Corrective Care for the Opioid Epidemic

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Search for safe, effective pain management increasing focus on chiropractic and other drug-free options

At an event hosted by a local TV station in Washington, D.C., last year featuring a phone bank of chiropractors responding to questions from the public, many callers expressed frustration with how their pain was being managed. Some were on prescription opioids and concerned about side effects and simply tired of not getting any better. A common question was, “What are my options?”

In the wake of the national opioid epidemic, the search for safe and effective treatment options for pain has elevated interest in non-drug approaches such as chiropractic care. Treatment of low back pain (LBP) in particular has been a focus, as research indicates it is one of the most common conditions for which opioids are prescribed — with over half of opioid users reporting back pain. As a result, several respected health care groups have reconsidered their approach to LBP, adopting recommendations for a more conservative approach that starts with trying non-drug treatments first.

Chiropractors practice a drug-free, hands-on approach to health care that has been shown to alleviate musculoskeletal (MSK) complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches. In addition to their expertise in spinal manipulation, chiropractors are trained to recommend therapeutic and rehabilitative exercises, as well as to provide nutritional, dietary, and lifestyle counseling.

The Burden of Low Back Pain

LBP is the single leading cause of disability worldwide, preventing millions of people from engaging in everyday activities. While often it is difficult to identify a specific cause for low back pain, the people most at risk are those with physically demanding jobs or who have other physical and mental conditions, smokers, and obese individuals.

Pain not only affects quality of life, it also takes a significant toll on healthcare budgets and worker productivity. Back pain alone accounted for more than 264 million lost work days in one year — more than two days a year for every full-time working adult in the country — according to the U.S. Bone and Joint Initiative.

A New Direction in Low Back Pain Treatment

In 2017, the American College of Physicians (ACP) took a bold step by updating its guideline for the treatment of acute and chronic low back pain to recommend first using non-invasive, non-drug treatments before resorting to over-the-counter and prescription drug therapies. ACP’s guideline cites heat therapy, massage, acupuncture and spinal manipulation (a centerpiece of chiropractic care) as options for non-invasive, non-drug therapies for low back pain.

Two years earlier, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S., including every major hospital, also embraced the use of conservative forms of pain management by adding chiropractic and acupuncture to its pain management standard.

One recent study found that patients who received services from a chiropractor for back pain were significantly less likely to fill a prescription for an opioid medication than other patients. Another found the likelihood of an adverse drug event occurring in an outpatient setting within 12 months was 51 percent lower among recipients of chiropractic services as compared to non-recipients.

Chiropractors note that beyond the risk of overuse and addiction, prescription drugs that numb pain may also convince a patient that an MSK condition is less severe than it is, or that it has healed. For some, that misunderstanding can lead to overexertion and a delay in the healing process or even to permanent injury.

Military, VA Develop Successful Models of Chiropractic Integration

Efforts to develop a better way to approach pain through the integration of non-drug treatments such as chiropractic care have been going on for more than 10 years in the U.S. military and the veterans’ health care systems, which are no strangers to the opioid crisis. In fact, utilization of chiropractic in the Department of Veterans Health Administration has seen a steady rise over more than a decade.

The reception of chiropractic in the military has been equally well-received and has yielded positive outcomes for service members. Results of a clinical trial published in 2018 in JAMA Open Network and featuring 750 active-duty members of the U.S. military — one of the largest comparative effectiveness trials between usual medical care and chiropractic care ever conducted — showed that chiropractic care combined with usual medical care for low back pain provides greater pain relief and a greater reduction in disability than medical care alone.

The Chiropractic Approach

Chiropractors assess patients through clinical examination, laboratory testing, diagnostic imaging, and other diagnostic interventions to determine when chiropractic treatment is appropriate and when it is not appropriate. Chiropractors readily refer patients to the appropriate healthcare provider when chiropractic care is not suitable for the patient’s condition or the condition warrants co-management in conjunction with other healthcare providers.

In many cases, such as LBP, chiropractic care may be a patient's primary method of treatment. When other medical conditions exist, chiropractic services may complement or support medical treatment by relieving the MSK pain associated with the other condition(s).

Moreover, utilizing safe and cost-effective chiropractic care can realize significant cost savings. An analysis of Optum claims revealed that, “Healthcare plans that formally incorporate chiropractic typically realize a 2:1 return for every dollar spent.” A similar study by Blue Cross Blue Shield of Tennessee found that, “Low back pain care initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD).”

ACA believes patients across the country would benefit tremendously if all healthcare professionals work more collaboratively to identify individuals who might benefit from conservative forms of care for pain before resorting to higher risk options such as opioids. To learn more about chiropractic or to find an ACA chiropractor near you, visit www.acatoday.org.

About the American Chiropractic Association

The American Chiropractic Association (ACA) is the largest professional chiropractic organization in the United States. ACA attracts the most principled and accomplished chiropractors, who understand that it takes more to be called an ACA chiropractor. ACA is leading its profession in the most constructive and far-reaching ways — by working hand-in-hand with other healthcare professionals, by lobbying for pro-chiropractic legislation and policies, by supporting meaningful research, and by using that research to inform our treatment practices. It also provides professional and educational opportunities for all its members and is committed to being a positive and unifying force for the practice of modern chiropractic. To learn more, visit www.acatoday.org, and connect with ACA on Facebook and Twitter.