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?

For more about StrongPosture® take the latest training via online course or posture certification training.

• The new FDA blueprint or prescriber education add non-pharmacologic options of assessment and treatment to the previous opioid pain management principles.

Potentially this is good news for those of us treating back and spine pain naturally, with the added opportunity for CPEPs and other posture professionals to engage MDs in the spine care world with non-pharm alternatives.

Back pain is a frequent reason for opioid use, but according to the American Society of Anesthesiologists’ opioids aren’t terribly effective for many patients. A recently published study in their official journal found patients who were prescribed opioids for chronic lower back pain had significantly less pain relief and were more likely to abuse their medication when there’s a psychological issue like depression or anxiety. With opioid use, patients with a history of mental illness experienced a mere 21% improvement in back pain, and those who were not (yet) showing signs of depression or anxiety showed just a 39% improvement.

According to study author Ajay Wasan, M.D., professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine, “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant. This is particularly important for controlled substances such as opioids, where if not prescribed judiciously, patients are exposed to unnecessary risks and a real chance of harm, including addiction or serious side effects.”

BOTTOM LINE:
Treat low back pain conservatively at first, and always address posture. Communicate this message to other health care providers with intelligence, and you may be surprised at the referrals.

PosturePractice Insight: In addition to relieving pain, teaching people to find and strengthen lost motion patterns with StrongPosture® exercise protocols engages and then empowers them for self-managment. And empowering someone to better control their bodies can can be a powerful antidote for depression.

Cited Study

Wasan, A. D., Michna, E., Edwards, R. R., Katz, J. N., Nedeljkovic, S. S., Dolman, A. J., . . . Jamison, R. N. (2015). Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology, 123(4), 861-72. doi:10.1097/ALN.000000000000076. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26375824

Bad news for drug merchants covering up back pain; really good news for those connecting body with mind, and mind with body (and the people needing their help).

From NIH to NPR to NBC, on top of the recent slams against opioid drugs for chronic pain from the Department of Health and Human Services¹ the media is reporting on new studies showing:

• Tylenol works no better than a placebo for arthritis² and offers virtually no benefit, according to a large study that follows on the heels of last year’s study blasting the drug acetaminophen (paracetamol) as ineffective for low back pain as well³

On the other hand…

• Mindful meditation and yoga (aka MBSR, or Mindfulness-Based Stress Reduction) improves function and reduces pain better than usual medical care. Improvements held 6 and 12 months after the start of an 8 week program⁴
• Cognitive-behavioral therapy (aka CBT) also improved function and reduced pain better than usual medical care. And here as well, after an 8-week program participants were better 6 and 12 months later⁵

So I am pleased to see an NIH director say in this March 22 Press Release:
“The results from this research affirm that non-drug/non-opioid therapies, such as meditation, can help manage chronic low-back pain.”  – Josephine Briggs, M.D., director of National Institute of Health(NIH)/ National Center for Complementary and Integrative Health (NCCIH)

Briggs also says, “It is vital that we identify effective nonpharmacologic treatment options for 25 million people who suffer from daily pain, in the United States.”

Why I’m Excited: The StrongPosture® protocols combined with passive therapies such as chiropractic for joints and massage for muscles are a “Cognitive Body Therapy,” combining the benefits of cognitive behavior therapy (CBT) with the demonstrated bio-mechanical benefits of what was previously called “alternative therapy.”

Coincidentally, my most recent blog post was Connecting Biofeedback, Cognitive Behavior Therapy and StrongPosture® (this was before the CBT and MBSR studies published)

Our goal is to retrain Body AND Mind to subjective and objective accuracy. Daily StrongPosture® exercises synergize with chiropractic manipulation of the spine and extremities as well as muscle therapy with posture exercise tracks for Balance, Alignment and Motion. Combining attentional focus with motor control training helps provide people ongoing skills to help them manage their pain, and along with manipulation to restore joint motion and massage to release soft tissue restrictions helps progressively increase muscle and joint function.

CITED SOURCES

1 The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain, Evidence Report/Technology Assessment Number 218  Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services, Roger Chou, M.D., FACP  Rick Deyo, M.D., M.P.H. Beth Devine, Pharm.D., Ph.D., M.B.A. Ryan Hansen, Pharm.D., Ph.D. Sean Sullivan, Ph.D.  Jeffrey G. Jarvik, M.D., M.P.H. Ian Blazina, M.P.H.  Tracy Dana, M.L.S. Christina Bougatsos, M.P.H.  Judy Turner, Ph.D.  AHRQ Publication No. 14-E005-EF September 2014. Retrieved from http://www.effectivehealthcare.ahrq.gov/ehc/products/557/1971/chronic-pain-opioid-treatment-report-140929.pdf

2 da Costa, B. R., Reichenbach, S., Keller, N., Nartey, L., Wandel, S., Jüni, P., & Trelle, S. (2016). Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: A network meta-analysis. Lancet. doi:10.1016/S0140-6736(16)30002-2. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30002-2/abstract

3 Williams, C, Maher, CG, Latimer, J, McLachlan, AJ, Hancock, MJ, O Day, R, Lin, C. (25 July 2014). Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. The Lancet. Retrieved from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/abstract

4 Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., . . . Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial. JAMA: The Journal of the American Medical Association, 315(12), 1240-1249. doi:10.1001/jama.2016.2323. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2504811

5 Study Finds Mindfulness Meditation Offers Relief for Low-Back Pain, National Institutes of Health, National Center for Complementary and Integrative Health (NCCIH), https://nccih.nih.gov/news/press/03222016

President Obama recently pledged a billion dollars to a war on opioid abuse, with financial incentives for addiction centers, new nasal sprays for OD’s, and “guidelines to improve the way opioids are prescribed, and help providers offer safer, more effective chronic pain treatment.”

Potentially this is good news for those of us treating back and spine pain naturally, with the added opportunity for CPEPs and other posture professionals to engage MDs in the spine care world with non-pharm alternatives.

Back pain is a frequent reason for opioid use, but according to the American Society of Anesthesiologists’ opioids aren’t terribly effective for many patients. A recently published study in their official journal found patients who were prescribed opioids for chronic lower back pain had significantly less pain relief and were more likely to abuse their medication when there’s a psychological issue like depression or anxiety. With opioid use, patients with a history of mental illness experienced a mere 21% improvement in back pain, and those who were not (yet) showing signs of depression or anxiety showed just a 39% improvement.

According to study author Ajay Wasan, M.D., professor of anesthesiology and psychiatry at the University of Pittsburgh School of Medicine, “Learning that we are able to better predict treatment success or failure by identifying patients with these conditions is significant. This is particularly important for controlled substances such as opioids, where if not prescribed judiciously, patients are exposed to unnecessary risks and a real chance of harm, including addiction or serious side effects.”

BOTTOM LINE:
Treat low back pain conservatively at first, and always address posture. Communicate this message to other health care providers with intelligence, and you may be surprised at the referrals.

PosturePractice Insight: In addition to relieving pain, teaching people to find and strengthen lost motion patterns with StrongPosture® exercise protocols engages and then empowers them for self-managment. And empowering someone to better control their bodies can can be a powerful antidote for depression.

Cited Study

Wasan, A. D., Michna, E., Edwards, R. R., Katz, J. N., Nedeljkovic, S. S., Dolman, A. J., . . . Jamison, R. N. (2015). Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology, 123(4), 861-72. doi:10.1097/ALN.000000000000076. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26375824