BMC Health Serv Res 2022 (Nov 3); 22 (1): 1313

Table 2.

Joint display of the quantitative association between receipt of chiropractic services at the Langs Community Health Centre and prescription opioid use, representative qualitative interview quotes, and meta-inferences

Variable	Quantitative results	Qualitative interview quotes	Meta-inferences
Receipt of chiropractic care (n = 49)	• Negative association with total number of opioid fills (adjusted IRR = 0.66) • Negative association with total number of opioid refills ^a (adjusted IRR = 0.27) • Negative association with higher opioid dosage at: 3-month follow-up (adjusted OR = 0.14) 6-month follow-up (adjusted OR = 0.14) 9-month follow-up (adjusted OR = 0.19) 12-month follow-up (adjusted OR = 0.22)	Resistance to taking medication: • “I don’t want to take so many medicine[s]. … It’s too much chemical going in your body, it’s no good. … I try to take, even with my pain, [only] one Tylenol #3, and [then] I will take Advil or extra strength Aspirin or Tylenol every six hours [for the rest of the day].” DC Patient 4 • “I try and adhere against [taking] Tylenol #3, if I can help it.” DC Patient 5 • “I’ve been prescribed [opioids], … but I just started reading about stuff, what it does to your liver and what it does to other organs in your body. I just, I chose other methods, i.e., like chiropractic, massage, I bought a hot tub – hydrotherapy. Just stuff like that. … I’m just so not a drug guy.” DC Patient 6 Impact of chiropractic treatment on chronic spinal pain: • “When I first started coming [to see the chiropractors at Langs] I couldn’t hardly walk and get in my car, to get in and out of the car, it was a challenge. And after a few chiropractor treatments, it got much better. And some days I couldn’t even turn my head sideways to see driving the car, and that got fixed. It’s gone well. Sometimes, it comes back a little bit, but then I just think – now I can get this fixed with the chiropractor.” DC Patient 3 • “When I had the chiropractor [treatments], … it wasn’t just the treatment, it was [them] givin’ me ideas of things to do to help yourself. And those kind[s] of things are so valuable.” DC Patient 5 • “It really brings home this message of – a chemical going into your body is only one way to influence this. So, if somebody’s having a positive experience [with chiropractic treatment], and we have had lots of people who’ve had positive experiences, it can mean the difference between not increasing a dose [versus increasing a dose]. Not starting a dose? I would say that there probably are situations where we’ve had that as well.” GP 7 Access to chiropractic services at the Langs CHC: • “A lot of our patients are from low income [backgrounds] and have transportation issues. So, having [chiropractic] services available for them here is very important.” GP 2 • “I just didn’t have the funds to have chiropractic [treatment]. But then when it was offered to me at Langs, I was just like – yeah, I’ll take it!” DC Patient 6 • “We definitely need those added services [for patients] who have chronic pain because it’s an option. … We need some way of getting that patient to treat pain in non-drug ways.” GP 3	The rate of filling and refilling opioid prescriptions was 34% and 73% lower, respectively, among chiropractic recipients versus non-recipients. Over 12 months of follow-up, chiropractic recipients were also between 78% and 86% less likely than non-recipients to have received a higher (≥ 50 mg MED) opioid dose. Patients who were referred by their GP for chiropractic services at Langs may have been more resistant to taking opioids than patients who were not referred for chiropractic services. Access to chiropractic treatment also gave patients and their GPs another non-opioid pain management option.

Variable

Quantitative results

Qualitative interview quotes

Meta-inferences

Receipt of chiropractic care

(n = 49)

• Negative association with total number of opioid fills (adjusted IRR = 0.66)

• Negative association with total number of opioid refills ^a (adjusted IRR = 0.27)

• Negative association with higher opioid dosage at:

3-month follow-up (adjusted OR = 0.14)

6-month follow-up (adjusted OR = 0.14)

9-month follow-up (adjusted OR = 0.19)

12-month follow-up (adjusted OR = 0.22)

Resistance to taking medication:

• “I don’t want to take so many medicine[s]. … It’s too much chemical going in your body, it’s no good. … I try to take, even with my pain, [only] one Tylenol #3, and [then] I will take Advil or extra strength Aspirin or Tylenol every six hours [for the rest of the day].” DC Patient 4

• “I try and adhere against [taking] Tylenol #3, if I can help it.” DC Patient 5

• “I’ve been prescribed [opioids], … but I just started reading about stuff, what it does to your liver and what it does to other organs in your body. I just, I chose other methods, i.e., like chiropractic, massage, I bought a hot tub – hydrotherapy. Just stuff like that. …
I’m just so not a drug guy.” DC Patient 6

Impact of chiropractic treatment on chronic spinal pain:

• “When I first started coming [to see the chiropractors at Langs] I couldn’t hardly walk and get in my car, to get in and out of the car, it was a challenge. And after a few chiropractor treatments, it got much better. And some days I couldn’t even turn my head sideways to see driving the car, and that got fixed. It’s gone well. Sometimes, it comes back a little bit, but then I just think – now I can get this fixed with the chiropractor.” DC Patient 3

• “When I had the chiropractor [treatments], … it wasn’t just the treatment, it was [them] givin’ me ideas of things to do to help yourself. And those kind[s] of things are so valuable.” DC Patient 5

• “It really brings home this message of – a chemical going into your body is only one way to influence this. So, if somebody’s having a positive experience [with chiropractic treatment], and we have had lots of people who’ve had positive experiences, it can mean the difference between not increasing a dose [versus increasing a dose]. Not starting a dose? I would say that there probably are situations where we’ve had that as well.” GP 7

Access to chiropractic services at the Langs CHC:

• “A lot of our patients are from low income [backgrounds] and have transportation issues. So, having [chiropractic] services available for them here is very important.” GP 2

• “I just didn’t have the funds to have chiropractic [treatment]. But then when it was offered to me at Langs, I was just like – yeah, I’ll take it!” DC Patient 6

• “We definitely need those added services [for patients] who have chronic pain because it’s an option. … We need some way of getting that patient to treat pain in non-drug ways.” GP 3

The rate of filling and refilling opioid prescriptions was 34% and 73% lower, respectively, among chiropractic recipients versus non-recipients.

Over 12 months of follow-up, chiropractic recipients were also between 78% and 86% less likely than non-recipients to have received a higher (≥ 50 mg MED) opioid dose.

Patients who were referred by their GP for chiropractic services at Langs may have been more resistant to taking opioids than patients who were not referred for chiropractic services.

Access to chiropractic treatment also gave patients and their GPs another non-opioid pain management option.

CHC community health centre,
DC doctor of chiropractic,
GP general practitioner, IRR incidence rate ratio,
MED morphine equivalents daily,
OR odds ratio

^a Prescription opioid refills were measured in 30-day equivalents