By: Sherry McAllister DC, MS(Ed)., CCSP
To understand how pain is typically managed in America, think of it as a baseball team. The physician is the manager, making up the lineup. The starters are pharmaceuticals, particularly opioids. Other forms of pain management, such as spinal manipulation, acupuncture, behavioral therapy, etc. have essentially been relegated to pinch hitters, called in off the bench if the starters aren’t performing. But they’re not ordinarily considered everyday players.
Fortunately, that viewpoint is starting to change, partially driven by the rampant opioid crisisfacing the U.S., which was responsible for more than 42,000 deaths in 2016 according to the Centers for Disease Control and Prevention (CDC).
Results of a clinical trial published in the March 8, 2018 issue of the Journal of the American Medical Association (JAMA) already found that the use of opioid vs. non-opioid medication therapy for patients with moderate to severe chronic back, hip or knee osteoarthritis pain “did not result in significantly better pain-related function over 12 months.”
New Team Rotation
Now a new article in the March 28, 2018 issue of JAMA describes the formation of a new Pain Management Collaboratory. This joint project between the National Institutes of Health (NIH), Department of Defense, and Veteran’s Administration (VA) is using $81 million in grants to create a six-year, evidence-based study of non-drug approaches to pain management at VA hospitals around the country.
What sets this initiative apart is that spinal manipulation/chiropractic, behavioral therapy and the other pain management strategies being studied by the Pain Management Collaboratory are not being treated as bench players, or “Complementary Alternative Medicine (CAM),” to use the industry vernacular. Instead, they are taking a front-line, starting role – i.e., being considered as a first choice for patients suffering from many forms of pain.
This could very well be a watershed moment in our approach to pain management. One that we have been building to for a while. Chiropractic in particular has an established body of evidence demonstrating its effectiveness in pain management. In fact, there is more evidence for the efficacy of chiropractic care than there is for the drug-based treatments that most physicians are taught to favor.
New Team Guidelines
The American College of Physicians, after a review of more than 150 studies, concluded that physicians should consider spinal manipulation and other non-drug therapies as their first option for treating acute, subacute and chronic lower back pain. Note: 94 percent of all spinal manipulations in the U.S. are performed by a doctor of chiropractic.
The Joint Commission and America’s Health Insurance Plans (AHIP) have issued similar guidance on the role of non-pharmacologic options in pain management, while the CDC, the U.S. Food and Drug Administration, and the Institute of Medicine, among other organizations, have also called for early use of non-pharmacologic approaches to pain and pain management.
In baseball or any other sport, good managers know how to gauge their athletes’ performance on a daily basis in order to put the best team on the field. The time is right to take chiropractic and other non-drug pain management strategies off the bench and insert them into the starting lineup.