As we’re reported before, opioid use in the treatment of spinal pain is a major problem. To be totally fair, it’s a bigger problem in other countries than it is in the UK since the NHS has for some time been trying to reduce the number of opioid prescriptions being given out – nonetheless it’s a concern. Now, new study results show that chiropractic care could have a role to play in reducing this further.
Spinal pain and opioids
Medication is often used as a first-line treatment for spinal pain – most commonly this means painkillers or non-steroidal anti-inflammatory drugs (like ibuprofen). There’s nothing necessarily wrong with this – there are no points for suffering and short term use of these kinds of medications can be totally appropriate for managing a condition until professional help can be sought. Issues begin to arise, however, when powerful painkillers become the norm.
In 2014, nearly half of the prescriptions that Australian general practitioners provided for non-specific low back pain were for opioid or opioid combinations, and approximately 3%–4% of the US population receive long-term opioid therapy. This is despite the fact that there have been no randomised placebo-controlled which have properly investigated opioids for conditions such as acute non-specific low back pain. The reason for this says it all – more than half of patients cannot even tolerate opioids and remain well enough to stay in a trial – let alone rely on them as a long term solution.[1] In the US, The National Survey on Drug Use and Health reported over 42,000 prescription opioid-related deaths in 2016, with total estimated costs of prescription opioid use reaching US $78.5 billion[2] – clearly, opioids present a health risk in and of themselves.
With this in mind, nations are looking at ways to reduce opioid usage, and chiropractic care is one of the primary approaches being considered.
Chiropractic care and opioids
Numerous studies (some of which we’ve written about) have now shown that chiropractic care is associated with decreased use of opioids and thus with a reduction of the complications associated with their use. One significant group that have not been studied in-depth, however, are older individuals on lower incomes – in the US, this means those who rely on Medicare rather than private insurance. A new study has now examined the association between chiropractic utilisation and the use of prescription opioids among older adults with spinal pain.
New study results
The just-published research[3] comprised a retrospective observational study in which the authors examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. Based on this population, the investigators measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following diagnosis of spinal pain – they then compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription.
In terms of results, the study showed that the adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients – a significant drop! The study, like others before therefore concluded that among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with a significantly lower risk of filling an opioid prescription.
Implications for the UK
In the UK our healthcare system is different to the US, or Australia – most people do not have private insurance and rely on the NHS, who, as we have pointed out, are trying to reduce opioid prescriptions. Where the NHS does not always do a fantastic job, however, is in replacing one possibly problematic treatment with something more beneficial in the long term. We hope that with these kinds of studies now being published more regularly, NHS commissioning boards will start to think about offering chiropractic in some way through our public health system – a step which we believe would be an excellent way forward for older people, and younger people too!
[1] Abdel Shaheed C, Maher CG, Williams KA, et al. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Intern Med 2016;176:958–68.
[2] Opioid Overdose Centers for disease control and prevention. centers for disease control and prevention, 2017.
[3]James M. Whedon, Sarah Uptmor, Andrew W. J. Toler, Serena Bezdjian, Todd A. MacKenzie & Louis A. Kazal Jr. Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study Chiropractic & Manual Therapies volume 30, Article number: 5 (2022)
