kind” of sleep are very important ways that may reduce the likelihood for developing the condition! Since emotions play a KEY ROLE in the cause and/or effect of FM, applying skills that keep life’s stressors in check is also important. This list can include hobbies like reading a good book, playing and/or listening to music, or meditation. The combination of exercise with mindful meditation using approaches like Tai Chi, Yoga, Qi Gong, and others has had positive impacts on FM patients such as improved balance and stability, reduced pain, enhanced mental clarity, and generally improved quality of life. Managing physical conditions that are associated with FM (such as irritable bowel syndrome, rheumatoid arthritis, or systemic lupus erythymatosis) is also important in managing and/or preventing FM.

Another management strategy of FM is diet. As most patients with FM will agree, certain foods help and others make the FM symptoms worse. In a survey published in the Journal of Clinical Rheumatology, 42% of FM patients reported certain foods exacerbated their symptoms. Of course, each individual case is unique, so keeping a food log or journal can be very helpful to determine dietary “friends” vs. “enemies.” The first step is to eliminate certain foods for four to six weeks, such as dairy and/or gluten. Most patients report a significant improvement in energy (less fatigue) while some report less pain when problem foods are eliminated from their diet. Generally, a diet rich in fruits, vegetables, and lean proteins can have a positive impact on the FM patient. Consider eating multiple small meals vs. two or three large meals during the day, as this can keep blood sugar levels more stable and reduce fatigue.

So back to the question, can fibromyalgia be prevented? Maybe…maybe not. Since the medical community doesn’t know the exact cause, it’s hard to answer this question. However, being proactive and implementing the strategies used to better manage FM may help in preventing it as well!

If you, a friend or family member requires care for Fibromyalgia, we sincerely appreciate the trust and confidence shown by choosing our services!