THE OPIOID EPIDEMIC
 
   

The Opioid Epidemic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

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Conditions That Respond Alternative Medicine Approaches to Disease
 
   

Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain:
A Systematic Review and Meta-analysis

Pain Medicine 2019 (Sep 27) [Epub] ~ FULL TEXT

This systematic review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Overall, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.

Access to Chiropractic Care and the Cost of Spine Conditions Among Older Adults
American Journal of Managed Care 2019 (Aug);   25 (8):   e230–e236 ~ FULL TEXT

This study is among the first to examine whether access to chiropractic care, a health service that provides a significant amount of the nation’s conservative management of nonspecific back pain, has any effect on Medicare spending. We found some evidence of a relationship between lower accessibility of chiropractic care and higher spending on diagnostic imaging and testing. Future work is required to determine if indeed access to chiropractic care for Medicare beneficiaries in any way breaks the pathway to care that is discordant with practice guidelines

Coverage of Nonpharmacologic Treatments for Low Back Pain Among
US Public and Private Insurers

JAMA Network Open 2018 (Oct 5);   1 (6):   e183044 ~ FULL TEXT

Insurers are increasingly recognized as influential stakeholders that are well positioned to drive changes in pain treatment practices. One key component of such changes is the greater use of nonpharmacologic approaches to managing chronic, noncancer pain, as has been recommended by the Centers for Disease Control and Prevention, [10] the President’s Commission on Combating Drug Addiction and the Opioid Crisis, [8] and others. [25] To our knowledge, our work represents the most comprehensive assessment of coverage policies regarding the medical necessity, coverage, and management of nonpharmacologic treatments for back pain.

A SMART Design to Determine the Optimal Treatment of Chronic Pain
Among Military Personnel

Contemp Clin Trials. 2018 (Oct);   73:   68–74 ~ FULL TEXT

Chronic pain is a leading cause of disability among active duty service members in the U.S. armed forces. Standard rehabilitative care and complementary and integrative health therapies are used for chronic pain rehabilitation. However, the optimal sequence and duration of these therapies has yet to be determined. This article describes a sequential multiple assignment randomized trial (SMART) protocol being used to identify the optimal components and sequence of standard rehabilitative care and complementary and integrative health therapies for reducing pain impact and improving other patient outcomes. Active duty service members referred to Madigan Army Medical Center for treatment of chronic pain are being recruited to the Determinants of the Optimal Dose and Sequence of Functional Restoration and Integrative Therapies study.

Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain
J Manipulative Physiol Ther. 2018 (Sep);   27 (Suppl 6):   901–914 ~ FULL TEXT

This study provides insight into the characteristics of patients who are successfully managing their chronic low back pain (CLBP) and chronic neck pain (CNP). Findings of this descriptive study of a large sample of chiropractic patients with CLBP or CNP reveal this sample to be similar to those found in other studies of chiropractic patients: highly-educated, non-Hispanic, white women, with at least partial insurance coverage for chiropractic. These individuals have also been in pain and using chiropractic care for years. Most came to chiropractic after trying other types of care, and just under a third continued to receive other concurrent care for their pain. Prior to chiropractic, they saw the best results with massage therapy and acupuncture and reported high levels of belief in the success of chiropractic in reducing their pain.

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 ~ FULL TEXT

The adjusted likelihood of filling a prescription for an opioid analgesic was 55% lower among recipients odf chiropractic care compared with nonrecipients (odds ratio 0.45; 95% confidence interval 0.40–0.47; p < 0.0001). Average charges per person for opioid prescriptions were also significantly lower among recipients.

Cannabis for Pain and Headaches: Primer
Curr Pain Headache Rep. 2017 (Apr);   21 (4):   19 ~ FULL TEXT

Synthetic cannabinoids are being developed and synthesized from the marijuana plant such as dronabinol and nabilone. The US Food and Drug Administration approved the use of dronabinol and nabilone for chemotherapy-associated nausea and vomiting and HIV (Human Immunodeficiency Virus) wasting. Nabiximols is a cannabis extract that is approved for the treatment of spasticity and intractable pain in Canada and the UK. Further clinical trials are studying the effect of marijuana extracts for seizure disorders. Phytocannabinoids have been identified as key compounds involved in analgesia and anti-inflammatory effects. Other compounds found in cannabis such as flavonoids and terpenes are also being investigated as to their individual or synergistic effects. This article will review relevant literature regarding medical use of marijuana and cannabinoid pharmaceuticals with an emphasis on pain and headaches.

Aging Baby Boomers and the Rising Cost of Chronic Back Pain:
Secular Trend Analysis of Longitudinal Medical Expenditures
Panel Survey Data for Years 2000 to 2007

J Manipulative Physiol Ther. 2013 (Jan);   36 (1):   2–11

The prevalence of back pain, especially chronic back pain, is increasing. To the extent that the growth in chronic back pain is caused, in part, by an aging population, the growth will likely continue or accelerate. With relatively high cost per adult with chronic back pain, total expenditures associated with back pain will correspondingly accelerate under existing treatment patterns. This carries implications for prioritizing health policy, clinical practice, and research efforts to improve care outcomes, costs, and cost-effectiveness and for health workforce planning.

The Association of Complementary and Alternative Medicine Use
and Health Care Expenditures for Back and Neck Problems

Med Care. 2012 (Dec);   50 (12):   1029–1036 ~ FULL TEXT

While health care conversations increasingly mention chiropractic care as a viable option for back and neck pain – and research increasingly supports its utility from a clinical standpoint – this nationwide study of complementary and alternative medicine (CAM)-related health care expenditures by 12,000–plus adults (ages 17 and older) with spinal conditions lends support to the suggestion that CAM in general, and chiropractic specifically, is also a cost-effective alternative to traditional medical care.

Advancements in the Management of Spine Disorders
Best Pract Res Clin Rheumatol. 2012 (Apr);   26 (2):   263–280 ~ FULL TEXT

Despite, or perhaps because of its impact, spinal disorders remain one of the most controversial and difficult conditions for clinicians, patients and policymakers to manage. This paper provides a brief summary of advances in the understanding of back and neck pain over the past decade as evidenced in the current literature. This paper includes the following sections: a classification of spinal disorders; the epidemiology of spine pain in the developed and developing world; key advancements in biological and biomechanical sciences in spine pain; the current status of potential methods for the prevention of back and neck pain; rheumatological and systemic disorders that impact the spine; and evidence-based surgical and non-surgical management of spine pain. The final section of this paper looks to the future and proposes actions and strategies that may be considered by the international Bone and Joint Decade (BJD), by providers, institutions and by policymakers so that we may better address the burden of spine disorders at global and local levels.

Chronic Pain Reconsidered
Pain. 2008 (Aug 31);   138 (2):   267–276 ~ FULL TEXT

Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support and does not account for chronic pain's multi-dimensionality. This study compared duration-based and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n = 971), headache (n = 1078), or orofacial pain (n = 455).   At baseline, their chronic pain was classified retrospectively based on Pain Days in the prior six months and prospectively with a prognostic Risk Score identifying patients with "possible" or "probable" chronic pain.


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