Chiropractic a key role in managing back pain

The efficacy of chiropractic in managing low back pain and its key role in reducing the use of pharmaceuticals has been highlighted by one of the biggest studies of its kind.

The study, published in April found significant improvements in lower back pain intensity and physical disability in favour of those receiving chiropractic care in addition to usual medical care.

The US study by New Zealand Professor Ian Coulter* is entitled A comparative effectiveness controlled trial evaluated the addition of chiropractic care to usual medical care for patients suffering from low back pain[1]. It was a multi-site, pragmatic, comparative effectiveness study which looked at 750 active duty military personnel with low back pain, aged 18 to 50 years who received either usual medical care or usual medical care plus chiropractic care. No related serious adverse events were reported in either group.

Professor Coulter (who is the keynote speaker at this week’s annual conference of the New Zealand Chiropractors’ Association in Christchurch) says: `The most common musculoskeletal condition reported is low back pain. Low back pain is also one of the most frequent reasons that people seek medical care. The burden of low back pain is made worse by the fact that many treatments included under the umbrella of usual medical care, such as NSAIDs, steroid injections, spinal surgery, and opioids, do not significantly decrease pain and may result in serious side effects. Spurred on primarily by the resultant opioid crisis, many government and private organizations, including the FDA, the Joint Commission, and the American College of Physicians are now recommending the use of non-drug, non-surgical therapies for chronic pain, including low back pain. Chiropractic care and/or spinal manipulation delivered by doctors of chiropractic is one of these recommendations.’

Last week Australasian doctors called for a shift in the way pain management is treated in an attempt to tackle New Zealand's opioid "epidemic". The Royal Australasian College of Physicians (RACP) Congress in Auckland heard that there was a need for a "multidisciplinary, evidence-based approach" to pain management, to stamp out New Zealand's "serious" opioid problem.

Recent evidence suggests that chiropractic care has an important role to play in reducing opioid prescriptions compared with non-chiropractic care.

There has been a tenfold increase in the number of people over 60 getting help for an addiction to opiate drugs. Figures released by the Ministry of Health show 530 people aged 60 or over are now getting what is called opioid substitution treatment.

In a new meta-analysis and systematic review, presented at the American Academy of Pain Medicine (AAPM) 2019 Annual Meeting in March, patients who visited a chiropractor to help manage a musculoskeletal pain condition were 49% less likely to receive an opioid prescription than their counterparts who went to other healthcare providers[2].

Ten years ago almost no one over the age of 60 had opioid substitution treatment, with just 42 people using it in 2008, but it has increased every year since. The Ministry of Health said the 530 people over 60 who got treatment in 2017 represents a 1200 per cent increase.

Professor Coulter says: `Our findings have the potential to impact clinical practice by strengthening the scientific literature regarding the use of chiropractic care in patients with lower back pain.’

New Zealand Chiropractors’ Association President Dr Hayden Thomas comments: `We know there are many more New Zealanders who have a dependence on opioids but have not put their hand up for help. Drugs such as morphine, codeine, Tramadol and Fentanyl are too often given as pain relievers when there are other drug free ways to help manage pain, such as chiropractic.

‘Some people develop an addiction to these drugs, even when used as prescribed by their doctor. Across the world preventing opioid addiction and overdose is a significant public health priority; and as part of a strategy to reduce opioid use, clinical guidelines in many countries now recommend many drug-free options to be considered as front-line treatment ahead of any medication.[3]’

Chiropractors are uniquely placed to provide care that specifically focuses on the health of the spine and the relationship between the spine and the nervous system.

New Zealand’s chiropractors are taking the lead to inform, and inspire people to prevent pain and disability by educating the public to have a greater understanding of the relationship between their spine and nervous system, improving their posture, addressing and preventing spinal problems, and engaging in physical activity.

*Professor Ian Coulter is a senior health policy researcher at the RAND Corporation, where he holds the Samueli Institute Chair in Policy for Integrative Medicine, based in Santa Monica, CA. He is a professor at UCLA’s Division of Public Health and Community Dentistry; Pardee RAND Graduate School; and the Southern California University of Health Sciences.

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