CF - Ep. 346

CF 346: REM And TMD & Psychological Factors In Knee Osteoarthritis

 

Today we’re going to talk about REM And TMD & Psychological Factors In Knee Osteoarthritis

 

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 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 [email protected]

 

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 #346

 

Now if you missed last week’s episode, we talked about SMT Comparison Of Short-Term Effects & GLP-1 And Obesity-Associated Cancers

Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

Alright let’s talk about business. What are you all seeing? I spent a lot of time over the last several months wondering if I made someone mad, pissed on the mayor’s dog, or something like that. 

 

Now, business seems to be picking back up a smidge. Before I went to NYC I had almsot 200 in one week by myself. I don’t have an associate so that was a challenge. Now this week, and we’re early in the week, I have 165 lined up. I think NYC knocked me back down but that’s OK. 200 in a week is honestly more than I want. I think about 180 is probably my sweet spot and I’m only 15 off of that so far this week. 

 

Anyway, I’m seeing a return of business and new patients. Being evidence-based, we depend on a consistent flow of new patients. So that’s what we got going here. A few things have played a part. We really buckled down and spent the money on website SEO. We started getting out and about in the community more. Shaking babies and kissing hands. And we made some key changes in our personnel. Once we were out with the bad seed, it just seemed like a cloud lifted. We have one more dark cloud on their way out in a couple of weeks and have a ray of sunshine replacing it and we can’t wait. 

 

It’s all good in the hood so we’re on the right path. Business is good. 

 

Another thing, yes the economy matters to our businesses and how much tax we pay each year but, don’t get tied up in politics if you can keep from it. They don’t care as much about you as they say they do. And for the love of all that’s holy, keep it off of Facebook and social media. If you’re posting political crap on your socials every day all day, you limit your patient base to half of your community because a republican will never treat with a mouthy democrat provider and a democrat will never treat with a mouthy republican provider. That’s a freaking guarantee. Both sides of the aisle need care and you can’t do that if you’re mouthy. Be smart, wise, trustworthy, and have good character. Treat people right and carry yourself correctly and the money will take care of itself. 

 

Just a tip from your Ol Uncle Jeffro. 

 

 

Item #1

Our first one this week is called, “Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia” by Reid, et al and published in Pain Medicine on March 28 2024 and it’s hotter than cat piss. 

 

Remember, the citations can be found at chiropracticforward.com under this episode. 

 

Matthew J Reid, Katrina R Hamilton, Sophie J Nilsson, Michael Alec Owens, Jane L Phillips, Patrick H Finan, Claudia M Campbell, Alexandros Giagtzis, Dave Abhishek, Jennifer A Haythornthwaite, Michael T Smith, Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia, Pain Medicine, Volume 25, Issue 7, July 2024, Pages 434–443, https://doi.org/10.1093/pm/pnae022

 

 

Why They Did It

Patients with chronic pain disorders, including Temporomandibular Disorders (TMDs) endorse high levels of sleep disturbances, frequently reporting reduced sleep quality. 

 

Despite this, little is known about the effect that daytime pain has on the microstructure and macro-architecture of sleep. Therefore, we aimed to examine the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST), is associated with objective sleep parameters the following night, including sleep architecture and power spectral density, in women with TMD.

 

 

How They Did It

144 females with myalgia and arthralgia by examination using the Diagnostic criteria for TMD completed a comprehensive quantitative sensory testing battery consisting of General Pain Sensitivity, Central Sensitization Index, and Masseter Pressure Pain Threshold assessments. 

 

Polysomnography was collected the same night to measure sleep architecture and calculate relative power in delta, theta, alpha, sigma, and beta power bands.

 

What They Found

Central Sensitization, General Pain Sensitivity Indices, and Masseter Pain Pressure Threshold were significantly associated with lower REM% both before and after controlling for covariates. 

 

Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands nor with any other sleep architectural stages.

 

 

Wrap It Up

Our findings demonstrate that higher generalized pain sensitivity, masseter pain pressure threshold, as well as central sensitization were associated with a lower percentage of REM in participants with myofascial pain and arthralgia of the masticatory system. 

 

These findings provide an important step toward understanding the mechanistic underpinnings of how chronic pain interacts with sleep physiology.

 

 

 

 

Item #2

Our last one this week is called, “Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis” by Hertel et al and published in PAIN in August of 2024 and it’s a steamy pile of saucy spice. 

 

Hertel, Emmaa; Arendt-Nielsen, Larsa,b,c,d; Olesen, Anne Estrupe,f; Andersen, Michael Skippera; Petersen, Kristian Kjær-Staala,b,*. Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis. PAIN 165(8):p 1719-1726, August 2024. | DOI: 10.1097/j.pain.0000000000003194

 

 

Why They Did It

This exploratory study aimed to explain baseline OA pain intensity and predict OA pain after administration of a nonsteroidal anti-inflammatory drug in combination with paracetamol for 3 weeks. 

 

 

How They Did It

The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score was used to estimate OA pain presentation. One hundred one patients were assessed at baseline and follow-up using QST (pressure pain thresholds and temporal summation of pain [TSP]), symptoms of depression and anxiety, pain catastrophizing scales (PCSs), and health-related quality of life. 

Linear regression with backward selection identified that PCS significantly explained 34.2% of the variability in baseline KOOS pain, with nonsignificant contributions from TSP. 

 

Pain catastrophizing score and TSP predicted 29.3% of follow-up KOOS pain, with nonsignificant contributions from symptoms of anxiety. 

 

 

What They Found

When assessed separately, PCS was the strongest predictor (32.2% of baseline and 24.1% of follow-up pain), but QST, symptoms of anxiety and depression, PCS, and quality of life also explained some variability in baseline and follow-up knee OA pain. Further analyses revealed that only TSP and PCS were not mediated by any other included variables, highlighting their role as unique contributors to OA pain presentation. 

 

 

 

Wrap It Up

This study emphasizes the importance of embracing a multimodal approach to OA pain and highlights PCS and TSP as major contributors to the baseline OA pain experience and the OA pain experience after OA treatment.

 

 

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. 

 

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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!

 

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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. 

 

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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