In this episode, Dr. Ronald Farabaugh and I discuss his recent systematic review regarding the cost of chiropractic vs. medical management of adults with spine-related musculoskeletal pain. Dr. Farabaugh has been in practice in Ohio since 1982. He was appointed by the Governor in 1994 to serve on the Healthcare Quality Advisory Council to help design managed care programs for the Bureau of Workers’ Compensation (BWC), specifically Qualified Health Plans (QHP). He became the 1996-President of the Ohio State Chiropractic Association. He is the former Chairman of the CCGPP (Council on Chiropractic Guidelines and Practice Parameters). He was past president of the Ohio Chiropractic State Board, appointed by Governor Strickland in 2010. He is on the ODG-Board of Advisors (Official Disability Guidelines). He currently serves as VP and National Physical Medicine Director for Advanced Medicine Integration Group, LP (AMI).
Dr. Farabaugh was appointed to serve on the Scientific Commission of The Clinical Compass and he has published 15 papers on clinical practice guidelines in peer reviewed journals including the paper that we will discuss today on cost-effectiveness that just came out in March of 2024.
https://chiropracticscience.com/wp-content/uploads/2024/03/DrFarabaughimage.jpg505384Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2024-03-19 10:54:412024-03-19 10:55:56066- Dr. Ronald Farabaugh – The Cost of Chiropractic vs Medical Management of Adults With Spine-Related Musculoskeletal Pain
Dr. Daniels and I discuss some of his publications dealing with prior spine surgery, medications for low back pain, suicide prevention, and health promotion. Dr. Clint Daniels is chiropractic section chief at VA Puget Sound Health Care System in Tacoma, Washington where he supervises a team of 9 chiropractors and is a resident director. He serves on the VA chiropractic Field Advisory Committee as the Research Coordinator, is a scientific commission board member for Clinical Compass, and is appointed to the Washington State Health Technology Clinical Committee. He is a 2010 chiropractic graduate from Logan University, where he also received his Master of Science in Sports Science and Rehabilitation. He worked in private practice for 4 years, and then joined VA and was the first graduate of the St. Louis VA chiropractic integrated clinical practice residency program. He has authored and contributed to numerous scientific publications on the topics of chiropractic integration into veteran and military facilities, postsurgical spine pain, suicide prevention, chiropractic best practices, and numerous case reports on a variety clinical presentations.
https://chiropracticscience.com/wp-content/uploads/2023/06/ClintDaniels.jpg439410Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2023-06-15 14:08:472023-06-15 14:17:14065- Dr. Clinton Daniels Discusses Manipulation and Prior Spine Surgery, Medications for Back Pain and More
Dr. Matt Fernandez is a registered chiropractor in Australia and is currently a senior lecturer at Central Queensland University (CQU), where he teaches and supervises students in the Master of Chiropractic program. Prior to his CQU appointment, he was a lecturer at the Department of Chiropractic, Macquarie University. Matt is very passionate about research and following the completion of his PhD at the University of Sydney, he now leads various research projects and supervises research students. He also regularly presents his research at conferences in targeted areas that advances the knowledge and understanding of chiropractic through physical activity, exercise and patient education interventions. Matt is also a member of the inaugural CARL fellows.
In this episode, we discuss physical activity, exercise, practice guidelines, and the chiropractic profession.
Dr. Robert Trager is a chiropractic physician and researcher at University Hospitals, in Cleveland, Ohio, in the United States. In this episode, we discuss his research covering a variety of clinically focused topics at the intersection of medicine and chiropractic, ranging from case reports to health service utilization. Dr. Trager first became interested in research when he was an undergraduate student at Northeastern University, where took part in a co-op program that got him hands-on experience in a research laboratory. He then attended Logan University, graduating in 2013, and has since practiced in an integrative healthcare setting.
Here are the articles we discuss in this episode. We also talked about the article that Dr. Brian Anderson and I discussed on episode 61 of the podcast.
https://chiropracticscience.com/wp-content/uploads/2023/01/Dr.Trager.jpg420300Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2023-01-09 11:01:322023-01-09 11:01:33063- Dr. Robert Trager Discusses Spinal Manipulation, Lumbar Discectomy and Case Reports
Dr. Lindsay Gorrell and I discuss her research regarding spinal manipulation, the vertebral artery and reporting of adverse events. Lindsay Gorrell completed her clinical training in Chiropractic and a Master of Research (The effect of manual and instrument applied cervical spine manipulation on mechanical neck pain) at Macquarie University, Australia. She then completed a PhD (Musculoskeletal Biomechanical and Electromyographical Responses Associated with Spinal Manipulation) under the supervision of Drs Walter Herzog and Jay Triano at The University of Calgary, Canada. She is now working as an International Research Fellow at the Balgrist University Hospital, University of Zurich, Switzerland. Lindsay is also studying a Master of Science in Medical Education at The University of Oxford, England.
Lindsay’s research interests are centered on investigating: i) the delivery of spinal manipulation; ii) the physiological responses and clinical outcomes occurring in response to spinal manipulation; and iii) the safety of the manual therapy. This requires different experimental approaches depending on the research question of interest. Most recently, she has published on the relationship between the amount of strain experienced by the vertebral artery, the 3D movements of the head and neck and the forces applied by clinicians during cervical spine manipulation and physiological responses to cervical and upper thoracic spinal manipulation. Lindsay has maintained part-time clinical practice since graduation.
Dr. Brian Anderson and I discuss the article, Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US (2022). We question the relationship between chiropractic and emergency department – ED visits in this paper. Does it makes sense that those who first saw a chiropractor had the lowest out of pocket and overall costs of care, the least hospitalizations and serious illnesses out of any provider type and yet had the highest emergency department – ED visits? Furthermore, those who first saw a chiropractor ranked second lowest of all providers for early opioid prescription, long opioid prescription, MRI/CT imaging, and surgery.
If you have not listened to Dr. Anderson’s podcast episode on chiropractic, treatment escalation, and medical services, please visit here.
https://chiropracticscience.com/wp-content/uploads/2022/12/briandean.jpg290357Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2022-12-13 16:01:242022-12-13 16:01:26061- Questioning the Relationship Between Chiropractic and ED Visits
Dr. Brian Anderson DC, MPH, MS, PhD is an Assistant Professor within the Palmer Center for Chiropractic Research (PCCR) at the Palmer College of Chiropractic, where his research is focused on evaluation of nonpharmacological spine care delivery in the US. His background includes 15 years of clinical experience as a licensed chiropractic physician in a variety of settings, including private practice, a hospital-based integrative medicine center, and a chiropractic academic teaching clinic. He has also been an educator for the past 15 years, teaching courses at the undergraduate, graduate, and post-graduate level. With a passion to better understand and contribute to conservative spine care research, he enrolled in a PhD program in Health Sciences in 2015 with a focus on Health Services Research. His dissertation was titled “A Secondary Analysis Of Insurance Claims Data To Determine The Association Between Provider Type And Treatment Escalation In Musculoskeletal Disorders”, which is a topic he continues to investigate currently. In this interview, we discuss his journey from chiropractor to researcher, and several of his publications.
After graduating with his PhD in 2019, he joined the faculty at the Palmer Center for Chiropractic Research, where he participated in a pilot clinical study as a treating clinician, developed relationships with several research collaborators, and made progress towards developing his own research program.
Dr. Anderson’s research has been presented at many academic conferences, for which he has received several best paper awards. He is currently a co-investigator and primary analyst on a R15 grant titled “Spinal Manipulative Therapy vs Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain”. He was recently awarded a 2-year Loan Repayment Award through the National Center for Complementary & Integrative Health (NCCIH), and also participated in the Fall 2022 cohort of the US Bone & Joint Young Investigators Initiative.
https://chiropracticscience.com/wp-content/uploads/2022/11/DrBrianAnderson.jpg500400Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2022-11-17 16:31:562022-11-17 16:31:57060- Dr. Brian Anderson Discusses Chiropractic, Treatment Escalation, Medical Services
In this interview, Dr. Scali discusses with me the upper cervical spine and myodural bridge (connective tissue between suboccipital muscles and the cervical spinal dura mater). Dr. Frank Scali grew up in Valley Stream, Long Island, New York, and studied Neuroscience at Stony Brook University. In 2009, he received his Doctorate in Chiropractic at Logan University in Chesterfield, Missouri. During his time in medical school, Dr. Frank Scali professionally prosected cadaveric specimens for Gray’s Anatomy and illustrated for multiple journals and textbooks, including the Oxford Handbook of Bariatric Surgery. While attending medical school, he published multiple non-variant anatomical findings in the medical literature and served as an Ad Hoc Reviewer in Journals such as The Spine Journal, The Anatomical Record, Surgical and Radiological Anatomy, and others. In 2018, he graduated with his MD from AUC School of Medicine with fifty-four publications, including textbook contributions and a patent for a medical device.
Dr. Scali is board certified in Chiropractic and Medicine. His current title is Assistant Professor of Medical Education and Anatomy at the California University of Science and Medicine. At CUSM, Dr. Scali serves as the Director of the ATLAS Lab Center, is the Director of the USMLE Board Preparation, and is the Course Director for MSK/Derm, Surgical Anatomy, and the Step 1/2CK Board Prep course. He was inducted into the Sigma Xi Scientific Research & Honor Society in 2020 and serves on the Editorial Board for the Journal of Medicine since 2019. As Assistant Professor of Medical Education, Dr. Scali has achieved dozens of teaching awards in Medical Foundations, MSK/Derm, Neuroscience, Reproductive Medicine, and Medical Board Preparation courses. Because of his innovative teaching style, in 2021, Dr. Scali became the inaugural recipient of the Robert Suskind & Leslie Lewinter-Suskind Pre-Clinical Faculty of the Year award.
Dr. Carlos Gevers joins me to discuss mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. He also shares a study on Tumor Necrosis Factor-Alpha in Urine Samples of Patients With Chronic Low Back Pain Undergoing Chiropractic Care.
Carlos Gevers Montoro is a second-generation chiropractor. He graduated from Life Chiropractic College West in 2003 as Valedictorian and the recipient of the Clinical Excellence Citation award. After practicing for a few years in Spain and France, he was instrumental in the opening of the Madrid College of Chiropractic (MCC), where he still lectures. His contributions at the MCC were mostly related to the clinical sciences. In parallel, he served for seven years as the President of the Spanish Chiropractic Association, being involved in chiropractic politics and policy at the national and international level.
In 2018 he decided to switch gears and take a completely new path in the research arena. He started his PhD in Pain Neurosciences at UQTR – University of Montreal joint program under the supervision of Prof. Mathieu Piché. His PhD studies are partially funded, by a prestigious grant from the Government of Quebec. His line of research and his first publications are mostly focused on mechanisms of spinal manipulation, particularly as they relate to central sensitization and neuroinflammation. These two phenomena seem to be strongly implicated in the development of chronic pain syndrome and other conditions.
In this episode, Dr. Meier discusses how people move differently in the presence of (or in anticipation of) pain. Changes in motor control may play an important role in musculoskeletal pain. His lab uses a cross-disciplinary approach that combines neuroscience and movement biomechanics to provide new insights into the role of potential interactions between movement behavior, psychological factors and supraspinal mechanisms in the development and maintenance of persistent low back pain. We’ll touch also on fear avoidance and pain related movement avoidance. Dr. Michael L. Meier is a senior pain researcher and group leader at the Department of Chiropractic Medicine at the University of Zurich. He received his master’s degree in neuropsychology and his doctorate in cognitive neuroscience from the University of Zurich, focusing on the processing of pain and nociception in the brain. In 2019, he received a grant from the Swiss National Science Foundation (SNF) to study the role of movement behavior and cortical processes in the development and persistence of low back pain. A hallmark of his work is linking research from different disciplines such as biomechanics, neuroscience, and psychology, shedding light on novel interacting pathomechanisms underlying persistent low back pain whose pathoanatomical cause is often unclear.
https://chiropracticscience.com/wp-content/uploads/2021/09/MMeier2021.jpg525350Dean Smith, DC, PhDhttps://chiropracticscience.com/wp-content/uploads/2017/01/chiroscience-logo-website-title-300x167.jpgDean Smith, DC, PhD2021-09-23 15:46:162021-09-23 15:46:19057- Low Back Pain, The Brain and Movement with Dr. Michael Meier