Chiropractic Physicians Urge Conservative Approach to Pain Management
Written by Editor   
Thursday, May 28, 2015 08:17 PM

With new research highlighting more risks associated with the increased use of opioids for pain, the American Chiropractic Association (ACA) strongly urges patients and healthcare providers to consider first exhausting conservative forms of pain management.  In recent comments submitted to the National Institute of Neurological Disorders and Stroke (NINDS) Office of Pain Policy on the draft National Pain Strategy, the ACA strongly urges the agency to include recommendations encouraging patients and health care providers to first exhaust conservative forms of pain management, when appropriate.

According to a recent report published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the increased usage of opioids has led to unanticipated consequences such as a tolerance among some patients to the drug hydrocodone and negative treatment outcomes for conditions such as work-related musculoskeletal disorders, joint replacements and spine surgery.  "Beyond the risks of overuse and addiction, prescription drugs that numb pain may convince a patient that a musculoskeletal condition is less severe than it is, or that it has healed. That misunderstanding can lead to over-exertion and a delay in the healing process or even to permanent injury," says ACA media spokesperson Robert Hayden, DC, PhD.

JAAOS points out that more than 80 percent of the world's opioids are consumed in the United States and that orthopedic surgeons are the third-highest prescribers of these medications - behind primary care physicians and internists. Researchers note that orthopedic surgeons must continue to treat pain but also implement strategies to battle the opioid epidemic.

According to Dr. Hayden, one potential strategy is the use of conservative forms of care for pain before initiating higher-risk options such as opioids. A conservative health care model emphasizes more cost-effective and safer approaches over potentially addictive medications or surgery for pain management and health enhancement. For example, conservative management of back pain may include trying spinal manipulation combined with exercise and stretching prior to moving on to procedures involving higher risk.
Health care quality organizations now recognize the value of a conservative approach. Earlier this year, the Joint Commission, which certifies more than 20,000 health care organizations and programs in the United States, including every major hospital, revised its pain management standard to include chiropractic services and acupuncture. Clinical experts in pain management who provide input to the Commission's standards affirmed that treatment strategies may consider both pharmacologic and nonpharmacologic approaches.
"Doctors of chiropractic practice a hands-on, drug-free approach to health care that has been shown to alleviate neuromusculoskeletal complaints. When other medical conditions exist, chiropractic care may complement or support medical treatment by relieving the musculoskeletal aspects associated with the condition," writes ACA Acting Executive Vice President Richard Miller as part of ACA's formal comments. 
ACA specifically urges the federal government to change outdated, statutory language in Medicare to allow chiropractic physicians to practice and be reimbursed for the fullest extent of their licensure, training and competencies; appoint doctors of chiropractic as officers in the commissioned Regular Corps and the Ready Reserve Corps of the Public Health Service; make clear the intention of Section 2706(a) of the 2010 Patient Protection and Affordable Care Act to allow patients to see providers of their choice when seeking treatment for pain and other musculoskeletal conditions; expand access to chiropractic services in the nation's military and Department of Veterans Affairs health care systems; and expand access to chiropractic services in all other federal health programs, including research programs related to pain management.
The comments submitted by ACA are part of the profession's on-going efforts to educate the public about the value of exhausting non-invasive, non-pharmaceutical treatments for pain management and health enhancement before moving on to other options. This health care model encourages, when appropriate, the use of more cost-effective and safer approaches over potentially addictive medications, surgery and other invasive procedures for pain management and health enhancement. Conservative management of painful conditions may include chiropractic manipulation combined with exercise and stretching prior to moving on to treatments involving higher risk.
The comments received by NINDS from ACA and other groups will be used to create a comprehensive population health level strategy for pain prevention, treatment, management, and research.