Years ago, those who were addicted to prescription opioids or NSAIDS were attached to a certain stigma.
That is no longer the case. Reliance on pain medication is widespread throughout many demographics, and no matter how or why the pills got in their hands, millions of Americans are learning the dire consequences of them.
“When you trace the roots, I think it started maybe 20 years ago, or perhaps less, when there was an actual concern that people’s pain wasn’t being sufficiently managed or even ignored,” says James Whedon, DC, MS, director of health services research at the Southern California University of Health Sciences. “Pharmaceutical companies started to jump on board with this idea and began engaging in some pretty aggressive marketing tactics. Now, we have a situation where many hundreds of thousands of opioid prescriptions are dispensed every day in the United States.”
In the midst of this crisis, stakeholders have devised a number of solutions intended to guide the public away from pharmacological pain-relief solutions. One resounding recommendation is for care by hands-on healthcare professionals who offer non-pharmacological care for pain disorders, but even so, there is debate as to which discipline has the answer.
Many studies over the years have shown the benefits of chiropractic as a proven, cost-effective approach to musculoskeletal pain, but where does chiropractic fall in the fight against the opioid epidemic?
“There is a lot of context here as it relates to why chiropractic care as opposed to any other discipline,” says Jay Greenstein, DC, chairman of Clinical Compass. “I think it’s important to understand that in 2016, the Lancet published a paper looking at the global burden of disease. What has been proven in the scientific literature to be effective for the treatment of neck and low back pain is chiropractic. It made so much sense to evaluate chiropractic in the context of opiate utilization because neck and low back pain are literally the world’s biggest problems.”
The search for an answer
To address the gap in literature, Whedon set out to investigate the use of chiropractic as a solution to the opioid crisis.
In 2016, his study, Association between Utilization of Chiropractic Services and Use of Prescription Opioids Among Patients with Low Back Pain, found a 55 percent reduction in the likelihood of people filling prescriptions for opioids in those who received chiropractic care as compared to those who did not.
Furthermore, the charges for filling opioid prescriptions and providing clinical services for chiropractic recipients were 74 percent and 78 percent lower, respectively.
“That’s statistically significant, and it may be a highly clinically significant result as well,” Whedon says. “Seeing this from the point of view of a chiropractor, I would be inclined to say that these results quite possibly stem from the positive clinical changes, reduction in pain, reduction in disability, and so on, that chiropractic delivers these results for the patients and is responsible for the reduced use of opioids. But from the point of view of a scientist, I need to say that what we have here is a correlation, and a correlation simply says these two things are tied together, but we don’t know the reason why.”
According to Whedon, it would be “scientifically irresponsible not to further investigate.”
A follow-up study
Currently underway, Whedon’s second study will explore the same question as the first, but on a much larger scale. He and his team of researchers have expanded the number of subjects from more than 12,000 to over a million, and they are diving deeper into the data.
“We will have access to a lot more data and there is power in that,” Whedon says. “It allows us to cut things a little finer and have more specifically defined cohorts in terms of patient characteristics, diagnoses and treatments, and still have enough subjects to achieve a statistically significant result. To the extent that we’re empowered by richer data, we’ll be able apply more rigorous methods.
The more variables we have, the stronger the study we can make and the better we’ll be able to reduce bias and confounding.”
While the problem of general underutilization of chiropractic can be attributed to a lack of public awareness and education, the U.S. health care system itself is a massive barrier. “People don’t have the same level of access to [chiropractic] as they have with conventional health care. This is particularly true if you look at Medicare, where the restricted coverage is arguably explicitly discriminatory and coverage for chiropractic services is quite limited,” Whedon says. And this is also true for other populations, depending on the insurer.
These barriers to chiropractic access are why Greenstein and his colleagues at Clinical Compass have a strong incentive to fund and support these studies. The studys’ data can not only persuade the public that chiropractic is an imperative component of fighting back against opioid overuse but also the policymakers who establish access to care in the first place.
“I think about the four Ps: driving policy change at the legislative level; informing the public about what chiropractic can do as opposed to a normal course of care that a medical doctor might provide; helping other health care providers understand what the evidence says around the utilization of chiropractic and its impact on prescription drug use; and convincing payers that, instead of a patient going to multiple doctors or even a pain management specialist after they see their primary care physician, maybe these patients should be moved on to the chiropractor instead, or maybe the chiropractor should be the portal of entry for spine-related disorders. I think this work that Dr. Whedon is doing is going to have an impact on all four Ps,” Greenstein says.
According to a Gallup poll recently conducted by Palmer College of Chiropractic, nearly 80 percent of the public surveyed want a non-pharmacologic approach to physical pain.
Research that demonstrates how chiropractic can be an alternative to pharmacologic solutions is what the majority of the public needs to hear. Whedon’s studies are an invaluable start. As the profession makes an even stronger case for chiropractic care, the need for research and funding for research will grow.
“We need to dispel this myth that people either believe in chiropractic or they don’t, and the only way that happens is through research,” Greenstein says. “The more quality research that occurs, the more quality research that can occur.”
As a chiropractor, driving public education and the funding to take your profession to the next level is a key responsibility.
By donating to Clinical Compass, you can help fund the sort of impactful research that can make a difference in the chiropractic industry as well as in the lives of the millions of people affected by opioid addiction. Visit clinicalcompass.org/donate to help.
Rebecca Moore is the marketing manager for clinical development programs at Performance Health. Over the last two years, she has focused her writing and marketing efforts on bringing quality, innovative clinical education to hands-on health care professionals. She can be reached at email@example.com.