Identifying patients who self-medicate for musculoskeletal pain

Research indicates the top reason people seek chiropractic care is low–back pain at 49.7%, followed by neck pain at 22.5%. During the exam, these patients may share where the pain exists, how long they’ve had it and how it impacts their lives.  

But what they might not say is that to deal with the discomfort, they are self-medicating with drugs or alcohol.

Identifying when this is occurring is critical to helping patients overcome their pain issues with healthier strategies.   

Prevalence of drug use and alcohol misuse for self-medicating

Slightly more than 59 million Americans aged 12 or older have used an illegal drug or misused a prescription medication in the past year, according to the National Center for Drug Abuse Statistics. Roughly 138.5 million drink alcohol. While the reasons for drug and alcohol use vary, many engage in these behaviors to relieve pain. 

A study published in the Journal of General Internal Medicine involved 589 patients with a positive screen for illicit drug use or prescription drug misuse. Eighty-seven percent reported being in chronic pain. More than half (51%) of the illicit drug users said that they used these substances to treat the pain. Eighty-one percent of the prescription drug misusers said the same, as did 38% of the participants with heavy alcohol use.  

Identifying patients who are self-medicating can be the first step to connecting them with resources for stopping substance use or misuse while simultaneously working to resolve their musculoskeletal pain. Yet, many chiropractic practitioners lack confidence in their ability to recognize these patients.   

Low identification confidence in DCs

A 2023 study involved 175 doctors of chiropractic providing direct patient care. These practitioners completed a 10-item survey designed to better understand their confidence in identifying substance issues related to pain management, as well as to assess their interest in further education in this area.  

It found 44% of the respondents did not feel confident they could identify prescription medication misuse in patients. Additionally, 89.7% felt they would benefit from a continuing education course covering this topic. 

Identifying self-medication in patients

One way to discover whether patients are engaging in drug or alcohol use to relieve pain is to ask questions during the intake or exam. After discussing their pain location, severity and onset, inquire about what they are doing to find relief. Explicitly ask if they ever use alcohol or drugs, or misuse pain medications to reduce the discomfort.  

Adding these types of questions to a pre-exam questionnaire is another way to get the answers without the patient feeling put on the spot by being asked directly. This might encourage them to open up about their self-medicating behaviors, which they may not otherwise do if they feel uncomfortable talking honestly about this issue. 

Recognizing the signs

It can also be beneficial to know the signs of problematic drug use. The National Institute on Drug Abuse reports the signs include: 

• Changes in eating or sleeping habits 
• Lack of concern about their appearance 
• Loss of interest in activities they once enjoyed 
• Increased problems with family and friends 

Legal or school-related troubles

While some of these signs may be difficult to discern from a chiropractic office, asking about these areas of a patient’s life may help shine a light on drug or alcohol issues.  

Next steps

If it is suspected a patient may be self-medicating for pain, talking with them about this concern can help open the door for treatment. Connect them with local resources if they admit an issue exists. If they deny any sort of problem, let them know help is available if they ever have the urge to use alcohol or drugs to ease the pain. Sometimes just leaving this door open is enough to help them walk in if they do have an issue and decide they want help.