Opioid Epidemic

A Retrospective Analysis of Pain Changes and Opioid Use Patterns Temporally Associated with a Course of Chiropractic Care at a Publicly Funded Inner-city Facility

By Frank M. Painter|November 4, 2022|Initial Provider, Opioid Epidemic|

A Retrospective Analysis of Pain Changes and Opioid Use Patterns Temporally Associated with a Course of Chiropractic Care at a Publicly Funded Inner-city Facility

SOURCE: J Can Chiropr Assoc 2022 (Aug); 66 (2): 107–117

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Steven Passmore, Hons BKin, MS, DC, PhD, Quinn Malone, BSc, MSc1, Christian Manansala, BSc, DC, MSc, Spencer Ferbers, BSc,
E. Audrey Toth, DC, Gerald M. Olin, BSc, DC, CDir

Faculty of Kinesiology and Recreation Management,
University of Manitoba,
102- Frank Kennedy Centre,
420 University Crescent,
Winnipeg, MB, R3T 2N2 Canada

FROM: Kazis et. al, BMJ Open 2019

Background: Non-pharmacologic treatment, including chiropractic care, is now recommended instead of opioid prescriptions as the initial management of chronic spine pain by clinical practice guidelines. Chiropractic care, commonly including spinal manipulation, has been temporally associated with reduced opioid prescription in veterans with spine pain.

Purpose: To determine if chiropractic management including spinal manipulation was associated with decreased pain or opioid usage in financially disadvantaged individuals utilizing opioid medications and diagnosed with musculoskeletal conditions.

Methods: A retrospective analysis of quality assurance data from a publicly funded healthcare facility was conducted. Measures included numeric pain scores of spine and extremity regions across three time points, opioid utilization, demographics, and care modalities.

Results: Pain and opioid use significantly decreased concomitant with a course of chiropractic care.

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Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries

By Frank M. Painter|May 10, 2022|Chiropractic Management, Escalation of Care, Opioid Epidemic|

Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976) 2021 (May 11) [EPUB]

James M Whedon, Anupama Kizhakkeveettil, Andrew W Toler, Serena Bezdjian, Daniel Rossi, Sarah Uptmor, Todd A MacKenzie, Jon D Lurie, Eric L Hurwitz, Ian Coulter, Scott Haldeman

Southern California University of Health Sciences,
Whittier, CA, USA

Geisel School of Medicine at Dartmouth,
Hanover, NH, USA.

Study design: We combined elements of cohort and crossover-cohort design.

Objective: The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

Summary of background data : Current evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain.

Methods: We examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.

Results: SMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% CI 2.64-2.69, p < .0001).

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Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

By Frank M. Painter|July 3, 2021|Initial Provider, Opioid Epidemic|

Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

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SOURCE: Archives of Phys Med and Rehabilitation 2020 (Aug)

Christopher J. Louis, PhD, Carolina-Nicole S. Herrera, MA, et. al.

Department of Health Law, Policy, and Management,
Boston University School of Public Health,
Boston, Massachusetts.

Objective: To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain.

Design: Retrospective cohort study.

Setting: Marketscan research databases.

Participants : Patients (N=427,966) with new-onset neck pain from 2010-2014.

Main outcome measures: Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings.

Results: Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%–91% less likely to fill an opioid prescription in the first 30 days, and between 41%–87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47–3.69; P<.001).

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Association Between Chiropractic Use and Opioid Receipt

By Frank M. Painter|October 25, 2019|Chiropractic Care, Opioid Epidemic|

Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis

The Chiro.Org Blog

SOURCE: Pain Medicine 2019 (Sep 27) [Epub]

Kelsey L Corcoran, DC, Lori A Bastian, MD, Craig G Gunderson, MD, Catherine Steffens, Alexandria Brackett, MA, MLIS, Anthony J Lisi, DC

Kelsey L. Corcoran, DC,
Yale Center for Medical Informatics,
300 George St., Suite 501,
New Haven, CT 06511, USA.

OBJECTIVE: To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt.

DESIGN: Systematic review and meta-analysis.

METHODS: The protocol for this review was registered on PROSPERO (CRD42018095128). The MEDLINE, PubMed, EMBASE, AMED, CINAHL, and Web of Science databases were searched for relevant articles from database inception through April 18, 2018. Controlled studies, cohort studies, and case-control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval.

RESULTS: In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3–57.6%) than nonusers (range = 31.2–65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30–0.43, P < 0.001, I² = 92.8%).

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Observational Retrospective Study of the Association

By Frank M. Painter|September 26, 2019|Low Back Pain, Opioid Epidemic|

Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

The Chiro.Org Blog

SOURCE: BMJ Open. 2019 (Sep 20); 9 (9): e028633

Lewis E Kazis, Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, et. al.

Department of Health Law,
Policy and Management,
Boston University School of Public Health,
Boston, Massachusetts, USA

OBJECTIVE: This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).

DESIGN: A retrospective cohort study of patients with new-onset LBP from 2008 to 2013.

SETTING: The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.

PARTICIPANTS: 216,504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.

EXPOSURES: The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).

MAIN OUTCOME MEASURES: Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).

RESULTS: Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).

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New Canadian Opioid Guidelines Recommends Chiropractic

By Frank M. Painter|May 9, 2017|Chiropractic Care, Opioid Epidemic, Opioid Guidelines|

Guideline for Opioid Therapy and Chronic Noncancer Pain

The Chiro.Org Blog

SOURCE: CMAJ 2017 (May 8); 189 (18): E659–E666

Jason W. Busse, DC PhD, Samantha Craigie, MSc, David N. Juurlink, MD PhD, D. Norman Buckley, MD, Li Wang, PhD, Rachel J. Couban, MA MISt, Thomas Agoritsas, MD PhD, Elie A. Akl, MD PhD, Alonso Carrasco-Labra, DDS MSc, Lynn Cooper, BES, Chris Cull, Bruno R. da Costa, PT PhD, Joseph W. Frank, MD MPH, Gus Grant, AB LLB MD, Alfonso Iorio, MD PhD, Navindra Persaud, MD MSc, Sol Stern, MD, Peter Tugwell, MD MSc, Per Olav Vandvik, MD PhD, Gordon H. Guyatt, MD MSc

Jason W. Busse
Department of Anaesthesia
McMaster University

New Canadian Opioid Guidelines Recommends
Chiropractic As Care OptionFROM: World Federation of Chiropractic
Monday, May 8, 2017A new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.The guideline is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.The lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

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