Overview of an Epidemic
The opioid epidemic we are facing now is the result of a push to combat severe and chronic pain in the 1990’s. While the intent to make patients more comfortable was noble, opioid addiction in the US has grown at a staggering rate. Researchers estimate around 20% of “patients with noncancer pain or pain-related diagnoses are prescribed opioids in office-based settings.” As would be expected, high rates of opioid prescriptions are from providers who specialize in pain medicine, surgery, and physical medicine/rehabilitation. However, almost half of the opioid prescriptions are from primary care doctors.
Once viewed as a go-to medication for pain, opioids are now under the microscope. Organizations in and out of the health care arena are looking closely at the addictive nature of these drugs, as well as the long list of potential side effects including things as trivial as dry mouth to more serious effects such as nausea and vomiting, confusion, depression, anxiety, and even increased sensitivity to pain.
Additionally, recent research has shown “little evidence that opioids improve chronic pain, function, or quality of life, and long-term use of opioids, particularly at higher dosages, is associated with overdose, misuse, abuse, and opioid use disorder.” The risk of developing an addiction to opioid medications drastically increases after just 5 days of using the drug. Patients who are on the medication a full month have an almost 30% chance of being on opioids a year later.
With long term usage comes increased risk of death, especially by overdose. The CDC relates that about 3,000 deaths involved opioids in 2014. In 2015, that number soared to over 22,000 deaths. While the number of patients seeking pain management has not changed significantly, the “sales of prescription opioids in the United States nearly quadrupled from 1999 to 2014.”
Drug-free Options are Needed
With the high financial cost, and more importantly the loss of life caused by opioids, an alternative pain management solution is needed. One that is free of the dangerous side effects and risks that accompany opioid usage and addiction.
While drug-free options have always existed, they have not been promoted as a primary method of pain control until recently. In response to the opioid crisis the American College of Physicians recently issued new guidelines for pain management. In that document, they “recommend nonpharmacologic treatment as the first-line approach to treating back pain, with consideration of opioids only as the last treatment option or if other options present substantial harm to the patient.” (You can find more information on the guidelines at https://www.tnchiro.com/articles/american-college-of-physicians-recommends-spinal-manipulation-as-a-primary-treatment-for-low-back-pain/ )
With this new emphasis on nonpharmacologic options, many patients have found chiropractic care to be the help they need to combat pain without resorting to opioid medications.
Study Links Chiropractic to 55% Reduction in Opioids for Low Back Pain
In a recently released study titled, Association between Utilization of Chiropractic Services and Use of Prescription Opioids Among Patients with Low Back Pain, researchers investigated links between chiropractic care and the utilization of prescription opioid medications among New Hampshire residents with low back pain. Researchers selected this state because health claims data was easily available and the opioid crisis has been more severe there than much of the country. (In 2015, they had the 2nd highest age-adjusted rate of drug overdose deaths in the United States which was a 31% increase from 2014 and more than twice the national rate.) As is the case in many areas, the NH opioid addiction epidemic “crosses all socioeconomic levels, affecting the life of every resident, and has many ‘hidden’ side effects in addition to overdose deaths.”
Researchers analyzed health insurance claims data from the all payer claims database, administered by the Department of Health and Human Services of the state of New Hampshire. This database includes claims data from 26 private and public 3rd-party payers, including PPO, HMO and indemnity plans. It does not include Medicare or Medicaid. Patients ranged from 18-99 years of age and had 2 or more clinical visits, for low back pain, within a 90 day time period. Patients with a cancer diagnosis were excluded from the study.
Researchers then designated two categories of patients: Recipients, who had 2 or more visits to a chiropractor for a diagnosis of low back pain, and Non-Recipients, who did not receive chiropractic care. The 13,384 subjects were almost equally divided between the 2 groups. The Recipients included a larger number of young adults and smaller number of middle-aged adults, and were overall healthier.
Researchers then compared the rate of prescription fills for opioids as well as associated charges for 2013-2014. The results were similar for both 2013 and 2014 are quite revealing:
- Only 19% of Recipients filled an opioid prescription, compared to 35% of Non-Recipients.
- Of the Recipients who did fill an opioid prescription, their average annual charges for those medications were 74% lower than Non-Recipients who filled an opioid prescription.
- Average annual charges, per person, for clinical services provided at office visits were 78% lower for Recipients versus Non-Recipients.
Overall, the researchers concluded that among New Hampshire adults who sought care for non-cancerous low-back pain, the likelihood of filling an opioid prescription was 55% lower for chiropractic patients. Additionally, “average charges per person for chiropractic users—for both opioids and office visits for low-back pain—were also significantly lower compared with nonusers over a 2-year period.”
Additional research on the impact of chiropractic care on opioid and drug use for large patient populations is to be conducted through support by the research organization, Clinical Compass. This second study, as was the first, is being carried out by principle investigator Dr. James Whedon at Southern California University of Health Sciences. The second study will begin in late 2017 and will require at least 18 months to collect, analyze and report on the data.
With the heavy costs of opioid addiction, both economically, and the mental, emotional and physical toll on the patient and their loved ones, it is imperative that we explore all viable options for pain management. Chiropractic has proven, and continues to be proven, as an effective treatment for many types of pain without the risks associated with opioid and other pain medications.
Additionally, chiropractors generally offer multiple services. A unique treatment plan is created for each patient. This may include, spinal manipulation, therapy modalities, rehabilitation exercises, stretches, nutritional and exercise recommendations. Additional research would be needed to determine if it is the spinal manipulation or the combination of manipulation with other services that reduce the need for opioid medications.
If you or a loved one are experiencing non-cancer pain, make an appointment with your local chiropractor for an evaluation and treatment. Learn more about chiropractic at https://www.tnchiro.com/for-patients/overview/ and find a doctor near you at https://www.tnchiro.com/find-a-doctor/ .
Whedon, James M., Toler, Andrew W.J., Goehl, Justin M., and Kazal, Louis A.. The Journal of Alternative and Complementary Medicine. February 2018, ahead of print. https://doi.org/10.1089/acm.2017.0131 . Online Ahead of Print: February 22, 2018
McDaniel, James. Performance Health Funds Expanded Study on Chiropractic’s Impact on Reduction in Opioid Prescriptions. http://clinicalcompass.org/news/performance-health-funds-expanded-study-on-chiropractics-impact-on-reduction-in-opioid-prescriptions