Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

Acharya, Mahip; Chopra, Divyan; Smith, Allen M.; Fritz, Julie M.; Martin, BC

doi:10.1016/j.jcm.2022.02.007

Cited by 7 publications

(4 citation statements)

References 55 publications

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“…Several observational studies have reported an association between use of chiropractic services and reduced opioid prescribing [17][18][19][20][21]61] or reduced opioid use [22][23][24]. Previous observational research [34][35][36][37][38][39] also suggests that integrating chiropractic services with physician management of spine-related pain is associated with improved patient outcomes and potential for cost savings (e.g., reductions in advanced imaging, GP visits, and specialist referrals).…”

Section: Discussionmentioning

confidence: 99%

“…Previous observational research [34][35][36][37][38][39] also suggests that integrating chiropractic services with physician management of spine-related pain is associated with improved patient outcomes and potential for cost savings (e.g., reductions in advanced imaging, GP visits, and specialist referrals). When accessed as a first-line treatment, chiropractic services may also help to delay, and in some cases prevent, opioid prescription [17][18][19][20][21]61]. In one of our interviews (see Theme #2, first sub-theme, Additional file 8), the following GP expressed that,…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Emary

Brown²,

Oremus

et al. 2022

BMC Health Serv Res

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Background: Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain. Methods: We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings. Results: Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52–0.83) and refills (IRR = 0.27; 95% CI, 0.17–0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04–0.47), six months (OR = 0.14; 95% CI, 0.05–0.40), nine months (OR = 0.19; 95% CI, 0.07–0.57), and 12 months (OR = 0.22; 95% CI, 0.08–0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors. Conclusion: We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Emary

Brown²,

Oremus

et al. 2022

BMC Health Serv Res

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show abstract

“…Interestingly, an estimated 85% of chronic low back pain cases are diagnosed as “non-specific low back pain”, not as a result of injury, but as a result of an unknown cause, typically from spinal biomechanical dysfunction [ 1 ]. DCs offer safe [ 2 , 3 , 4 ], non-pharmaceutical, non-surgical approaches to musculoskeletal conditions that have been shown to reduce opioid usage [ 5 , 6 , 7 , 8 ] and decrease surgical intervention [ 9 , 10 ] and disability [ 11 , 12 , 13 ] when compared to other therapies. Research shows that when a patient sees a DC first after a low back injury, surgical intervention is reduced to 1.5% compared to 42.7% when initially evaluated by a surgeon even after considering other important variables [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

Arnone

Kraus²,

Farmen

et al. 2023

JCM

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Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.

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“…There is mixed quality evidence of early physical therapy initiation favoring decreased healthcare costs and utilization [6] . Early use of chiropractic care or physical therapy has been found to be associated with reduced opioid use (including long-term opioid use) [ 7 , 8 ]. Limited evidence exists in other clinical disciplines commonly providing NPM for LBP.…”

Section: Introductionmentioning

confidence: 99%

Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration

Coleman

Lisi

Abel

et al. 2023

North American Spine Society Journal (NASSJ)

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Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

Cited by 7 publications

References 55 publications

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration

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