Get Started with Chiropractic: Key Messages

Getting started with chiropractic for low back pain and other common musculoskeletal conditions may help people reduce or avoid the need for prescription pain medications down the line. Research shows that people who start with chiropractic treatment for low back pain have a significantly lower probability of being prescribed an opioid later. Research and clinical guidelines today support this approach.

What are you waiting for? Get started with chiropractic! Below are key messages and supporting information to share with patients and your community during the campaign:

Message #1: Chronic musculoskeletal pain is a widespread problem. Factors contributing to this issue are the aging population, an increase in obesity, and sedentary lifestyles.

  • It is estimated that about 20% of adults in the U.S. – or one in five – experience chronic pain.1
  • Low back pain is the single leading cause of disability worldwide.2
  • The number of people worldwide living with back pain is projected to rise 36% over the next 30 years, (from 619 million currently to 843 million in 2050).3
  • New cases of chronic pain occur more frequently among adults than new cases of chronic conditions such as diabetes, depression and high blood pressure.4
  • One-half of all working Americans admit to having back pain symptoms each year.5

Message #2: Prescription opioids are not a good strategy for managing chronic low back pain long term. People are looking for better, safer options to manage their pain.

  • In the U.S., low back pain is one of the leading reasons why people are prescribed opioids.6
  • Research shows that opioids do not provide clinically meaningful pain relief for people with chronic back pain.7
  • As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction.8
  • Almost 80 percent of Americans prefer to first try options other than prescription drugs for their pain.9
  • From 59%-90% of those who use alternative therapies for chronic pain find it to be helpful.10

Message #3: For years, pain medications have been the go-to treatment for musculoskeletal conditions. However, clinical guidelines from leading health care organizations now encourage patients with common musculoskeletal conditions to try non-drug treatments first.

  • In the 2022 Clinical Practice Guideline for Prescribing Opioids, the Centers for Disease Control and Prevention promotes “diverse approaches and varied pain management solutions” and specifically encourages use of non-opioid/non-drug therapies as a first line of treatment against subacute and chronic pain.11
  • The American College of Physicians (ACP) updated its guidelines for the treatment of acute and chronic low back pain in 2017 to recommend first using noninvasive, non-drug treatments—including spinal manipulation—before resorting to over-the-counter and prescription drugs.12
  • The Department of Defense/Veterans Administration 2017 guideline for the treatment of low back pain includes spinal manipulation as a non-drug, noninvasive option.13
  • The Joint Commission, which accredits every major U.S. hospital, recognized the value of non-drug approaches in 2015 by adding chiropractic to its pain management standard.14

Message #4: Research studies have shown that patients who receive chiropractic services first may be able to significantly reduce or eliminate their reliance on prescription opioids.

  • A 2018 study focusing on adults with office visits for noncancer low back pain found that the likelihood of filling an opioid prescription was significantly lower (55% lower) for recipients of services delivered by chiropractors compared with nonrecipients.15
  • A study published in the journal Pain Medicine found that chiropractic users had 64% lower odds of receiving an opioid prescription than non-users.16
  • A study published in the British Medical Journal found that patients who saw a chiropractor as their initial provider for low back pain had 90% decreased odds of both early and long-term opioid use.17
  • A 2022 study focusing on older Medicare beneficiaries with spinal pain found that use of chiropractic care is associated with a significantly lower (56% lower) risk of filling an opioid prescription.18
  • A 2017 study published by the Mayo Clinic found that people with neck pain initiating care with chiropractors had lower odds of using advanced imaging, injections and opioid medications.19

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References

  1. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI: http://dx.doi.org/10.15585/mmwr.mm7215a1.
  2. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428.
  3. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatology, June 2023. DOI: https://doi.org/10.1016/S2665-9913(23)00098-X.
  4. Nahin RL, Feinberg T, Kapos FP, et al. Estimated rates of incident and persistent chronic pain among U.S. adults, 2019–2020. JAMA Network Open. 2023;6(5):e2313563.
  5. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
  6. Mojtabai R. National trends in long-term use of prescription opioids. Pharmacoepidemiology and Drug Safety, 2017; doi: 10.1002/pds.4278.
  7. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med.2016;176(7):958–968. doi:10.1001/jamainternmed.2016.1251.
  8. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82. http://dx.doi. org/10.1111/j.1360-0443.2010.03052.
  9. “Americans Prefer Drug-Free Pain Management Over Opioids,” Gallup-Palmer College of Chiropractic Annual Survey of Americans (2017), Palmer College of Chiropractic. https://www.palmer.edu/wp-content/uploads/2021/12/americans-prefer-drug-free-pain-management-over-opioids.pdf.
  10. Urits I, Schwartz RH, Orhurhu V, et al. A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care. Adv Ther. 2021;38(1):76-89. doi:10.1007/s12325-020-01554-0
  11. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1.
  12. Qaseem A et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. DOI: 10.7326/M16-2367
  13. VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain, Sept. 2017, https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGPatientSummary092917.pdf
  14. The Joint Commission, “Clarification of the Pain Management Standard,” Joint Commission Perspectives, November 2014.
  15. Whedon et al. Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22. PMID: 29470104 DOI: 10.1089/acm.2017.0131.
  16. Kelsey L Corcoran, Lori A Bastian, Craig G Gunderson, Catherine Steffens, Alexandria Brackett, Anthony J Lisi, Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis, Pain Medicine, pnz219, https://doi.org/10.1093/pm/pnz219.
  17. Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019; 9:e028633. doi: 1136/bmjopen-2018-028633.
  18. Whedon et al. Association between chiropractic care and use of prescription opioids among older Medicare beneficiaries with spinal pain: a retrospective observational study. Chiropr Man Therap. 2022 Jan 31;30(1):5. PMID: 35101064, PMCID: PMC8802278, DOI: 10.1186/s12998-022-00415-7.
  19. Horn et al. Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain. Mayo Clin Proc Innov Qual Outcomes. 2017 Oct 19;1(3):226-233. doi: 10.1016/j.mayocpiqo.2017.09.001. eCollection 2017 Dec. PMID: 30225421 PMCID: PMC6132197.