Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 333: Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic Today we’re going to talk about Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic 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 #333 Now if you missed last week’s episode, we talked about Individual Alpha Frequency & McKenzie vs. Cranio-Cervical Flexion. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things….. Nothiing too special is going on with the clinic this week. We’re just doing our deal. Seeing patients. No big events last week and nothing too huge on the horizon other than the big Texas Chiropractic Association convention called ChiroTexpo goign on in Frisco, TX which is basically Dallas. That will be June 28-30 I believe and if you’re in TX or wish you were, come on and join us. We’ve always got a great crown and would love to have you down there. Seminars are a great way to get that continuing education but an even better way to network and develop a little bit of influence. Why not? We sit around and we bitch about the state of our profession.

But are we doing anything at all to influence it? Are you a member of the ACA or your state association? If there are a bunch of subbies running your state association, instead of that being a turn-off, shouldn’t that be an amazing opportunity for you and some of your evidence-based friends to get involved and get yourselves in the seats of influence and control so that you can gently start to turn that air craft carrier the right direction? Instead of seeing the obstacle, see the opportunity. Ryan Holliday wrote a book called The Obstacle Is The Way. I highly recommend it.

I promise, when you walk into a board meeting and you realize that only 15-20 people in your entire state run the association, determine the speakers at your events, fight your fights and battles, etc….then you realize what kind of difference you can make. And I mean rather quickly if there’s a handful of you. So, get it together, get involved, and make this profession respected the way the 2024 brand of chiropractic should be respected. Stop letting the loud-mouthed and angry subbies run the show. It’s your turn now.

Item #1

The first one this week is called “Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer A Systematic Review and Meta-Analysis” by Demb et al and published in JAMA Network Open on May 24, 2024. Aye, Chihuaua!! Es muy caliente! Remember, the citations can be found at chiropracticforward.com under this episode.

Demb J, Kolb JM, Dounel J, et al. Red Flag Signs and Symptoms for Patients With Early-Onset Colorectal Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(5):e2413157. doi:10.1001/jamanetworkopen.2024.13157

Why They Did It To report the frequency of presenting red flag signs and symptoms among individuals with early-onset colorectal cancer, to examine their association with early-onset colorectal cancer risk, and to measure variation in time to diagnosis from sign or symptom presentation.

How They Did It

• PubMed/MEDLINE, Embase, CINAHL, and Web of Science were searched from database inception through May 2023.
• Studies that reported on sign and symptom presentation or time from sign and symptom presentation to diagnosis for patients younger than age 50 years diagnosed with nonhereditary colorectal cancer were included.
• Data extraction and quality assessment were performed independently in duplicate for all included studies using Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines.
• Joanna Briggs Institute Critical Appraisal tools were used to measure risk of bias. Data on frequency of signs and symptoms were pooled using a random-effects model.
• Outcomes of interest were pooled proportions of signs and symptoms in patients with early-onset colorectal cancer, estimates for association of signs and symptoms with early-onset colorectal cancer risk, and time from sign or symptom presentation to early-onset colorectal cancer diagnosis.

What They Found

• Of the 12,859 unique articles initially retrieved, 81 studies with 24,908 126 patients younger than 50 years were included.
• The most common presenting signs and symptoms, reported by 78 included studies, were hematochezia, abdominal pain, and altered bowel habits.
• Hematochezia (is the passage of fresh blood through the anus, usually in or with stools), abdominal pain, and anemia were associated with higher early-onset colorectal cancer likelihood.
• Time from signs and symptoms presentation to early-onset colorectal cancer diagnosis was a mean of 6.4 months and a median of 4 months.

Wrap It Up

• In this systematic review and meta-analysis of patients with early-onset colorectal cancer, nearly half of individuals presented with hematochezia and abdominal pain and one-quarter with altered bowel habits.

• Hematochezia was associated with at least 5-fold increased early-onset colorectal cancer risk.

• Delays in diagnosis of 4 to 6 months were common.

• These findings highlight the need to identify concerning early-onset colorectal cancer signs and symptoms and complete timely diagnostic workup, particularly for individuals without an alternative diagnosis or sign or symptom resolution.

Item #2

The second one is called, “Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data” by Trager et al and published in BMJ open in

Trager RJ, Cupler ZA, Srinivasan R, et al Association between chiropractic spinal manipulation and gabapentin prescription in adults with radicular low back pain: retrospective cohort study using US data BMJ Open 2023;13:e073258. doi: 10.1136/bmjopen-2023-073258

Why They Did It

Radicular low back pain (rLBP) is often treated off-label with gabapentin or by chiropractors using chiropractic spinal manipulative therapy (CSMT). To date, no studies have examined the association between these interventions. We hypothesised that adults under 50 years of age receiving CSMT for newly diagnosed rLBP would have reduced odds of receiving a gabapentin prescription over 1 year-follow-up.

How They Did It

Retrospective cohort study. Setting US network including linked medical records, medical claims and pharmacy claims of >122 million patients attending large healthcare organisations (TriNetX), queried 15 June 2023, yielding data from 2017 to 2023.

Participants Adults aged 18–49 were included at their first occurrence of rLBP diagnosis. Exclusions were severe pathology, other spinal conditions, on-label gabapentin indications and gabapentin contraindications. Propensity score matching controlled for variables associated with gabapentin use and receipt of prescription medication over the preceding year. Interventions Patients were divided into CSMT or usual medical care cohorts based on the care received on the index date of rLBP diagnosis. Primary and secondary outcome measures OR for gabapentin prescription.

What They Found

• After propensity matching, there were 1635 patients per cohort.
• Gabapentin prescription over 1-year follow-up was significantly lower in the CSMT cohort compared with the usual medical care cohort, with an OR of 0.53.
• Sensitivity analyses revealed early divergence in cumulative incidence of prescription; and no significant between-cohort difference in a negative control outcome (gastrointestinal medication) suggesting adequate control for pharmacological care preference.

Wrap It Up

• Our findings suggest that US adults receiving CSMT for newly diagnosed rLBP have significantly reduced odds of receiving a gabapentin prescription over 1-year follow-up compared with those receiving usual medical care.
• Results may not be generalisable and should be replicated in other healthcare settings and corroborated by a prospective study to reduce confounding.

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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