Chiropractic Care Significantly Reduces Opioid Prescriptions

A new systematic review presented at the annual meeting of the American Academy of Pain Medicine was the first to ask the question: Does seeing a DC reduce overall use of opioids?

The Answer:  Yes

Presenting to neurologists, physiatrists and others at the “voice of pain medicine” conference, lead author Kelsey Corcoran, a DC with the Yale School of Medicine, Yale Center for Medical Informatics, and VA Connecticut Health Care System observed that currently, “a small but growing amount of scientific literature” suggests chiropractic care may negatively correlate with opioid use.”

“Chiropractors provide many of the treatments included in the clinical guidelines for the initial treatment of low back pain, neck pain, and osteoarthritis of the hip, knee, and hand”, so they looked at 62,000 patients in six studies from all available literature on chiropractic use and opioid prescription patterns.

The Findings:

Less chiropractic patients received an opioid prescription. Overall, chiropractic utilization was 11.3% to 51.3%.

In that Group:

Chiropractic patients opioid use ranged from 12.3% – 57.6%) vs
non-chiropractic opioid utilization ranged from  31.2% – 65.9%

BOTTOM LINE: Patients seeing a DC for a NMS pain condition were 49% less likely to receive an opioid prescription than similar patients seeing other healthcare providers.

Now, read the unbelievable spin that appeared in Medscape…

COMMENTS by Ann E. Hansen, MD, University of Washington/Boise VA Medical Center, Boise, ID, on above in the Medscape Medical News article

Steven Weiniger’s comments are in italics below Dr. Hansen’s.

Hansen: “Muscle pain and dysfunction are the most common etiology of back and neck pain and is best addressed with conservative care.”

Weiniger comment: We agree.

“The importance of complementary medicine, physical therapy, chiropractic care, and movement therapies are well recognized as first-line management for common back and neck pain.”

Weiniger comment:  Again, we agree.

“There is little scientific data to support the specific applications of these modalities.”

Weiniger: Not completely true.  There’s been an explosion of research supporting the value of chiropractic and other motion based therapies.  However, adding the word “specific” means that you can always ask another question. A straightforward reasonable question being dodged is precisely what this study answered: Does chiropractic reduce opioid prescriptions.

“Chiropractic management is not limited to manipulation, but also may include other manual therapies, massage and therapeutic exercise instruction.”

Weiniger: True, and one of the strengths of the profession.

“However, assessment of the impact of these diverse approaches is beyond the scope of their study.”

Weiniger: Again, a dodgy opening a door to ask” How about chiropractic and massage, vs chiropractic and exercise, vs exercise and XYZ “other manual therapies”.  Add in questions of technique and “dosages”, and it’s ALWAYS possible to say “more research is needed”.  As they did for decades denying that cigarette smoking was dangerous.

“This timely meta-analysis supports the need for further research in an important area.”

Weiniger: True

“It is important to remind people suffering from musculoskeletal pain to consult their physicians for a thorough medical evaluation prior to adopting a chiropractic program or exercise regimen.”

Weiniger: Where is the support for this conclusion? I am not aware of a study showing benefit from her asserting MD assessment before seeing a DC.  My observation is this appears to be a biased and unfounded opinion that contradicts the very study she’s commenting on. 

What do you think?

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