A recent review of use by researchers at Spine Medical Journal found that over a 12-month period, only 8.4% of Americans sought treatment from a chiropractic physician to manage some level of spine-related pain. However, Delaware legislators, public health officials, and health professionals hope to increase that number as they work on policies to improve use, insurance coverage, and access to alternative pain management therapies to help fight the opioid epidemic that is affecting plagues our state and nation. Chiropractic care in particular can play a significant role in these changes because of the relationship between spinal pain, particularly low back pain, and opiate prescription patterns.
Back pain is currently the most common cause of disability worldwide. In the United States, it is the second most common reason for doctor visits, after upper respiratory tract infections. Non-cancerous or mechanical spinal pain, in particular, has been found to have a high correlation with opiate prescription, with previous studies showing that 61% of spinal pain patients received a prescription opiate, with nearly 19% of patients having an episode of long-term opiate use. In addition, statistically 1 in 550 patients prescribed opiates will die from an overdose within 2.6 years of their first opiate prescription. This mortality rate is even more dramatic as dosages increase, escalating to 1 in 32 in patients receiving more than 200 milligram-milligram equivalents of morphine.
Despite the fact that chiropractic care has always been a drug-free and surgical-free form of treatment throughout its 100+ year history, its use among the general population and even the traditional medical community has always remained relatively low due to over-prescribing and over-reliance on painkillers opiate base has increased over the past two decades. However, the reason it is coming into focus now is because of the correlation between patients undergoing treatment with a chiropractor and a reduced need and use of opiate-based pain relievers and other drugs.
In New Hampshire, where the death rate from drug overdose is one of the highest in the United States, researchers documented a 55 percent reduction in opioid use among patients who went to a chiropractor compared to those who didn’t. Another study that focused on Medicare beneficiaries found that higher chiropractic therapy utilization resulted in lower rates of opioid prescriptions, while an even earlier study found an 85% reduction in drug spending for chiropractic patients im compared to non-patients associated.
Delaware policymakers know they have an uphill battle trying to increase the use of alternative pain management therapies, particularly chiropractic care, among the general public. They have already made significant strides in changing coverage with the passage of Senate Bill 225, a 2019 law that prohibited insurance companies from denying coverage for chiropractic treatments for chronic back pain. In addition, the Ministry of Health has developed HelpisHereDE.com, an online resource created in collaboration with numerous local health professionals. Through this site, the general public and healthcare providers can obtain additional information and assistance on all the different components of opiate addiction, including guidelines on the use of non-pharmaceutical methods to treat chronic pain. Despite these advances, the limited exposure to chiropractic care and misinformation has led to limited education among the public, and especially among medical providers, leaving them with two main questions; is it effective and is it safe?
The answer to both of these questions is clearly yes. In terms of their effectiveness, chiropractic and spinal manipulation have consistently demonstrated high clinical success rates. In fact, research from the Spine Journal has ranked chiropractic care as superior to standard medical care, physical therapy, and exercise programs for treating certain types of spinal pain. This is combined with the fact that chiropractic treatment plans are, on average, 40% less expensive than physician-initiated treatment episodes.
Besides being a highly effective treatment for back pain, chiropractic care has also proven to be one of the safest options. Even with the high velocity, low amplitude (HVLA) impacts and “popping” sounds associated with certain forms of chiropractic fitting, the rate of adverse events associated with chiropractic care is among the lowest in the entire health care system. A 2015 study evaluated over 1 million Medicare patients over the course of more than 10 million doctor visits. They found that “there was no mechanism by which spinal manipulation would induce injury in normal, healthy tissue.” Surprisingly, they also came to the conclusion that the risk of injury to the head, neck, or trunk was actually 76% lower in patients who went to a chiropractor than in patients who went to a family doctor. However, they cautioned against the use of chiropractic care in patients with certain pre-existing medical conditions, particularly those with a history of chronic bleeding disorders, long-term use of anticoagulant therapy, inflammatory spondylopathy, and aortic aneurysm and dissection.
Delaware lawmakers also hope that the chiropractor’s unique position in the market will help them ease the burden on primary care practices, emergency clinics, and emergency rooms. Unlike most other forms of alternative pain therapy and physical therapists, chiropractic doctors have no access restrictions, meaning most patients do not require a referral to schedule an appointment. In addition, they are able to diagnose and manage care, refer patients for further testing, including MRI or CT scans, and manage care alongside surgeons, orthopedists and traditional pain management physicians. Most insurance plans currently also offer coverage for chiropractic care.
Ultimately, the hope is to provide patients with better insurance coverage and easier access to alternative pain management methods such as chiropractic care, thereby reducing the likelihood that they will end up receiving an opiate prescription. Since 2019, opiate prescription patterns in Delaware have improved but are still fairly high, with an average of 51.6 opiate prescriptions per 100 people, according to the CDC. This is a significantly higher rate than the national average.
With greater acceptance and education in the medical community, Delawareans should find it easier to use alternative therapies that not only reduce their pain, but also limit their exposure to potentially dangerous and addictive drugs.
dr Travis McKay is a chiropractor and clinical director of the Advanced Back & Neck Pain Center in Newark. He is also the President of Hands For Life – Omega Drive, a Newark-based nonprofit dedicated to bringing non-pharmacological pain management to members of the community. He can be reached at 302-368-1300 or at [email protected]