Can chiropractic care reduce opioid abuse?

Stats show pain lowered from 64% to 55%

THE OPIATE EPIDEMIC IN THE UNITED STATES has been well-documented and is the focus of our society, ranging from organized medicine to individual practitioners to governmental policies.  

The epidemic response has escalated to the point that the 115th Congress (2017-18) passed extensive public health laws in number 115-271, Titles I, II, III, specifically aimed to curtail the abuse of opiates.¹ Despite awareness, legislation and changes in prescription practices, in 2019, 70.6% of drug overdose fatalities in the United States involved opioids. These premature deaths have been associated with millions of years of life lost, including more than 1.6 million life-years attributed to opioid-related deaths in 2016 alone.²

Treating back pain

Patients with a new onset of back pain, with or without radicular components, initially present in various clinical settings that span from primary care medical providers (family medicine, internal medicine, etc.), urgent care centers, emergency rooms, and to a lesser degree, orthopedic surgeons, and chiropractors. Treating musculoskeletal issues such as back pain is problematic in primary care medicine, urgent care and emergency room settings.  

Humphreys et al. reported that 25% of primary care encounters are musculoskeletal (MSK) complaints, yet medical school training devotes less than 5% in the United States and approximately 2.5% to MSK medicine. The results in an MSK competency examination of medical residents and staff physicians was 20.7%, reflecting the lack of training and aptitude in caring for approximately 25% of their patients.³ Perhaps this is the etiology of a 24.4% increased risk of early opiate prescriptions in primary care practices, a 41.1% increased risk of opiate use in emergency medicine, and a 40.8% increased risk of opiate use with urgent care facilities.⁴

Chiropractic costs less

Whedon et al. (2018) reported in 2013 average annual charges per person for filling opioid prescriptions were 74% lower among chiropractic patients compared with non-chiropractic patients.  

For clinical services provided at office visits for low-back pain, average annual charges per person in 2013 were 78% lower among chiropractic patients compared with non-chiropractic patients. The likelihood of filling a prescription for an opioid analgesic was 55% lower for recipients of services provided by a doctor of chiropractic compared with non-chiropractic patients.⁵ Corcoran et al. (2020) reported that chiropractic users had 64% lower odds of receiving an opioid prescription than non-chiropractic patients.⁶  

Another significant factor in opiate use is the lack of a diagnosis with back pain and medicine. Eklund et al. (2019) reported, [Non-Specific] “LBP is not only a societal problem, but it also has profound impacts on an individual level with both psychological and social consequences. The condition is still poorly managed clinically, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Since over 90% of LBP cases have no underlying spinal pathology or other specific disease causing their pain (i.e., no structural diagnosis can be made), the target for clinical intervention in non-specific LBP cannot be identified from a biomedical perspective.”⁷ 

Conversely, Ndetan et al. reported that over 96% of survey respondents with spine-related problems said the use of chiropractic manipulation (adjustments) helped with their spinal-related condition. Comparing these statistics to medicine, which persists in diagnosing 90-95% as non-specific low back and unable to identify the cause of the pain, with significant evidence of a perpetual failed care path, chiropractic has superior outcomes.

Chiropractic and work loss

When considering work loss and returning to partial workability (function), chiropractic outcomes were 313% better than physical therapy. Regarding work loss and returning to full workability (function), chiropractic outcomes were 271% better than physical therapy.⁸  

Cifuentes et al. stated that chiropractic care during the health maintenance care period resulted in a 250% decrease in disability duration of the first episode compared to a medical physician’s care and a 21% decrease in the average weekly cost of medical expenses during disability episodes compared to a medical physician’s care.⁹ 

Despite the overwhelming evidence of chiropractic outcomes vs. medicine and physical therapy for back pain, most highly regarded medical institutions still recommend failed treatment pathways. This practice perpetuates the need for opiates by not initially suggesting what evidence in the literature reports as superior treatment options.

Medical solutions to back pain

The Mayo Clinic’s website underscores this issue with the following published back pain diagnosis and treatment pathways: Diagnosis: X-ray, MRI/CAT scans, blood tests and nerve studies. For treatment (in this order): Do nothing, non-narcotic pain relievers, heat, walking, muscle relaxants, topical pain relievers, narcotics, antidepressants, physical therapy, cortisone injections, radiofrequency ablations, implanted nerve stimulators and surgery. The site then offers a few inches of commercials, then clinical trials for experimental treatment.

Below that, they list alternative treatments, and chiropractic is first. However, the caveat is they urge you to discuss the benefits of alternative treatment with your health care provider before starting care. This part is perplexing as their health care provider has perpetually failed despite billions spent in “dead-end care.”

One would think this a classic example of “Alice in the Looking Glass” with the medical world upside-down based on the overwhelming evidence in the literature. However, understanding medical politics and business, perhaps there is too much money “at stake” throughout the medical community to change direction for what has been determined to be 25% of all primary care visits in the United States.          

MARK STUDIN, DC, is an adjunct assistant professor of chiropractic at the University of Bridgeport, College of Chiropractic; adjunct professor at Cleveland University – Kansas City, College of Chiropractic; and educational provider for the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Post-Doctoral Division. He is the president of the Academy of Chiropractic, teaching doctors of chiropractic and interfacing with the medical and legal communities (DoctorsPIprogram.com). He can be reached at DrMark@AcademyOfChiropractic.com or at 631-786-4253.

REFERENCES

1 https://www.congress.gov/bill/115th-congress/house-bill/6 

2 Mauro, P. M., Gutkind, S., Annunziato, E. M., & Samples, H. (2022). Use of medication for opioid use disorder among US adolescents and adults with need for opioid treatment, 2019. JAMA network open, 5(3), e223821-e223821. 

3 Humphreys, B. K., Sulkowski, A., McIntyre, K., Kasiban, M., & Patrick, A. N. (2007). An examination of musculoskeletal cognitive competency in chiropractic interns. Journal of Manipulative and Physiological Therapeutics, 30(1), 44-49         

4 Azad, T. D., Vail, D., Bentley, J., Han, S. S., Suarez, P., Varshneya, K., … & Ratliff, J. K. (2019). Initial provider specialty is associated with long-term opiate use in patients with newly diagnosed low back and lower extremity pain. Spine, 44(3), 211-218. 

5 Whedon, J. M., Toler, A. W., Goehl, J. M., & Kazal, L. A. (2018). Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. The Journal of Alternative and Complementary Medicine, 24(6), 552-556. 

6 Corcoran, K. L., Bastian, L. A., Gunderson, C. G., Steffens, C., Brackett, A., & Lisi, A. J. (2020). Association between chiropractic use and opioid receipt among patients with spinal pain: a systematic review and meta-analysis. Pain Medicine, 21(2), e139-e145. 

7 Eklund, Andreas, et al. “Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial.” European Journal of Pain 23.7 (2019): 1378-1389. 

8 Blanchette, M. A., Rivard, M., Dionne, C. E., Hogg-Johnson, S., & Steenstra, I. (2017). Association between the type of first healthcare provider and the duration of financial compensation for occupational back pain. Journal of occupational rehabilitation, 27(3), 382-392