Over my past six-plus years in ACA leadership, I have written and lectured on the subject of diversity in chiropractic medicine. I believe diversity in clinical practice is a strength of our profession. Individual areas of interest and expertise include imaging, orthopedics, sports medicine, pediatrics, neurology and many others. Another discipline is aging health, and I’m hopeful we can grow interest in that sphere by the creation of the ACA College on Aging.
As we each progress through our individual careers as clinicians, it’s natural to develop enthusiasm for particular patient populations or specific management strategies. The list is too long to enumerate. The point I’m trying to illustrate is that it’s natural for each of us to carve out our own niche in the health care universe. Caring for patients is a dynamic enterprise requiring contemporary skills to supplement the basics we learned during our college experience. Indeed, standards of care are based on information currently being taught in our educational institutions.
On some level we can agree that pain, more often than not, drives patients to our practices. So the vast majority of practicing chiropractic physicians have a high level of interest and expertise in managing painful conditions. Pain can be insidious or traumatic in nature; acute, subacute or chronic; constant or intermittent. Chronic pain has been described as a disease in itself.
According to the American Academy of Pain Medicine (AAPM), “Chronic pain affects more Americans than diabetes, heart disease and cancer combined. When asked about four common types of pain, respondents in a NIH Statistics survey indicated that low-back pain was the most common, followed by severe headache or migraine, neck pain and facial ache or pain. Back pain is the leading cause of disability in Americans under the age of 45.”
Common medical strategies for pain management include OTC and prescription medications, including opiates. Common opiates include fentanyl, hydrocodone, hydromorphone, morphine and oxycodone. With the utilization of these prescription medications comes a risk of overuse, abuse and addiction. There may be a higher risk of addiction if a family member has a history of substance abuse. Opioid abuse has also been associated as a gateway to heroin use. In 2013, there were 16,235 deaths involving prescription opioids.
There is a consensus that pain in America is a problem of epidemic proportion and that many types of prescription management and some surgical procedures to control pain have associated risks and may lead to further health-related issues. The chiropractic profession is poised to play a vital role in the conservative management of many painful syndromes and, indeed, chronic pain. Treatment modalities that have been associated with pain relief include manipulation/mobilization, acupressure and acupuncture, self-correcting exercises, TENS application, massage and others. Chiropractic physicians are trained and competent in many of these procedures, and these procedures are associated with lower risks.
Our role in pain management is currently being demonstrated in community health centers, the U.S. Department of Defense and the U.S. Department of Veterans Affairs. In many states, we are participating in the management of injured workers. The Joint Commission recently revised its pain management standards to include chiropractic services. The American Pain Society now has a CAM shared interest group, co-chaired by Norman Kettner, DC.
ACA fully supports chiropractic inclusion in conservative management strategies across the wide pain spectrum. Our colleges and universities should be active in training our physicians in this discipline. We should collaborate with the psychology profession in understanding and recognizing the psychosocial aspects of pain. Let’s collectively expand and define our role in managing the current musculoskeletal pain burden in the United States.