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Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain

By |October 25, 2019|Chiropractic Care, Opioid Epidemic|

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

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SOURCE:   Pain Medicine 2019 (Sep 27) [Epub]

Kelsey L Corcoran, DC, Lori A Bastian, MD, Craig G Gunderson, MD, Catherine Steffens, Alexandria Brackett, MA, MLIS, Anthony J Lisi, DC

Kelsey L. Corcoran, DC,
Yale Center for Medical Informatics,
300 George St., Suite 501,
New Haven, CT 06511, USA.



OBJECTIVE:   To investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt.

DESIGN:   Systematic review and meta-analysis.

METHODS:   The protocol for this review was registered on PROSPERO (CRD42018095128). The MEDLINE, PubMed, EMBASE, AMED, CINAHL, and Web of Science databases were searched for relevant articles from database inception through April 18, 2018. Controlled studies, cohort studies, and case-control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval.

RESULTS:   In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and six met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3–57.6%) than nonusers (range = 31.2–65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30–0.43, P < 0.001, I2 = 92.8%).

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Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

By |September 26, 2019|Low Back Pain, Opioid Epidemic|

Observational Retrospective Study of the Association of Initial Healthcare Provider for New-onset Low Back Pain with Early and Long-term Opioid Use

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SOURCE:   BMJ Open. 2019 (Sep 20); 9 (9): e028633

Lewis E Kazis, Omid Ameli, James Rothendler, Brigid Garrity, Howard Cabral, Christine McDonough, et. al.

Department of Health Law,
Policy and Management,
Boston University School of Public Health,
Boston, Massachusetts, USA


OBJECTIVE:   This study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).

DESIGN:   A retrospective cohort study of patients with new-onset LBP from 2008 to 2013.

SETTING:   The study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.

PARTICIPANTS:   216,504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.

EXPOSURES:   The primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).

MAIN OUTCOME MEASURES:   Short-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).

RESULTS:   Short-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).

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Low Back Pain and Chiropractic Page

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New Canadian Opioid Guidelines Recommends Chiropractic As Care Option

By |May 9, 2017|Chiropractic Care, Opioid Epidemic, Opioid Guidelines|

Guideline for Opioid Therapy and Chronic
Noncancer Pain

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SOURCE:   CMAJ 2017 (May 8); 189 (18): E659–E666

Jason W. Busse, DC PhD,   Samantha Craigie, MSc,   David N. Juurlink, MD PhD, D.   Norman Buckley, MD,   Li Wang, PhD,   Rachel J. Couban, MA MISt,   Thomas Agoritsas, MD PhD,   Elie A. Akl, MD PhD,   Alonso Carrasco-Labra, DDS MSc,   Lynn Cooper, BES,   Chris Cull, Bruno R. da Costa, PT PhD,   Joseph W. Frank, MD MPH,   Gus Grant, AB LLB MD,   Alfonso Iorio, MD PhD,   Navindra Persaud, MD MSc,   Sol Stern, MD,   Peter Tugwell, MD MSc,   Per Olav Vandvik, MD PhD,   Gordon H. Guyatt, MD MSc

Jason W. Busse
Department of Anaesthesia
McMaster University


New Canadian Opioid Guidelines Recommends
Chiropractic As Care Option

FROM:   World Federation of Chiropractic
Monday, May 8, 2017

A new Canadian guideline published today (May 8, 2017) in the Canadian Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.

The guideline is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.

The lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

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Chiropractic and Spinal Pain Management Page

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