Current insights:
What does the research say about opioids and musculoskeletal pain?
Opioids were the most frequently prescribed class of drug with 61% of patients receiving a prescription, both in emergency rooms and at the time of patient discharge. This is an alarming statistic given the proven efficacy of non-drug treatment options for patients with low back pain.
Based on a previous population study, opioids were found to be the most common prescription drug given to adults with LBP in the US. In this specific study from the Journal of Pain, 36.9% of the participants were found to be taking one or more prescription medications in the last 30 days, with the most common being opioids. Of those participants with chronic LBP who are taking opioids, 76.9% of them reported taking opioids for one year or more.
Physicians are burdened by the significant portion of patients presenting with spine related pain. Research from the Rochester Epidemiology Project (REP) demonstrated back problems to be the third greatest reason (23.9%) patients present to their doctors for non-acute conditions.
“We included a total of 142,377 patients, 75,512 (53%) of whom were female. Skin disorders (42.7%), osteoarthritis and joint disorders (33.6%), back problems (23.9%)”
More than 2.6 million Emergency Department visits are for low back pain “LBP” in the US annually, and untimely and improper follow up can lead to chronic pain.
“Low back pain related disorders caused 2.63 million (95%CI: 2.32, 2.93 million) annual ED visits in the US.“
A study in Academic Emergency Medicine found that approximately 30% of patients who present to the ED with LBP report some level of functional impairment 3 months later. This impairment then put these patients at risk of developing chronic LBP.
With annual expenditures for MD, DC, and PT care combined being estimated anywhere from $84.1 billion to $624.8 billion for low back problems in the US, the objective of this JMPT study was to compare utilization and charges for the above mentioned professions to determine the most effective management for LBP. While all 3 professions saw an increase in patient visits over the past decade, chiropractic care was the only profession that did not see a parallel increase in cost per patient visit. This study showed that DC care and MD-DC care incurred fewer total charges per patient for patients with LBP.
With healthcare costs rising and the rate of disability from neck pain increasing 29% in the US over the past 2 decades, this study in The Spine Journal aims to determine the cost-effectiveness of SMT compared to other rehabilitative methods. Recent RCTs found that SMT in conjunction with home exercise and advice (HEA) are generally well tolerated by older adults (>65) with neck pain and resulted in reduced symptoms. It was found after this study was conducted that SMT with HEA resulted in better clinical outcomes and lower total societal costs when compared to exercises alone.
With a significant proportion of patients suffering from conditions that chiropractors manage successfully, integration of chiropractors into healthcare systems could significantly benefit the presenting patients. As of 2018, only 8% of chiropractors were in integrative settings contributing to patient care.
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