It’s pretty difficult to open up a newspaper these days without seeing an article on the devastating public health impact of the opioid epidemic in the United States. While there appears to be general agreement on the scope of the problem, there is less consensus regarding what can be done to solve it. Policy-makers and professional associations taking on this challenge have tended to focus on mortality statistics and/or expert opinion. These are obviously critically important pieces of the puzzle but it is also important to take a patient-centered approach. To facilitate discussion on this important topic, Gallup held a research release event on Sept. 12 in Washington, D.C., titled “Addressing the Opioid Epidemic With Drug-Free Pain Management.”
Cynthia English, Gallup senior research consultant, presented new data from the Gallup-Palmer College of Chiropractic study, which found that 78% of adults in America would prefer to use drug-free alternatives rather than prescription pain medicine when first experiencing physical pain, such as low back or neck pain. They are also more likely to rate physical therapy and chiropractic care as very safe/very effective when compared to prescription pain medication.1
The keynote speaker and panel moderator for this event was Aaron E. Carroll, MD. Dr. Carroll is a professor of pediatrics and associate dean for research mentoring at Indiana University School of Medicine. He also contributes regularly to “The Upshot” in The New York Times. In fact, I wrote about Dr. Carroll recently2 after he published a blog post titled, “For Bad Backs, It’s Time to Rethink Biases about Chiropractors.”3 Dr. Carroll gave an excellent presentation outlining the truly pervasive impact of the opioid crisis in this country and pointing out that evidence-based non-drug treatments, including spinal manipulation, are reasonable alternatives.
Dr. Carroll’s keynote was followed by a panel discussion. Panel members included Joe Selby, MD, MPH, executive director of the Patient-Centered Outcome Research Institute (PCORI); David Shurtleff, PhD, deputy director of the National Center for Complementary and Integrative Health (NCCIH); Carolyn Clancy, MD, MACP, deputy undersecretary for health for organizational excellence of the Department of Veteran’s Affairs; and myself.
Dr. Selby spoke about the need for taking a patient-centered approach to comparative effectiveness research and outlined PCORI initiatives that focus on decreasing the use of opioids.4
Dr. Shurtleff talked about NCCIH’s strong interest in the conduct of research that evaluates the use of complementary and integrative health approaches for the treatment of chronic pain. He highlighted plans to fund a Pain Management Collaboratory that brings together the NIH, the Department of Defense, and the Veterans Health Administration (VHA) to study “non-pharmacological approaches to pain management and other co-morbid conditions in U.S. military personnel, veterans and their families.”5
Dr. Clancy pointed out that our nation’s veterans are even more likely to experience chronic pain than civilians and that non-drug options have become an important area of interest for the VHA. Last year, VHA started the Integrative Health Coordinating Center to facilitate the development of consistent clinical and policy recommendations on the use of complementary and integrative approaches to expand this care throughout the VA.6
During my presentation, I spoke about the Primary Spine Practitioner model, based on a paper recently published by Drs. Weeks, Haldeman, Justice and myself in the Spine Journal. This model is consistent with consumer preferences for the treatment of low back pain and neck pain presented during this Gallup event, in that patients would have access to conservative non-drug therapies delivered by spine-care experts such as doctors of chiropractic, first. My co-authors and I believe that The Primary Spine Practitioner model has the potential to impact healthcare delivery in two important ways. The first is by improving the value of spine care delivery and the second is by helping to address the primary care shortage.7
It was incredibly exciting to be a part of this important dialogue on public perception regarding the use of non-drug therapies in combating the opioid crisis, and to hear the perspectives of scientists and policy-makers who are invested in finding solutions that make sense to patients and to our healthcare system. I believe that there is an unprecedented opportunity for the chiropractic profession to make a critical contribution to this nationwide discussion.
Dr. Goertz is senior scientific advisor for the ACA. She also serves as vice chancellor for research and health policy at Palmer College of Chiropractic and CEO of the Spine Institute for Quality (Spine IQ).
- “American Prefer Drug-free Pain Management Over Opioids,” Gallup, http://www.gallup.com/reports/218495/americans-prefer-drug-free-pain-management-opioids.aspx?g_source=link_wwwv7&g_campaign=item_217676&g_medium=copy
- “Taking an Evidence-based Approach to Patient Care,” American Chiropractic Association, https://www.acatoday.org/News-Publications/ACA-News-Archive/ArtMID/5721/ArticleID/266
- “For Bad Backs, It May Be Time to Rethink Biases About Chiropractors,” The New York Times, published online May 1, 2017.
- “Tackling Chronic Pain While Reducing Opioid Abuse,” Patients-Centered Outcomes Research Institute, https://www.pcori.org/research-in-action/tackling-chronic-pain-while-reducing-opioid-use
- “NIH-DoD-VA Pain Management Collaboratory,” National Institutes of Health, https://grants.nih.gov/grants/guide/rfa-files/RFA-AT-17-001.html
- “Advancing Complementary and Integrative Health,” Veterans Administration, https://www.va.gov/PATIENTCENTEREDCARE/features/Advancing_Complementary_and_Integrative_Health_in.asp
- Goertz, C, et al. A proposal to improve health-care value in spine care delivery: the primary spine practitioner, The Spine Journal, DOI: http://dx.doi.org/10.1016/j.spinee.2017.06.013