Chiropractic Provides Pain Relief with Lower Odds of Opioid Usage
With the ongoing opioid epidemic, there has been an increase in research into alternative pain relief treatments that do not have the addictive side effects associated with opioid medications or the dangerous risks associated with more invasive procedures. While those avenues of treatment are needed in some cases, many patients can experience pain relief with safer, conservative care.
Low back pain (LBP) ranks among the three most common conditions that send Americans to seek medical care. This, coupled with LBP being one of the most common conditions that opioids are prescribed to treat, leads to a very high rate of people being given opioids for low back pain. In fact, a history of LBP is reported among over half of opioid users.
Both the American College of Physicians and the Centers for Disease Control have issued recommendations that for most acute LBP patient, treatment should begin with non-pharmacological treatments such as: heat therapy, massage, acupuncture and SPINAL MANIPULATION. They then recommend low risk medications such as muscle relaxers or nonsteroidal anti-inflammatory drugs (NSAIDS) be tried before opioid medications are prescribed. Even then, any medications should be utilized at the lowest effective dosage and for the shortest effective time frame.
Despite these recommendations, opioids continue to be widely prescribed, with many patients transitioning from a short-term prescription to long term opioid usage. Therefore, researchers began to look at not just the diagnosis that opioids are being prescribed to treat, but also, how patients are reaching that point of treatment. They found a significant difference in both early* opioid use and long-term** opioid usage based on what type of provider from which the patient initially sought care.
The researchers reviewed records for over 215,000 adult patients from across the country who were diagnosed with LBP and had not had opioids for at least the 12 month period prior to the diagnosis. Because the participants were from commercial and Medicare Advantage plans, there was a range of sociodemographic and clinical characteristics represented. Based on the claims data, researchers were able to compare both early and long term opioid usage by what provider the patient had initially seen: chiropractic physician, physical therapist, acupuncturist, PCP, orthopedic surgeon, emergency medicine physician, neurosurgeon, radiologists, other non-physicians (physician assistant or nurse practitioners) or physical medicine and rehabilitation physician.
Patients whose initial care was from a chiropractic or acupuncturist had the two lowest odds of both early and long-term opioid usage. Physical therapists came in third with the other specialties all falling well behind these three. Compared to patients who saw their PCP for their initial treatment, odds of opioid usage was:
While it can be expected that more severe injuries would start care with surgeons or emergency medicine providers, contributing to the difference between the opioid usage rates, the difference between the conservative care providers from even the primary care doctors suggests that there are many patients for whom conservative care would be both safe and effective. The researchers concluded:
A growing body of evidence suggest that spinal manipulation, massage, acupuncture and superficial heat are effective for reducing acute LBP intensity and improving function… Therefore and importantly, early engagement of conservative therapists may decrease initial opioid prescriptions in association with MD visits by providing the opportunity to incorporate evidence-based non-pharmacological interventions.”
They also note that while chiropractic physicians and physical therapists are not found in the typical American Emergency Room at this time, there may be benefits to their availability in that setting, citing, “other countries have successfully introduced physical therapists into emergency departments to treat patients with LBP.”
The last decade has seen an increase in multi-disciplinary clinics where medical doctors, doctors of chiropractic, physical therapists and other healthcare professionals work side by side, collaborating on patient care to provide the best outcomes for their patients. Additionally, there is a growing awareness of information and resources educating the public of conservative care options for initial care as alternatives to opioid medications.
In conclusion, this study shows that if a patient can be treated conservatively from the beginning, reducing or even eliminating the need for opioids, this can be a huge step in addressing the opioid epidemic and helping people in our community live long, healthy lives without the need for constant pain medications.
If you or someone you know is experiencing low back pain, schedule an evaluation with your local chiropractic physician. You may be able to get the relief you need easier than you think!
*Early opioid use – within 30 days of the initial visit
** Long-term opioid use – within 60 days of the initial visit and either 120/+ days supply over 12 months or 90/+ days supply and 10 or more opioid prescriptions over 1 year
Sources:
Kazis LE, Ameli O, Rothendler J, et al Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use BMJ Open 2019;9:e028633. doi: 10.1136/bmjopen-2018-028633
Mole, Beth. “CDC just says no to opioid prescriptions for chronic pain” March 15, 2016. https://arstechnica.com/science/2016/03/cdc-just-says-no-to-opioid-prescriptions-for-chronic-pain/ accessed 6/20/2017
Amir Qaseem, Timothy J. Wilt, Robert M. McLean, et al; for the Clinical Guidelines Committee of the American College of Physicians . Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med.2017;166:514-530. [Epub 14 February 2017]. doi:10.7326/M16-2367