Chiropractic and the opioid epidemic

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Rethinking your approach to pain

By American Chiropractic Association staff
Americans are accustomed to getting things fast: their food, their news, and even their pain relief. But the public, as well as the health care community, is recognizing more and more that popping a pill to relieve pain is not always the best option.
News of the epidemic of abuse and overuse of prescription opioid pain medication in the United States has dominated headlines for several years now. The Centers for Disease Control and Prevention (CDC) estimates that as many as one in four patients who receive prescription opioids long term for non-cancer pain in primary care settings struggles with addiction. About 1,000 people are treated daily in the ER for misuse of these powerful drugs.
While many opioid prescriptions are written for people with back pain, studies show that opioids are not an effective treatment for chronic lower-back pain. Beyond the risks of addiction and overdose, prescription drugs that numb pain may convince a patient that a musculoskeletal condition such as back pain is less severe than it is or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process—or even permanent injury.
Chiropractic and non-drug approaches to pain management can be an important first line of defense against pain and addiction caused by the overuse of prescription opioid pain medications. A recent survey by Gallup-Palmer College of Chiropractic found that nearly 80 percent of Americans would prefer to first use options other than prescription drugs for their pain.

What is chiropractic?
Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic services are used most often to treat musculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches.

What is a chiropractor?
Chiropractors—also known as doctors of chiropractic—practice a hands-on, drug-free approach to health care that includes patient examination, diagnosis and treatment. Chiropractors have broad diagnostic skills and are also trained to recommend therapeutic and rehabilitative exercises, as well as to provide lifestyle counseling.
Chiropractors may assess patients through clinical examination, laboratory testing, diagnostic imaging and other diagnostic interventions to determine when chiropractic treatment is appropriate or when it is not appropriate. Chiropractors will readily refer patients to the appropriate health care provider when chiropractic care is not suitable for the patient’s condition, or the condition warrants co-management in conjunction with other health care providers.
In many cases, such as lower back pain, 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 musculoskeletal aspects associated with the condition.
Chiropractors are educated in four-year doctoral graduate school programs that are nationally accredited through an agency that operates under the auspices of the U.S. Department of Education. After graduation, they must pass national board exams before obtaining a license to practice and then must maintain their license annually by earning continuing education (CE) credits through state-approved CE programs.

What is spinal manipulation?
One of the most common and well known therapeutic procedures performed by chiropractors is spinal manipulation (sometimes referred to as a “chiropractic adjustment”). The purpose of spinal manipulation is to restore joint mobility by manually applying a controlled force into joints that have become restricted in their movement as a result of a tissue injury. Tissue injury can be caused by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses, such as sitting in an awkward position with poor spinal posture for an extended period. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function for an individual. Manipulation, or adjustment of the affected joint and tissues, restores mobility, thereby alleviating pain and muscle tightness, allowing tissues to heal.
A chiropractic adjustment rarely causes discomfort. However, patients may sometimes experience mild soreness or aching following treatment (as with some forms of exercise) but that usually resolves within 12 to 48 hours. Compared to other common treatments for pain, such as over-the-counter and prescription pain medications, chiropractic’s conservative approach offers a safe and effective option.

Rising recognition of the value of non-drug approaches to pain
There is a growing body of research that validates the effectiveness of chiropractic services, such as spinal manipulation, leading many respected health care organizations to recommend chiropractic and its drug-free approach to pain relief.
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 non-invasive, non-drug treatments before resorting to drug therapies. ACP’s guidelines, published in the Annals of Internal Medicine and based on a review of randomized controlled trials and observational studies, cite heat therapy, massage, acupuncture and spinal manipulation (a centerpiece of chiropractic care) as possible options for non-invasive, non-drug therapies for low-back pain. Only when such treatments provide little or no relief, the guidelines state, should patients move on to medicines such as ibuprofen or muscle relaxants, which research indicates have limited pain-relief effects. According to the guidelines, prescription opioids should be a last resort for those suffering from low-back pain, as the risk of addiction and overdose may outweigh the benefits.
Likewise, the Joint Commission, the organization that accredits more than 20,000 health care systems in the U.S. (including every major hospital), recognized the value of non-drug approaches by adding chiropractic and acupuncture to its pain management standard in 2015.

Where to find a chiropractor
The American Chiropractic Association has launched a movement in the chiropractic profession that’s built on the highest membership standards, on working hand-in-hand with other health care professionals, on being evidence-based and on making sure the ACA logo is a sign to patients that our members promise the best possible care. To find an ACA chiropractor near you, check out the American Chiropractic Association’s website at acatoday.org/FindaDoctor. This search tool provides the names and contact information of ACA chiropractors in your area and, in some cases, will even list the doctor’s specialties. It might also be interesting for people to know that when chiropractors join ACA they are asked to sign ACA’s Pledge of Professional Values and comply with ACA’s Code of Ethics, which promotes the highest standards of ethics and patient care.

Resources:
ACA: acatoday.org
ACA – chiropractic research – acatoday.org/Research
ACP treatment guidelines for low back pain –
annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
CDC – Drug overdose – cdc.gov/drugoverdose/epidemic/
Joint Commission – Clarification of the Pain Management Standard: jointcommission.org/assets/1/18/Clarification_of_the_Pain_Management__Standard.pdf

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