Click here to download the transcript.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. We suggest you watch the video while reading the transcript.
Hi, I’m Dr. Mark Studin and thank you for sharing your time with me today to discuss Addictionology Low Back Pain and Chiropractic. First, I’d like to thank ChiroSecure for the opportunity to present on this platform as they’ve always taken a very progressive role in bringing the latest information in the industry to you.
So let’s get right to it and put up the screen now when we talk about addiction. And Addictionology is a relatively recent specialty within medicine. I was introduced to a, to an addictionology specialist, a medical doctor. And with that doctor, let me just go to the next screen, see if this will work.
There we go. Okay. I was introduced to an addictionology specialist actually when I sold the. And I owned a building and he came in, he wanted to put addiction treatment centers in there. And we really I really got quite an education. He was trained at Mount Sinai School of Medicine in New York City, became an ER doc, trained at John Hopkins.
His credentials were pristine and he went into Addictionology based upon his understanding or his experience in the emergency room, watching addicted patients come in and just, it’s like a revolving door over and over, and. And years ago, dealing with the State University of New York at Buffalo Jacobs School of Medicine and biomedical sciences researchers up there said to us years ago, if you could just get rid of the underlying back issue, which by the way is the fifth most prevalent diagnoses.
We’ll talk about that in a little bit. For primary care providers, then we could work on that addiction stuff. And this doctor said the exact same thing to me, but what’s the core of the. The core of the problem is simple. There’s a dogmatic understanding.
Non anatomic pain and anatomic pain is fracture, tumor infection, and herniation. Non anatomic pain is called non-specific, and in non-specific pain medicine really has zero solution. So even in, in a recent research order, the last year reported according to chronic, accordingly, chronical back pain and neck pain are considered non-specific.
In a large majority of cases, in large majority is 98%, meaning the pain cannot be attributed to a specific origin or to a pathology detectable with imaging methods. So that dogma has perpetuated and it’s extremely problematic. But when you look at spine pain generators, Here they are. The spinal cord can be a gen pain generator.
You could see that on imaging, especially with herniated discs or tumors or infections. The nerve root itself is a pain generator. That’s the nerve root, which is in the neural canal, exiting at the, or within the canal below the conus. Meis in the quarter aquina. And you can image those easily.
The fecal. The fecal sac is the covering of the spinal cord and spinal nerves, and you two can image that as well. Then you have the disc itself. The disc has the recurrent meningial nerve, which normally resides in the ato one third of the disc. It used to be called the sinu vertebral nerve, and you could really image the auto one third of the disc.
Look at look to see if it’s degenerated. That’s, Then there’s cord edema, which leads to myelomalacia. First is swelling, which you can image easy, and then over time if there’s swelling that compresses the vessels and then the nerve cells start to die, and then the cord starts to die and you get myelo.
We’re gonna skip the next one, then we’re gonna go to chemical Ridiculitis. When we look at chemical ridiculitis You’re seeing usually a tear in the annus where a piece of that nucleus prop material comes out and contacts at some degree of the nerve root, somewhere, either within the canal or as it exits.
All of those things are pain generators, which happens maybe in, in not 2%, a little bit more. That 2% is surgical, but maybe 90% of. But what you can see, or at least in medicine doesn’t know how to see, is connective tissue pathology, which is in specifically ligaments.
And that’s what we’ve heard. If you lived in the personal injury world of strain sprain, it’s soft tissue, it’s nothing. I hate when they say soft tissue. It’s nothing. Your brain, your liver, your spine your spleen, your spinal cord, that’s all soft tissue. It’s not nothing. It’s something. And connective tissue in of itself is an organ.
And you also have significant ligamentous issues which create problems. And it is demonstrable. So connective tissue really is responsible for upwards of 98% of back pain. And if you look at this piece of technology, which I’ve talked about in the past, called Sim Verta on this on this slide, you could see that there are little dots here.
And when you look at those dots, by the way, it’s gonna be a little disconcerting for you. For me to move my mouse, I have to look at a screen to my. When I’m looking back at you, I’m looking this way, so I apologize for turning my head, but when you look at the screen here, you could see little dots in the corner of the vertebra.
That’s called X-ray digitizing. And when we digitize inflection and extension, we look at the movement either forward and back in translation or angular deviation, and depending upon the amount of degrees that the. The vertebra rotate or they translate back and forth. We get a number for that, and there are guidelines in the literature.
For those numbers being pathological and depending upon which movement we’re discussing, it can be the facet capsule, the ligament of flava, the anterior longitudinal ligament, the posterial longitudinal ligament, all of those things we are getting, that’s the green line for pathology, or we’re looking at impairment rating, which is the red line, which is an administrative guideline of a whole person.
But nonetheless, we are, this is very, where is this patient has no fractured tumor or infection or herniation. But look, it’s clear where this person’s problem is. It’s between C six and C6 and seven. They’ve got a C6 and C7 problem. This is extremely specific and hearing lies the problem because when medicine goes back, Non-specific back pain.
They don’t know what they’re treating. So what they do is they try to cover up the problem and that is a specific issue. So Dr. Paul Capo, this is what mentioned a moment ago. Let me just read his bio a little bit. Simultaneously earned a Bachelor’s of Science in mathematics at New York University and a Bachelor of Engineering at Cooper Union, which is one of the.
Rigorous schools in the world. Back in 1990, he completed his medical degree at the Mount Sinai School of Medicine. He and then he completed his residency in emergency medicine at John Hopkins. In Baltimore, Maryland, he’s board certified in addiction Medicine by the American Board of Preventive Medicine and Board Certified in Emergency Medicine by the American Board of emergency medicine.
He’s a member of the American College of Emergency Physicians, the American Society of Addictive Medicine. So the guy’s well credentialed, he’s got a great pedigree. He’s not a lightweight, and he’s just unbelievably experienced in. And his quote when I spoke with him yesterday, fixing the cause of the pain is most of the battle and gives the patients hope.
He said, what good is me getting them off of their opiates if they’re back to ground zero for the reason they took the opiates in the first place? Unless you fix the underlying. You have fixed nothing. And that was a powerful statement. And it reminded me, listen, I’m in the game 42 years. I’ve been in a chiropractor since actually 41 years.
December next month will be my 42nd year. But it goes back to what we always laughed about when I was in school back in the 1970s. You’re a DC doctor of Cause we used to say that all the time. You’re a doctor of cause you’re not gonna treat the problem. And the immature, stupid person that I was.
Years ago said, oh great, this person’s an addiction specialist. He was the one that created the addiction in the first place by giving the opiates, and now he has to fix it. Guess what? That’s partly true, but it’s not the real issue and it’s not the real truth. The truth is up until recently, chiropractic hasn’t stepped up to the plate to give us the evidence in the literature in the scientific community because MDs are cla.
For real solutions that are not anecdotal. They want to refer, they want to be able to say, Hey and right now the evidence does point to all of these things and has given us the ammunition. Listen, I have doctors that I placed in hospitals. I have doctors I placed, I’m. He’s got six locations on Long Island.
I’m placing a chiropractor in all six of them right now, and everything is based on the evidence, every single thing. So let’s look at a typical MD primary Care Triage. Let’s see how this works and how people end up in addiction or being addicted. Number one, they go to the primary care. Fifth most prevalent diagnosis is back pain.
And we’re gonna talk about the training on musculoskeletal care. Primary care, which is virtually nothing. Theor, muscle relaxers usually fit treatment fails cuz it just doesn’t work. Then they go to the surgeon. 98% of the surgical issues are mechanical and non-specific. They can’t treat ’em. Then they go to physical therapy for the first provider.
PT doesn’t help for. PT is not a solution. We’re gonna talk about that as well. Then they fail and they go back to the ortho with the primary care and they go back on muscle relaxers, steroids, painkillers and opiates, and it goes in a circle till they go to a final solution, which is the pain management doctor, which is legalized addiction.
And that’s a problem and that’s a huge problem. And it goes in circles. So they end up there because they have no other solution. In a recent article written by Humphreys, et cetera, in 2007 in the United States, upwards of 25% of all visits to primary care medical doctors are musculoskeletal complaints.
Yet it has been estimated that less than 5% of the undergraduates. In graduate medical curriculum in the United States, and 2.2% in Canadian medical schools developed to musculoskeletal medicine, yet 25% of their patients are musculoskeletal, but yet less than 5% of their education. The following results were published.
In this paper for basic competency examination of various professions, and they found that recent medical graduates had only an 18% competency in musculoskeletal medicine, medical students and staff physicians, 20%, even osteopathic students, 29%. And another article. By Rini Monsoon, et cetera. Reporter regarding medical providers, 92.2% believe that musculoskeletal education has not been sufficient for general medical practitioner training.
They get it. They understand it. However, Whedon in 2013 reported that an annual charge per person filling in opioid pres. It was 74% less if they saw a chiropractor versus an MD or pt, et cetera. We also reported in 2018 that there were 55% lower recipients of opiates if they saw a doctor of chiropractic compared to non recipient pt, md osteopath, exercise, rehab, acupuncture, on and on.
Then another article came out two years later, which is two years ago by Corcoran, which said the same thing reported that the proportion of patients receiving opioid prescriptions was 64%. PTs, MDs, dos and all other treatment. So the evidence is out there. By the way, this one page got the attention of that Addictionology specialist, but according to independent research, me, I lecture and speak to hundreds of surgeons around the country, orthos, neurosurgeons pain management specialists.
Only 2% of their cases require surgery. Where do the other 98% go, folks, today? Pub, today’s web published, published care. No, this is web. Today’s web published Care Paths for non. Let’s talk about non-specific back pain. Let’s go to two highly regarded institutions, the Cleveland Clinic that talk about low back pain, non-specific issues.
These patients may best be served through prompt access to care from physical. Or a nurse practitioner is an entry level. Providers, when pain persists beyond four to six weeks, CarePath defines when referral to spine pain spine pain specialist, spinal surgeons or behavioral health providers. I dealt with someone in the va.
They misdiagnosed her. She screwed, they sent her to back pain school. That back pain. Which cost five times as much as a chiropractor would cost. It’s just absurd. The Mayo Clinic physical therapy is the cornerstone of back pain treatment. A physical therapist can apply a variety of treatments such as heat, ultrasound, eim, and muscle release techniques to your back muscles and soft tissue.
The Mayo Clinic does list chiropractic now. They amended it, they put it after rest, doing nothing surgery. . And then under your supervision of your physician, of your medical doctor, then you might want to consider a chiropractor. After all of those things have failed implanting electric muscle stimulators, surgical, after all of those things, it’s just beyond crazy.
But the question is, Where do those other 98% go? Today we’re focusing on the 98% in capturing that market share based upon the evidence and avoiding unnecessary opiate use.
Physical therapy. I love physical therapy, by the way, for everything, but it’s fine. I love physical therapy and I’ve worked with many incredibly great PTs. I’ve had my hip replaced. I needed a PT to help me to learn how to walk shoulders, elbows, extremities, it’s great. Humphreys in 2007 published a paper again for basic competency, and they found a passing score of 70% better on musculoskeletal.
Physical therapist at the master’s level had a 21% passing physical therapist at the doctorate level, 26%. And chiropractic students, much to my dismay, was only 64%. But still, it’s almost tripled out of physical therapists now. I. When you talk about a doctor of physical therapy, they learn more of the same.
They’re not learning how to diagnose, analyze, create prognosis. They don’t learn how to do those things. It’s not within their training. But according to Blanch, in 2016, medical medicine versus chiropractic had a 12% longer. Disability, full disability than chiropractic and physical therapy. If they were, the first provider had a 239% more.
Full compensation and 313% increase in partial dis I said compensation, I meant disability. So a 239% increased disability to full being fully disabled, and 313% more being partially disabled. Then if chiropractic was the. Provider Ente reported a 32% decrease in average. Weekly cost of medical expenses for chiropractic care were cheaper and Ma.
And Al reported just managing low back pain. Just managing, and this is a 2013, had 106 billion increase. They’re spending $106 billion when with PTs, when they have a 313% increase partial dis. It just doesn’t make sense. There are 64% more opiates. It just doesn’t make sense. It just doesn’t make sense.
So let’s move on. Ente reported there was a 250% decrease in disability compared to the MV with chiropractic. Day at AL reported 82% of fourth year Harvard medical students fail the basic competency in musculoskeletal. Divo, she revealed that 80% of chiropractic patients exhibited decrease in pain, verified by luxury Diagnostic testing.
Had another article in here which showed that 96% of chiropractic patients had satisfaction based upon pain decrease, and on. Here’s the outcome, folks of the perpetuating this failed care path. It just perpetuates. You live into drugs, you have no choice. You can’t function.
Then you get addicted or sick and you still can’t function with the drugs. But the other part of the problem is that the bones are still out of position. You’ve got biomechanical failure and based upon the Pier Electric effect, which was defined, I think about 50, 60 years. You get Wolf’s law come into effect, which was actually coined by Julius Wolf, I believe, in 1853, where bones will remodel.
Now you’ve got remodeling of a spine because you’re trying to fix a mechanical problem with a pharmac, Pharmac pharmaceutical issue. A pharmacological issue. You cannot, you. Fix a mechanical problem with a pharmacological solution, there can never be because the drug is not gonna move that bone.
Now, here’s what Dr. Capo stated. With the advent of an addiction specialist, they have understood and searched for a solution to the underlying cause of the fifth most prevalent reason for visiting a US doctor. Low back pain and the reference. Addiction specialists are searching for the education of the cause of the pain that led to the opiate use initially, and chiropractic outcomes of warranted inclusion into their treatment plans for the management of substance addiction.
The challenge that addiction specialists must overcome with using chiropractic is coverage issues where Medicaid and workers compensation system place unrealistic roadblocks. These systems in every. Full coverage for services that realize 64% higher opiate use and a 313% increase in disability yet still prevent.
Patients from receiving evidence based care that prevents opiate addiction. In New York, for instance, Medicaid does not cover chiropractic, but they cover opiates, they cover surgery, they cover physical therapy. In other states like New Jersey, Medicaid covers chiropractic, it’s $6 a visit. I, it’s just, it’s just crazy.
And in workers comp systems many states are now precluding chiropractic, or they’ve made the gatekeeper, either the employer or the orthopedic surgeons for chiropractic just like they did for, like they did for physical therapy. So they’re actually paying through the nose proverbially for a system or a program that’s proof to fail.
It just doesn’t. This isn’t my opinion. This is people. It is my opinion, but it’s also corroborated by those in the industry all over the globe. They’re looking for the cause of the problem. They’ll never fix the addiction problem. Now folks, this is only the tip of the iceberg. And it’s not just people who are addicted, it’s people walk around with chronic pain.
Chronic pain is deemed that of which is persisted for more than six months. And I believe about 13% of our population in the United States walks around with chronic back pain at any given time, 13%. So if we take the popula, I’m gonna calculate working off to. Times 0.13 equals you’re talking 45 and a half million people are walking around with chronic back pain.
Now, right now in the United States, it’s reported about 50,000 actively practicing ChiroSecure practice. There’s not f unreported actively practicing. I don’t. But let’s be. . Let’s be real. Okay, so if we take 45 million and divide that by 50,000, that means every chiropractor should be treating an extra 910.
New patients every year just for the chronic non-specific back pain patients in this country. Can you imagine that not every one of you would’ve a close practice? Everyone would’ve close practices. It’s just incredible. It’s just unbelievable that this country is spending 106 billion a year for a failed pathway of treating chronic.
This, and I know we’re talking about pain and some of you might be more inclined, you want to treat systemic issues and colitis or breach babies and eczemas. I don’t really care what you do as long as it’s within your lawful scope. But let me share something with you from someone who used to do that at a very high level.
Patients are trained right now and accept chiropractic for back. I don’t want to pigeonhole you as a back pain doctor, but I don’t care why they come into your office. You can educate them any way you want, but if they don’t come in your office, what good is having all this wonderful theories and philosophies and experiences and helping people.
I’ve had, I’ve seen miracles in my office through the years. Really, truly miracles. And I have to tell you, my practice took. When I stopped marketing advertising, or just focusing on those miracles with the average patient in the street, I started talking about back pain and neck pain. And the next thing I knew, my practice took off.
And then while those patients are in my office, I would educate them and they tell their friends in the, oh, Dr. Stu, do you know he helped all these people with asthma. The next thing I knew, those back pain people referred dozens of asthma patients into my office. Guess what? They threw their medicine out.
Also. It’s not that I treat asthma, I treat the underlying cause. They didn’t need the, they didn’t need the drugs anymore in those inhalers. Just like this doctor, Dr. Capo says, I don’t give a crap what you do to them. If you fix their underlying problem, I can help them throw away their drugs, but if you don’t fix it, I’m not helping ’em throw away their.
And it doesn’t matter what condition you’re doing that for. And again, if you are looking for an evidence based pathway, and I am a big evidence dude, if you are looking for an evidence based pathway, this technology, some verta that we talk about, this technology right here, We’ll tell you exactly where that lesion is because folks truly, and really it’s very specific, it’s very easy to see.
It’s very easy to do, and all you need is a simple x-ray and let me clear up one myth. X-ray has, regardless of the political rhetoric from our national organization, singular x-ray has no negative side effect. Zero. In order for you to have a side effect of an x-ray, a negative side effect, you would need to take a minimum of 52 lumbar x-rays in any one setting or in any one given time because also x-ray is not cumulative.
So if you take an x-ray today, in a month from now and a month from now, it’s not cumulative and that’s not my opinion. It’s right from the evidence of the litera. You need a hundred millis at any one time of radiation, and that’s a radiation dose to have a negative effect and a negative effect means less than one in 100,000, which is still and of itself almost nothing.
A lumbar x-ray I believe has 1.52 milli serves of radiation. So you need 52 or 54 lumbar x-rays just to have one than 100,000 issue. And in fact, X-rays serves to be an anticarcinogenic property. In many human cells, there are zero. Zip not a zilch in the totality of the literature. And some people say let’s go back to Hiroshima and look at that radiation.
My goodness, I’ve heard that crap until I wanna vomit. The amount of radiation is like thousands of milli serves from that. That’s not what we do in a diagnostic clinic, in a chiropractic office. You can’t hurt your patient by taking an x-ray. It’s just not possible. Based upon the evidence in the scientific literature, it’s not my opinion, and it’s all over the literature, and that’s according to the American society of medical physicists, radiation physicists, and a myriad of other things.
So you really need the evidence. Simple x-ray. Look at how much the bone moves. You can see what ligaments are now pathological. You have very specific back pain. This picture right here is the cause of many doctors getting hundreds and hundreds of referrals from surgeons and medical primary care providers because they can see based upon the evidence, and what I’m sharing with you is all evidence based.
This graph right here is based upon what’s in the literature. It’s all evidence based. It’s all there. Listen, I could go on and on and I really would love to. So if you have any questions, I’d love to hear from you. Give me a jingle. I’m Dr. Mark Studin. We’re from the Academy of Chiropractic.
If you have any questions, you want some research, you want to take courses just go to the academy of chiropractic.com. Again, I would like to thank ChiroSecure so much for giving me the platform to share this with you. I’ve been doing it for quite some time and I like it, so I’m gonna keep doing it until they tell me to, not to come anymore.
So listen, thank you so much. See you next time. Have a great day!