Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 351: Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain Today we’re going to talk about Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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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• Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #351 Now if you missed last week’s episode, we talked about Acupuncture For Sciatica & Adolescent Cannabis Usse And Academic Achievement. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Being a part of Parker College’s CBI or internship program…..folks…..it Ain’t easy. But, going to school there, I can share with you that it’s never been easy with Parker. Lol. Example, I signed up with the preceptor program with Logan out in St. Louis. I sent in my sample notes, and was accepted and that was it. I don’t hear from them except once a year to make sure I’d like to remain in their program and the answer is always a pleasant yes. Not with my alma mater. Nope, they need the updated license, the updated building liability policy, the updated malpracticee dec page, the updated CPR cert every two years, they need you to watch videos each year, they send emails fairly consitently, and it’s just a whole lot. Honestly. A LOT. I told you that to tell you this; the entire team here at my clinic went to get our CPR certs re-newed last week. I had to stay late to pay for everyone.

My team left and I was talking with the CPR dude and he asked me if my whole team was different from when we came and did the training 2 years ago. I said, yes, completely different. He shared with me that he has seen that with every organization and clinic in town that has come through. I told him that it’s so frustrating to me because I’ve never raised my voice to a team member. Ever. I get frustrated like everyone else. I’m not perfect but yelling isn’t my vibe. I can be calm and direct and they understand, hey, Boss is fussy about this…..let’s get that tightened up. Whatever it is. So, I treat them with respect. Then another big one is money, right?

The least I pay any of them is $18/hr. I don’t cheap out on paying them. They need off to go to a doctor or pick up their kid from school?/

Okay, hurry and we’ll see you asap.

I can’t tell you how many people we’ve gone through in the last 2-3 years but off the top of my head I can think of about 10 and I only have 4 full timers not counting myself. I’m pretty sure it’s more than 10 but we’ll go with it for the sake of the conversation. I used to hold onto staff members for 3 or more years in general. That might demonstrate why 10 in 1-2 years has been such a challenge and so disappointing. It really has been a struggle.

And after so many of them, you start to wonder, “Was it me? Was there something I did or something I could have done better?” Many times, you can answer that question yourself. For example, I had one that went bad on me. At first I didn’t know but then it became overt and obnoxious. I love people and I believe in them and hung on too long. I should have cut that person loose much much faster. This person made life difficult on everyone else after some time and the tension was just thick and palpable toward the end.

I think this person was partly to blame for so much turnover as well. But, who knows? Sometimes, you can’t find something you could have done better. It just is what it is. But, what was somewhat comforting to hear is that it is not only me. It’s everyone. Eveyrone is having the turnover problem. Gen X peoplee like me look at it as a generational issue or a post-COVID issue. I don’t know the issue. I just know that it is indeed a very real issue. However, my current team, I feel really really good about. I have the best front desk member that I’ve ever had in 27 years of practice. My 3 in the back office are all friends and work hard.

We enjoy being at work with each other now and look foward to seeing each other. My new medical team is excited to be here treating our patients and our team loves them. So, as of right now, we are in the best, most positive, most optimistic spot we’ve been in business-wise in at least 2-3 years. This was not a gripe session. This was more of a relaying of a conversation I had but to also say, we’ve gone through this, and may go through it again in the future. However, there is hope if you’re experiencing the turnover problem and just do your best until your reach some level of homeostasis like we finally have reached here in the clinic. It’s still possible in 2024. Alright, onto the research.

Item #1

Our first onee today is called, “A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO’s Package of Interventions for Rehabilitation” by Zaina et al and published in Archives of Physical Medicine and Rehabilitation in November of 2023 and it’s not a year old so that makes it hot, hot, hot! Remember, the citations can be found at chiropracticforward.com under this episode.

Fabio Zaina, Pierre Côté, Carolina Cancelliere, Francesca Di Felice, Sabrina Donzelli, Alexandra Rauch, Leslie Verville, Stefano Negrini, Margareta Nordin, A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO’s Package of Interventions for Rehabilitation, Archives of Physical Medicine and Rehabilitation, Volume 104, Issue 11, 2023, Pages 1913-1927,

This systematic review synthesized recommendations from high-quality clinical practice guidelines (CPGs) on the rehabilitation management of low back pain (LBP) with or without radiculopathy in adult populations. The researchers conducted a comprehensive search to identify relevant clinical practice guidelines, and then used the AGREE II tool to critically appraise the methodological quality of the included guidelines. They selected the 4 highest quality clinical practice guidelines for their final analysis. The key findings were:

• Education: guidelines emphasized the importance of providing patients with tailored education and advice to promote self-management and encourage continued activity.
• Exercise: Recommendations focused on exercise-based approaches, often in combination with other interventions like manual therapy and cognitive-behavioral strategies.
• Multimodal rehabilitation: For chronic, complex cases, the guidelines recommended intensive interdisciplinary rehabilitation programs with a cognitive-behavioral emphasis.
• Limited role of passive modalities: guidelines generally did not support the use of passive physical agents like ultrasound, TENS, and interferential therapy.
• Cautious use of pharmacotherapy: The guidelines recommended judicious, short-term use of medications like NSAIDs and limited the role of opioids and antidepressants.

This seems a bit more weighted toward exercise than anyhting else but for massage specifically, one guideline recommended considering manual therapy techniques like massage as part of a treatment package including exercise, with or without psychological therapy. For acupuncture specifically, one guideline recommended acupuncture for subacute low back pain, but another guideline did not recommend acupuncture for managing low back pain with or without sciatica. But, if you have listened in the last week or so, we covered a paper that addressed acupuncture and low back pain with sciatica that showed it to actually be an effective way to treat it. And for spinal manipulative therapy specifically, for patients with chronic (>3 months) low back pain, the guidelines suggested or recommended SMT to decrease pain and disability, either alone or as part of a multimodal approach.

One guideline recommended considering SMT as part of early intervention for acute and subacute low back pain. The researchers noted that many guideline recommendations were based on lower quality evidence or expert opinion, highlighting the need for higher quality rehabilitation research. Overall, this review provides a synthesis of the current best practice recommendations for the rehabilitation of adults with low back pain, emphasizing a biopsychosocial, multimodal approach centered on empowering patients through education and active treatment.

Item #2

OK, our second one today is called, “The relationship between emotion regulation and pain catastrophizing in patients with chronic pain” by Yuan et al and published in Pain Medicine in July of 2024 and get me an oven mitt… it’s too hot to freakin’ handle. Yan Yuan, Kristin Schreiber, K Mikayla Flowers, Robert Edwards, Desiree Azizoddin, LauraEllen Ashcraft, Christina E Newhill, Valerie Hruschak, The relationship between emotion regulation and pain catastrophizing in patients with chronic pain, Pain Medicine, Volume 25, Issue 7, July 2024, Pages 468–477, https://doi.org/10.1093/pm/pnae009

Why They Did It

Pain catastrophizing (PC) is a cognitive/emotional response to and in anticipation of pain that can be maladaptive, further exacerbating pain and difficulty in emotion regulation (ER). There is a lack of research on the interplay between pain catastrophizing and emotion regulation and its impact on pain. Our aim was to investigate whether emotion regulation exacerbated the pain experience through pain catastrophizing.

How They Did It

• Adults with chronic non-cancer pain of >3 months’ duration (n = 150) who were taking opioid medication were recruited from a large medical center in Pennsylvania.
• A battery of questionnaires was conducted to gather data on demographics, substance use, mental health histories, and health and pain outcomes.
• Measures used included the 18-Item Difficulties in Emotion Regulation Scale, the Pain Catastrophizing Scale, the Brief Pain Inventory–Short Form, and the Hospital Anxiety and Depression Scale.
• A structural equation model with latent variables was conducted to examine our aim.

What They Found

• Both pain interference and severity were significantly positively associated with several psychosocial variables, such as anxiety, depression, emotion regulation constructs, pain catastrophizing, and distress intolerance.
• The associations between subscales and pain interference were larger than the associations between subscales and pain severity. pain catastrophizing fully mediated the paths from emotion regulation to pain experiences.

Wrap It Up

• Our results highlight the importance of several cognitive and emotional constructs: nonacceptance of negative emotions, lack of emotional awareness, magnification of the pain experience, and a sense of helplessness.
• Furthermore, by showing the indirect effects of pain catastrophizing in affecting emotion regulation and pain, we posit that emotion regulation, mediated by pain catastrophizing, might serve a critical role in influencing the pain experience in patients with chronic pain.

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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