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“There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.”  Explore: The Journal of Science and Healing

The cost of the opioid crisis is staggering and increasing at alarming rates. From 2007-2014, opioid dependence rose by 3,203% among patients with private insurance. (1) Expenses to the patient and the insurers are equally impressive.  From 2011-2015, opioid abuse or dependence charges rose from $72 million to $722 million for privately insured patients. (2) The US prescribes 50 times more opioids than the rest of the world combined. (3)

In collaboration with state and national organizations, ChiroUp has created an Opioid Whitepaper that succinctly outlines the problem and relays how you can play a meaningful role in its solution. This powerful tool will help you influence physicians and healthcare decision makers.

Opioid prescriptions typically have one common cause—acute pain.  However, most acute pain is due to musculoskeletal damage, sometimes referred to as mechanical neck and back pain.  Mechanical pain does not typically respond well to a chemical solution (opioids). This ineffective treatment leads to diminished outcomes and chronic use. Opioid dependence, tolerance, and addiction often commence following an acute problem such as dental procedure, surgery or injury. In fact, more than 25% of chronic use follows post-operative or injury-related pain. (4)

So why am I preaching to chiropractors about the importance of avoiding opioids? I think we are partial to blame.  I can think of more than one patent in the past week that I could have spent two more minutes with explaining the importance of managing their pain naturally.  The Lancet recently published a paragraph that hit home:

“Disabling low back pain is partly iatrogenic. Such negative effects of health care reflect a change in views, from LBP being a fairly benign part of daily life to requiring medical attention. Increased use of ineffective potentially unsafe treatments has wasted limited health-care resources and harmed patients.  For people with persistent low back pain, positive health entails learning how to cope with a long-term health problem through self-management activities and learning to seek health care only when needed. Passive approaches such as rest and medication are linked with worsening disability, whereas active strategies such as exercise result in reduced disability and less reliance on formal health care. In the occupational setting, interventions focusing on positive health, including peer support for the notion that low back pain is not an injury in need of medical treatment, and redirecting problem-solving efforts away from seeking cures and towards improved individual adaptation to the pain, yield beneficial outcomes.” (5)

The first and last sentences struck a chord with me.  We take for granted all of our successes yet rarely learn from our failures.  Chronic pain is not a failure of medicine or chiropractic care.  It is a failure of the doctor and patient to fully understand the problem and all of the interventions necessary to alleviate symptoms.  We understand that patients often need more than a pill, but the same goes for manipulation. Imagine the results you and your patients will achieve by comprehensively addressing all of the condition triggers. (rehab exercises, habits, hobbies, postural advice, workstation ergonomics, etc.)

  • Chiropractors specialize in the diagnosis of musculoskeletal disorders: our primary responsibly to the patient is to fully diagnose them—not treat them.
  • Chiropractors are uniquely trained to find the etiology of a pain presentation and work towards finding a solution—not just covering it up.
  • Chiropractors select the right treatment, for the right patient, at the right time, to resolve problems quickly.
  • As a profession; chiropractors must be an integrated part of the solution to the opioid epidemic.

Share our common message with your patients and fellow providers.  Distribute these points and the opioid whitepaper in your office, through social media, and email. More importantly, embrace systems in your office to keep you up to date with the best patient education, rehabilitation exercises, treatment strategies, and the most useful clinical evaluations.  If we can fully diagnose the patient right the first time, then we can avoid patients slipping through the cracks into chronic pain presentations.

The opioid epidemic is a gateway to spread our message.  However, if we don’t have a forceful and united voice, it will be another opportunity wasted.

Watch Dr. Steele explain how ChiroUp can help build and spread your message of excellence to the providers and patients in your community.

References

1. FAIR Health. The opioid crisis among the privately insured; the opioid abuse epidemic as documented in private claims data (July 2016). 2016 https://www.fairhealth.org/publications/whitepapers. Accessed April 2, 2018.

2. FAIR Health. The impact of the opioid crisis on the healthcare system; a study of privately billed services (September 2016). 2016 https://www.fairhealth.org/publications/whitepapers.

Accessed April 2, 2018.

3. Manchikanti L, Helm S, 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. 2012;15(3 Suppl):ES9-38.

4. Callinan CE, Neuman MD, Lacy KE, Gabison C, Ashburn MA. The initiation of chronic opioids: a survey of chronic pain patients. J Pain. 2016.

5. Buchbinder R, et al. Low back pain: a call for action The Lancet. Published online March 21, 2018 http://dx.doi.org/10.1016/S0140-6736(18)30488-4

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman

DC, CCSP, DACO

Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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