Chiropractic: On the Frontline for Pain

During National Chiropractic Health Month (NCHM) 2022 this October, Drs. Zach Shiels and Jake Lipski of Elite Sport & Spine join the American Chiropractic Association and doctors of chiropractic nationwide to promote better access to non-drug therapies and remind people that chiropractic’s non-drug approach is on the Frontline For Pain management, offering evidence-based treatments that are safe, effective and that may help some patients to reduce or eliminate their need for prescription opioids.

In addition to our nondrug approach to musculoskeletal care, we provide patients with exercise and performance-based advice to prevent injuries. Our chiropractors also frequently co-ordinate care with Ashley, our clinical nutritionist, to provide information on nutrition to enhance overall health.

National Chiropractic Health Month is a nationwide observance held each October and hosted by the American Chiropractic Association (ACA). NCHM highlights the importance of musculoskeletal health and raises awareness of the benefits of chiropractic care and its natural, patient-centered and nondrug approach to pain management, health, and wellness. Learn more at handsdownbetter.org and follow the conversation on social media with the hashtag #FrontlineForPain.

The ACA has compiled a great deal of research and clinical guidelines supporting spinal manipulation and a conservative approach to treating pain.

Back pain is a global problem, and it has fueled the opioid epidemic in the United States. 

• Low back pain is the single leading cause of disability worldwide.(1)  
• One-half of all working Americans admit to having back pain symptoms each year. (2)   
• In the United States, low back pain is one of the leading reasons why people are prescribed opioids.(3) 
• Almost half of all U.S. opioid overdose deaths involve a prescription opioid. (4) 

Prescription opioids are not a good strategy for managing low back pain long term. 

• Research shows that opioids do not provide clinically meaningful pain relief for people with chronic back pain. (5) 
• As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction. (6) 
• In 2018, about 2 million Americans abused or were dependent on prescription opioids.(7) 
• Almost 80 percent of Americans prefer to first use options other than prescription drugs for their pain. (8) 

Guidelines published by major healthcare groups encourage patients with common musculoskeletal conditions to try non-drug treatments.  

• In 2017, the American College of Physicians (ACP) updated its guidelines for the treatment of acute and chronic low back pain to recommend first using noninvasive, non-drug treatments—including spinal manipulation—before resorting to over-the-counter and prescription drugs. (9) 
• The Joint Commission, which accredits every major U.S. hospital, recognized the value of non-drug approaches in 2015 by adding chiropractic to its pain management standard. (10) 
• The Department of Defense/Veterans Administration 2017 guideline for the treatment of low back pain includes spinal manipulation as a non-drug, noninvasive option. (11) 
• In its proposed 2022 Clinical Practice Guideline for Prescribing Opioids, the Centers for Disease Control and Prevention promotes “diverse approaches and varied pain management solutions” and specifically encourages use of non-opioid/nonpharmacologic therapies as a first line of treatment against subacute and chronic pain. (12) 

Evidence supports the use of non-drug approaches such as chiropractic services to reduce reliance on prescription opioids for pain. 

• A 2018 study focusing on adults with office visits for noncancer low back pain found that the likelihood of filling an opioid prescription was significantly lower (55% lower) for recipients of services delivered by doctors of chiropractic compared with nonrecipients. (13) 
• A study published in the journal Pain Medicine found that chiropractic users had 64% lower odds of receiving an opioid prescription than non-users. (14) 
• The Department of Veterans Affairs reports that it has reduced opioid prescriptions by 63% using its Whole Health approach, which includes non-drug treatments for pain such as chiropractic care. (15) 

Studies show visiting a chiropractor first for treatment may even reduce the likelihood of receiving an opioid prescription later.   

• A 2018 study examining the effect of initial provider selection concluded that seeing a chiropractor first for new back or lower body pain was associated with lower odds of receiving an opiate prescription. (16) 
• A 2017 study published by the Mayo Clinic found that people with neck pain initiating care with chiropractic physicians had lower odds of using advanced imaging, injections, and opioid medications. (17) 
• A study published in the British Medical Journal found that patients who saw a chiropractor as their initial provider for low back pain had 90% decreased odds of both early and long-term opioid use. (18) 

Seniors are at greater risk of falls and other adverse side effects associated with taking multiple medications. It’s vital they have increased access under Medicare to chiropractic’s non-drug services. 

• A 2022 study focusing on older Medicare beneficiaries with spinal pain found that use of chiropractic care is associated with a significantly lower (56% lower) risk of filling an opioid prescription. (19) 
• A study examining large datasets of Medicare patients revealed that in geographic locations with more doctors of chiropractic and a higher level of Medicare payments for chiropractic manipulation, there were fewer patients taking opioid drugs. (20) 
• Proposed federal legislation, the Chiropractic Medicare Coverage Modernization Act (S. 4042/H.R. 2654), would increase chiropractic coverage for seniors and other Medicare beneficiaries to the full array of Medicare services that doctors of chiropractic are allowed to provide under their state license.  

Chiropractic patients report high satisfaction with their care.  

• Chiropractors treat more than 35 million Americans (adults and children) each year. (21) 
• A survey conducted by Gallup on behalf of Palmer College of Chiropractic found that two-thirds (61%) of adult Americans believe chiropractors are effective at treating neck and back pain. (21) 
• A consumer survey found that chiropractors are the highest rated healthcare practitioners for low-back pain treatments, above physical therapists, specialist physicians and primary care doctors. (22) 

References 

1. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic DiseasesPublished Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428 
2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98. 
3. Mojtabai R. National trends in long-term use of prescription opioids. Pharmacoepidemiology and Drug Safety, 2017; doi: 10.1002/pds.4278. 
4. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov. 
5. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med.2016;176(7):958–968. doi:10.1001/jamainternmed.2016.1251 
6. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction2010;105:1776–82. http://dx.doi. org/10.1111/j.1360-0443.2010.03052. 
7. National Survey on Drug Use and Health, 2018. Substance Abuse and Mental Health Services Administration. https://bit.ly/36DJWeq 
8. “Americans Prefer Drug-Free Pain Management Over Opioids,” Gallup-Palmer College of Chiropractic Annual Survey of Americans, http://www.gallup.com/reports/217676/americans-prefer-drug-free-pain-management-opioids.aspx 
9. Qaseem A et al. 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(7):514-530. DOI: 10.7326/M16-2367 

References Cont…

1. The Joint Commission, “Clarification of the Pain Management Standard,” Joint Commission Perspectives, November 2014.  
2. VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain, Sept. 2017, https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGPatientSummary092917.pdf  
3. “Proposed 2022 CDC Clinical Practice Guideline for Prescribing Opioids,” Regulations.gov, https://www.regulations.gov/docket/CDC-2022-0024. 
4. Whedon et al. Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22.  PMID: 29470104 DOI: 10.1089/acm.2017.0131. 
5. Kelsey L Corcoran, Lori A Bastian, Craig G Gunderson, Catherine Steffens, Alexandria Brackett, Anthony J Lisi, Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis, Pain Medicine, pnz219, https://doi.org/10.1093/pm/pnz219. 
6. “VA Continues to Reduce Opioid Prescribing Throughout the Pandemic,” Vantage Point (official blog of the U.S. Department of Veterans Affairs), May 13, 2021. https://blogs.va.gov/VAntage/88759/va-continues-to-reduce-opioid-prescribing-throughout-the-pandemic/  
7. Azad T, Vail D, Bentley J et al. Initial Provider Specialty is Associated with Long-term Opiate Use in Patients with Newly Diagnosed Low Back and Lower Extremity Pain. Spine (Phila Pa 1976). 2018 Aug 7. 
8. Horn et al. Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain. Mayo Clin Proc Innov Qual Outcomes. 2017 Oct 19;1(3):226-233. doi: 10.1016/j.mayocpiqo.2017.09.001. eCollection 2017 Dec. PMID: 30225421 PMCID: PMC6132197. 
9. 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. 
10. Whedon et al. Chiropr Man Therap. 2022 Jan 31;30(1):5. doi: 10.1186/s12998-022-00415-7. Association between chiropractic care and use of prescription opioids among older Medicare beneficiaries with spinal pain: a retrospective observational study.  PMID: 35101064, PMCID: PMC8802278, DOI: 10.1186/s12998-022-00415-7. 

More References…

1. Weeks WB, Goertz CM. Cross-Sectional Analysis of Per Capita Supply of Doctors of Chiropractic and Opioid Use in Younger Medicare Beneficiaries. JMPT. 2016 May;39(4):263-6. doi: 10.1016/j.jmpt.2016.02.016. Epub 2016 Mar 28. 
2. 2015 Gallup-Palmer Inaugural Report: Americans’ Perceptions of Chiropractic, www.palmer.edu/gallup-report 
3. Consumer Reports Health Ratings Center. Relief for your aching back: What worked for our readers. ConsumerReports.org; March 2013.