Vertebrogenic Pain & Fish Oil Benefit Claims

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 296: Vertebrogenic Pain & Fish Oil Benefit Claims Today we’re going to talk about Vertebrogenic Pain & Fish Oil 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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. 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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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 #296 Now if you missed last week’s episode , we talked about Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. Ugh, the dreaded September slowdown is upon me and the Tri-State Fair. We have a big fair here mid-to end of September every year and people literally take out small loans to take their families to this thing. Who does thtat? I don’t know. Not this family. Even if we were broke. But, I digress. The point being that September is always a challenging month for us and this year is no exception whatsoever. But, we know it’s going to be this way and we expect it so it’s not a surprise or terribley upsetting. It just is so we do the things we gotta do to deal with it. We take that extra time to market. I know that’s called reactive marketing but we have a constant online presence. Constant and consistent. We have email marketing and we have constant internal marketing strategies. It’s not like we only market when we’re slow. We just have MORE time to market when it’s slow. So, we will continue to broaden our footprint this month and see the fruits of our efforts in the next couple of weeks. Time is the same for us all but are you going to waste time? OR are you going to invest time? We choose to invest it. I invest my time in all aspects of my life. You’ll rarely find me sitting idle or just laying around the house with no purpose, goals or achievement happening. Is that healthy? Who knows? But I get a lot done annd I consistently have people asking me how I seem to get so much more done than everyone else?? How do I seem to have more hours in the day compared to others? Well, because I invest time instead of waste it. Item #1 This one is called, “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain” by Conger et al published in Pain Medicine in August of 2022. https://doi.org/10.1093/pm/pnac081 Why They Did It The reasons we’re looking at this one is not to promote ablasions but to get us thinking a bit about vertobrogenic low back pain, endplates, sensitization, and all kinds of other stuff. Vertebrogenic low back pain (LBP) is a type of chronic LBP that is thought to originate from the vertebral endplates. The vertebral endplates are richly innervated by nociceptors, which are nerve endings that sense pain. When the vertebral endplates are damaged, the nociceptors can be activated, sending pain signals to the brain. The researchers say in t his paper that where we used to think that nerves would develop ingrowth into the cracks of a previously injured disc, this may not be an adequate explanation of disc pain. Specifically, they say, “Previously, it was thought that pathological neurovascular ingrowth penetrated into annular fissures, leading to increased sensitivity and nociception via the sinuvertebral nerve. However, more recent evidence appears to refute the occurrence of such neurovascular ingrowth in many cases.” I found that interesting and notable. The paper continues – Vertebral endplate damage can occur due to a variety of factors, including aging, disc degeneration, osteoarthritis, spinal injuries, and repetitive stress. The type of pain caused by vertebral endplate damage is often described as a dull, aching pain that is localized to the lower back. It may be aggravated by sitting or standing for long periods of time, and it may also radiate into the buttocks and legs. Once vertebrogenic pain has been diagnosed, there are a number of treatment options available. These options include physical therapy, medication, injections, and surgery. The current standard of care for vertebrogenic low back pain is intraosseous basivertebral nerve ablation (BVN RFA). This procedure has been shown to be effective in reducing pain and improving function in patients with Modic changes (MC1 or MC2) on MRI. The results of basivertebral nerve ablation appear to be durable, with improvements lasting for at least 2 to 5 years. Other treatments for vertebrogenic pain have been proposed, but there is less evidence to support their use. These treatments include extraosseous epiduroscopic basivertebral nerve ablation or bipolar RFA, intraosseous plasma rich growth factor, intraosseous injection of bioresorbable cement, and full endoscopic disc debridement surgery. Oral therapies for presumed low grade infection affecting the discovertebral complex are also controversial, but research is ongoing to determine which subpopulations of patients might benefit from this treatment. Finally, there is some evidence that paraspinal muscle quality may be associated with vertebrogenic pain, but it is not yet clear how treatments to address paraspinal muscle deficits might impact patients with this condition. Wrap It Up

• Accumulated damage to the discovertebral complex may result in chemical and mechanical sensitization of endplate nocioceptors resulting in chronic vertebrogenic LBP.
• Midline LBP, pain exacerbation by physical activity, sitting, and forward flexion are factors associated with treatment success after basivertebral nerve ablation
• In appropriately selected patients, basivertebral nerve ablation results in substantial reduction in pain and disability in the majority of those treated at 12 months, with similar long term outcomes at 5 years.
• The presence of MC1 or MC2 is currently the best radiographic indicator of vertebrogenic pain. Outcomes after basivertebral nerve ablation are not impacted by the volume of MC, location of MC, degree of disc degeneration, or presence/size of endplate defects. Patients with MC1 vs MC2 experience similar rates of success after basivertebral nerve ablation

Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 The last one today is called, “Health Claims and Doses of Fish Oil Supplements in the US” by Assadourian, et. Al. and published in JAMA Cardiology on August 23, 2023 and dayum it’s got sizzle for shizzle. Why They Did It One in 5 US adults older than 60 years takes fish oil supplements often for heart health despite multiple randomized clinical trials showing no data for cardiovascular benefit for supplement-range doses. Statements on the supplement labels may influence consumer beliefs about health benefits. The authors wanted to answer the questions, “What health claims are made on the labels of fish oil supplements, and what is the total daily dose of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) in commonly available fish oil supplements? How They Did It his cross-sectional study used data from labels of on-market fish oil (and nonfish ω-3 fatty acid) supplements obtained from the National Institutes of Health Dietary Supplement Label Database. The study was conducted and data analyzed from February to June 2022. The frequency and types of health claims made on fish oil labels and the organ system referenced were evaluated. The total daily doses of combined EPA and DHA were assessed for supplements from 16 leading manufacturers and retailers. What They Found

• Across 2,819 unique fish oil supplements, 2082 (73.9%) made at least 1 health claim.
• Of these, only 399 (19.2%) used an FDA-approved qualified health claim; the rest (1683 [80.8%]) made only structure/function claims (eg, “promotes heart health”).
• Cardiovascular health claims were the most common (1747 [62.0%]).
• Across 16 leading brands/manufacturers, 255 fish oil supplements were identified. Among these, substantial variability was found in the daily dose of EPA, DHA, and total EPA+DHA.
• Only 24 of 255 supplements (9.4%) evaluated contained a daily dose of 2 g or more EPA+DHA.

Wrap It Up Results of this cross-sectional study suggest that the majority of fish oil supplement labels make health claims, usually in the form of structure/function claims, that imply a health benefit across a variety of organ systems despite a lack of trial data showing efficacy. Significant heterogeneity exists in the daily dose of EPA+DHA in available supplements, leading to potential variability in safety and efficacy between supplements. Increasing regulation of dietary supplement labeling may be needed to prevent consumer misinformation. 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. Website

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1. Aaron Conger, Matthew Smuck, Eeric Truumees, Jeffrey C Lotz, Michael J DePalma, Zachary L McCormick, Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain, Pain Medicine, Volume 23, Issue Supplement_2, August 2022, Pages S63–S71, https://doi.org/10.1093/pm/pnac081
2. Assadourian JN, Peterson ED, McDonald SA, Gupta A, Navar AM. Health Claims and Doses of Fish Oil Supplements in the US. JAMA Cardiol. Published online August 23, 2023. doi:10.1001/jamacardio.2023.2424

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