Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids | Forum

"On Tuesday, the state of Massachusetts filed a lawsuit against the multi-billionaire Sackler family over the role their drug OxyContin has played in sparking one of the worst addiction and overdose epidemics in history. The lawsuit accuses the company, Purdue Pharma, and its heirs of spinning a “web of illegal deceit” which fueled the deadly crisis in which America currently finds itself.

Members of the Sackler family, who’ve made billions pushing their deadly OxyContin drug on the masses are arguably responsible for more deaths than any Mexican drug cartel. Instead of being hunted down at their plush mansions by DEA agents, they are rubbing elbows with members of Congress. Now, however, for the first time, the family is being targeted by a landmark lawsuit for the damages they knowingly caused with their products."

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• Meet the Sacklers: The family that’s killing millions (maybe more than Stalin)

Related article:

Chiropractic Improves Neck Pain in a Military Veteran Population & Lowers the Need for Opiates

By Mark Studin

William Owens

A Report on the Scientific Literature

According to the American Academy of Pain Medicine, neck pain accounts for 15% of commonly reported pain conditions. Sinnott, Dally, Trafton, Goulet and Wagner (2017) reported:

Neck and back pain problems are pervasive and associated with chronic pain, disability and high healthcare utilization. Among adults 60% to 80% will experience back pain and 20% to 70% will experience neck pain that interferes with their daily activities during their lifetime. At any given time, 15% to 20% of adults will report having back pain and 10% to 20% will report neck pain symptoms. The vast majority of back and neck pain complaints are characterized in the literature as non-specific and self-limiting.” (pg. 1) 

The last sentence above describes why back and neck pain has contributed significantly to the opioid crisis and why our population, after decades still suffers from back and neck problems that have perpetuated. Mechanical lesions of the spine are not “self-limiting” and are not “non-specific.” They are well-defined and based upon Wolff’s Law (known since the 1800’s) don’t go away. Allopathy (Medicine) has purely focused on the pain and has vastly ignored the underlying cause of the neuro-bio-mechanical cause of the pain. 

Corcoran, Dunn, Green, Formolo and Beehler (2018) reported that musculoskeletal problems as the leading cause of morbidity for female veterans and females are more prone to experience neck pain than men. In addition, there has been a 400% increase in opioid overdoes deaths in females since 1999 compared to 265% for men and as a result, the Veterans Health Administration has utilized chiropractic as a non-pharmacological treatment option for musculoskeletal pain. Neck pain has also comprised of 24.3% of musculoskeletal complaints referred to chiropractors. 

Corcoran et. Al. also reported with chiropractic care, based upon a numeric rating scale (NRS) and the Neck Bournemouth Questionnaire (NBQ) scores, the NRS improved by 45% and the NBQ improved by 38%, with approximately 65% exceeding the minimum clinically important difference of 30%. A previous study of male veterans revealed a 42.9% for NSC and a 33.1 improvement for NBQ; statistics similar to female veterans. 

Although this is a very positive outcome that has helped many veterans, the percentages do not reflect what the authors have found in their clinical practices. These authors of this article (Studin and Owens) reported that for decades, cervical pain has been eradicated in 90 and 95% of the cases treated in our practices. The question begs itself, why is the population of veterans showing statistics less than half? 

Corcoran, et. Al. (2018) reported how the chiropractic treatment was delivered in their study:

The type of manual therapy varied among patients and among visits, but typically included spinal manipulative therapy (SMT), spinal mobilization, flexion – distraction therapy, and or myofascial release. SMT was operatively defined as a manipulative procedure involving the application of a high - velocity, low – ample to thrust the cervical spine. Spinal mobilization was defined as a form of manually assisted passive motion involving repetitive joint oscillations typically at the end of joint playing without application of a high- velocity, low – ample to thrust. Flexion – distraction therapy is a gentle form of a loaded spinal manipulation involving traction components along with manual pressure applied to the neck in a prone position. Myofascial release was defined as manual pressure applied to various muscles on the static state or all undergoing passive lengthening.

The above paragraph explains why the possible disparity in outcomes as Corcoran et. Al  do not reflect the ratios of who received high-velocity low-amplitude chiropractic spinal adjustment vs. the other therapies. When considering the other modalities; mobilization, flexion distraction therapy and myofascial release we must equate that to the outcomes physical therapist realize when treating spine as those are their primary reported treatment modalities. The following paragraphs indicate why spine care delivered by physical therapist is inferior to a chiropractic spinal adjustment, which equates to only a portion of the referenced chiropractic treatment modalities cited in the Corcoran Et. Al. The following citations conclude why these modalities provide inferior results compared to the high-velocity, low-amplitude chiropractic spinal adjustment that was exclusively used by the authors and rendered significantly higher positive outcome. ...

full article

http://www.uschirodirectory.com/index.php?option=com_k2&view=item&id=828:chiropractic-improves-neck-pain-in-a-military-veteran-population-lowers-the-need-for-opioids&Itemid=320

Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain

Conclusions: Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.

https://pubmed.ncbi.nlm.nih.gov/32142140/

Whedon JM, Toler AWJ, Goehl JM, Kazal LA. J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22. PMID: 29470104

Conclusions: Among New Hampshire adults with office visits for noncancer low-back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients. The underlying cause of this correlation remains unknown, indicating the need for further investigation.

Observational Study BMJ Open

Lewis E Kazis 1 , Omid Ameli 2  3 , James Rothendler 2 , Brigid Garrity 2 , Howard Cabral 4 , Christine McDonough 5 , Kathleen Carey 2 , Michael Stein 2 , Darshak Sanghavi 3 , David Elton 6 , Julie Fritz 7 , Robert Saper 8

Affiliations

• PMID: 31542740
• PMCID: PMC6756340
• DOI: 10.1136/bmjopen-2018-028633

Conclusions: Initial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.

Kelsey L Corcoran 1  2 , Lori A Bastian 2  3 , Craig G Gunderson 2  3 , Catherine Steffens 2 , Alexandria Brackett 4 , Anthony J Lisi 1  2

Affiliations

• PMID: 31560777
• DOI: 10.1093/pm/pnz219

Results: In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3-57.6%) than nonusers (range = 31.2-65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30-0.43, P < 0.001, I2 = 92.8%).

Conclusions: This review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.