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Prasad A, Printon R, Vang M, Kurschner S, Dusek JA. Mapping Evidence-Based Non-Opioid and Non-Pharmacological Pain Management Modalities Across Minnesota: The Non-Opioid Pain Alleviation Information Network Project. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:645-653. [PMID: 38108635 DOI: 10.1089/jicm.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Objective: The Non-Opioid Pain Alleviation Information Network (NOPAINMN) project was designed to identify, consolidate, and map evidence-based non-opioid and non-pharmacological pain management complementary and integrative health (CIH) modalities for chronic pain management across Minnesota into a searchable and informational website (www.nopainmn.org ). Methods: The Academic Consortium for Integrative Medicine & Health's Pain Task Force White Paper identifying evidence-based research of non-pharmacological pain practice (NPPC) was reviewed and referenced. National and state certifying boards and accrediting organizations for NPPC modalities were accessed to identify Minnesota-based NPPC providers' name, business/health-system affiliation, address, contact information, and credentials. The NOPAINMN website displays these data in a consumer-facing website with searchable fields such as NPPC modality type, and location with varying distances. The website was β-tested by practitioners and stakeholders for optimization. Eight main NPPC modalities and their respective subcategories were identified and mapped: Acupuncture; Integrative Medical Care (Functional medicine consultation and Integrative medicine consultation); Massage Therapy; Mind-Body Therapies (Biofeedback, Clinical Hypnosis, Mindfulness-Based Stress Reduction, and Music Therapy); Movement Therapies (Tai Chi, qigong, and Yoga Therapy); Psychology (Cognitive Behavioral Therapy); Rehabilitative Therapies (Physical and Occupational Therapy); and Spinal Manipulation. Results: All information compiled resulted in 17,155 providers/practitioners. Physical Therapy had the greatest number of reported providers (n = 5224), followed by Occupational Therapy (n = 3792), Psychology (n = 3324), Chiropractic (n = 3033), Acupuncture (n = 591), and Massage Therapy (n = 544). The Resource Map included 56 major health systems, 686 facilities, 2651 solo or private group practices, and 14 academic training schools. With web-based cross-referencing, providers and facilities were affiliated and linked with health systems to produce an interconnected mapping system. β-Testing with patients found that the website was reported as relatively easy to use and informative. Conclusion: The website was created to assist individuals, health care providers, insurance carriers, and health care facilities in finding evidence-based information and resources on NPPC to guide, support, and proactively manage and engage chronic pain patients across Minnesota.
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Affiliation(s)
- Arti Prasad
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Richard Printon
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Miamoua Vang
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | | | - Jeffery A Dusek
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
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Trager RJ, Cupler ZA, Srinivasan R, Casselberry RM, Perez JA, Dusek JA. Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data. BMJ Open 2024; 14:e078105. [PMID: 38692725 PMCID: PMC11086504 DOI: 10.1136/bmjopen-2023-078105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVES Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care. DESIGN Retrospective cohort study. SETTING US medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023. PARTICIPANTS Opioid-naive adults aged 18-50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching. INTERVENTIONS Patients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care). PRIMARY AND SECONDARY OUTCOME MEASURES Risk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary). RESULTS After propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts. CONCLUSIONS This study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.
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Affiliation(s)
- Robert James Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA Health Care System, Butler, Pennsylvania, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Roshini Srinivasan
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Regina M Casselberry
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Farabaugh R, Hawk C, Taylor D, Daniels C, Noll C, Schneider M, McGowan J, Whalen W, Wilcox R, Sarnat R, Suiter L, Whedon J. Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review. Chiropr Man Therap 2024; 32:8. [PMID: 38448998 PMCID: PMC10918856 DOI: 10.1186/s12998-024-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain. METHODS A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators. RESULTS The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures. CONCLUSION Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted.
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Affiliation(s)
- Ronald Farabaugh
- American Chiropractic Association, 2008 St. Johns Avenue, Highland Park, Illiois. 60035, Arlington, VA, USA.
| | - Cheryl Hawk
- Texas Chiropractic College, 5912 Spencer Highway, Pasadena, TX, 77505, USA
| | - Dave Taylor
- Texas Chiropractic College, 5912 Spencer Highway, Pasadena, TX, 77505, USA
| | - Clinton Daniels
- VA Puget Sound Health Care System, 9600 Veterans Drive Southwest Tacoma, Tacoma, WA, 98493-0003, USA
| | - Claire Noll
- Texas Chiropractic College, 5912 Spencer Highway, Pasadena, TX, 77505, USA
| | - Mike Schneider
- University of Pittsburgh, 100 Technology Drive, Suite 500, Pittsburgh, PA, 15219, USA
| | - John McGowan
- Saint Louis University, 3674 Lindell Blvd, St. Louis, MO, 63108, USA
| | - Wayne Whalen
- Clinical Compass-Past Chairman, 9570 Cuyamaca St Ste 101, Santee, CA, 92071, USA
| | - Ron Wilcox
- Private Practice, 204 Pinehurst Dr. SW, Suite 103, Tumwater, 9850, USA
| | - Richard Sarnat
- LP AMI Group, AMI Group, LP; 2008 St. Johns Avenue, Highland Park, IL, 60035, USA
| | - Leonard Suiter
- Clinical Compass-Past Chairman, 9570 Cuyamaca St Ste 101, Santee, CA, 92071, USA
| | - James Whedon
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA
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Johnson CD, Green BN, Agaoglu M, Amorin-Woods L, Brown R, Byfield D, Clum GW, Crespo W, Da Silva KL, Dane D, Daniels CJ, Edwards M, Foshee WK, Goertz C, Henderson C, Hynes R, Johnson V, Killinger L, Konarski-Hart K, Kopansky-Giles D, Kowalski M, Little C, McAllister S, Mrozek J, Nixdorf D, Peeace LD, Peterson C, Petrocco-Napuli KL, Phillips R, Snow G, Sorrentino A, Wong YK, Yelverton C, Young KJ. Chiropractic Day 2023: A Report and Qualitative Analysis of How Thought Leaders Celebrate the Present and Envision the Future of Chiropractic. JOURNAL OF CHIROPRACTIC HUMANITIES 2023; 30:23-45. [PMID: 37841068 PMCID: PMC10569958 DOI: 10.1016/j.echu.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Objective This study aimed to (1) collect and analyze statements about how to celebrate chiropractic in the present and roles that chiropractors may fulfill in the future, (2) identify if there was congruence among the themes between present and future statements, and (3) offer a model about the chiropractic profession that captures its complex relationships that encompass its interactions within microsystem, mesosystem, exosystem, and macrosystem levels. Methods For this qualitative analysis, we used pattern and grounded theory approaches. A purposive sample of thought leaders in the chiropractic profession were invited to answer the following 2 open-ended questions: (1) envision the chiropractor of the future, and (2) recommendations on how to celebrate chiropractic. Information was collected during April 2023 using Survey Monkey. The information was entered into a spreadsheet and analyzed for topic clusters, which resulted in matching concepts with social-ecological themes. The themes between the responses to the 2 questions were analyzed for congruence. We used the Standards for Reporting Qualitative Research to report our findings. Results Of the 54 experts invited, 32 (59%) participated. Authors represented 7 countries and have a median of 32 years of chiropractic experience, with a range of 5 to 51 years. Nineteen major topics in the future statements and 23 major topics in statements about celebrating chiropractic were combined in a model. The topics were presented using the 4 levels of the social-ecological framework. Individual (microsystem): chiropractors are competent, well-educated experts in spine and musculoskeletal care who apply evidence-based practices, which is a combination of the best available evidence, clinical expertise, and patient values. Interpersonal relationships (mesosystem): chiropractors serve the best interests of their patients, provide person-centered care, embrace diversity, equity, and inclusion, consider specific health needs and the health of the whole person. Community (exosystem): chiropractors provide care within integrated health care environments and in private practices, serve the best interests of the public through participation in their communities, participate through multidisciplinary collaboration with and within the health care system, and work together as a profession with a strong professional identity. Societal (macrosystem): chiropractors contribute to the greater good of society and participate on a global level in policy, leadership, and research. There was concordance between both the future envisioning statements and the present celebration recommendations, which suggest logical validity based on the congruence of these concepts. Conclusion A sample of independent views, including the perceptions from a broad range of chiropractic thought leaders from various backgrounds, philosophies, diversity characteristics, and world regions, were assembled to create a comprehensive model of the chiropractic profession. The resulting model shows an array of intrinsic values and provides the roles that chiropractors may provide to serve patients and the public. This study offers insights into the roles that future chiropractors may fulfill and how these are congruent with present-day values. These core concepts and this novel model may have utility during dialogs about identity, applications regarding chiropractic in policy, practice, education, and research, and building positive relationships and collaborations.
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Affiliation(s)
| | - Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Mustafa Agaoglu
- AECC University College, Bournemouth, United Kingdom
- Turkish Chiropractic Association, Turkey
| | - Lyndon Amorin-Woods
- College of Health & Education, School of Allied Health, Murdoch University, Perth, Australia
| | | | - David Byfield
- Welsh Institute of Chiropractic, University of South Wales, Pontypridd, United Kingdom
| | | | | | - Kendrah L. Da Silva
- Chiropractic Association of South Africa, Centurion, South Africa
- University of Johannesburg, Johannesburg, South Africa
| | - Dawn Dane
- Central Queensland University, Queensland, Australia
| | - Clinton J. Daniels
- Veterans Administration Puget Sound Health Care System, Tacoma, Washington
| | | | | | | | - Charles Henderson
- Henderson Technical Consulting and Life Chiropractic College West, Hayward, California
| | - Roger Hynes
- Palmer College of Chiropractic, Davenport, Iowa
| | - Valerie Johnson
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | - Matthew Kowalski
- Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Craig Little
- Council on Chiropractic Education, Scottsdale, Arizona
| | | | | | | | | | - Cynthia Peterson
- European Council on Chiropractic Education and Councils on Chiropractic Education International, British Columbia, Canada
- University of Johannesburg, Johannesburg, South Africa
| | | | | | - Gregory Snow
- Palmer College of Chiropractic West, San Jose, California
| | | | - Yi Kai Wong
- Association of Chiropractic Malaysia, Kuala Lumpur, Malaysia
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Manansala C, Ferbers S, Johnson M, Passmore S. Factors associated with non-pharmacological, non-operative treatment utilization prior to thoracolumbar spine surgery in Manitoba: A Canadian Spine Outcomes Research Network (CSORN) study. Musculoskelet Sci Pract 2023; 63:102695. [PMID: 36473826 DOI: 10.1016/j.msksp.2022.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence for managing chronic low back pain suggests beginning with non-invasive treatments and having surgery as a last resort. Currently, no studies examine treatment engagement for back pain in the six-months preceding elective spine surgery assessment. OBJECTIVES This study aims to: 1) determine the engagement in non-pharmacological, non-operative treatment before elective thoracolumbar spine surgery (ETSS) assessment in XXXXXXXX; and 2) investigate potential factors associated with engagement in this population. DESIGN Retrospective cohort design. METHODS Canadian Spine Outcomes Research Network (CSORN) registry data were analyzed to compare groups who reported minimal engagement in non-pharmacological, non-operative treatment before ETSS assessment to those who engaged. Binary logistic regression was used to identify factors associated with engagement. RESULTS A total of 144 patients qualified, 41.7% reported minimal engagement with non-pharmacological, non-operative treatment in the six-months preceding ETSS assessment. Four statistically significant factors associated with minimal engagement were identified: 1) 61-90 years of age (odds ratio [OR] 4.6, 95% confidence interval [CI] 2.0-10.7, p < .001); 2) Oswestry disability index (ODI) score >60% (OR 3.5, 95% CI 1.4-9.2, p = .010; 3) body mass index (BMI) score 25-29.9 (OR 6.7, 95% CI 2.2-20.9, p < .001) and BMI ≥ 30 (OR 4.2, 95% CI 1.4-12.2, p = .009); and 4) female biological sex (OR 2.4, 95% CI 1.0-5.6, p = .039. CONCLUSIONS In total, 41.7% of CSORN patients had minimal engagement with non-pharmacological, non-operative treatment in the six-months prior to ETSS assessment in XXXXXXXX. Factors associated with minimal engagement included: older age, high disability, increased BMI, and female biological sex.
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Affiliation(s)
- Christian Manansala
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada.
| | - Spencer Ferbers
- Max Rady College of Medicine, University of Manitoba, 260 Brodie Centre - 727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Michael Johnson
- Departments of Orthopedics and Neurosurgery, AD401 - 820 Sherbrook Street, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Steven Passmore
- Department of Kinesiology and Recreation Management, University of Manitoba, 179G Frank Kennedy Centre, Winnipeg, Manitoba, R3T 2N2, Canada
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Youn BY, Moon S, Mok K, Cheon C, Ko Y, Park S, Jang BH, Shin YC, Ko SG. Use of traditional, complementary and alternative medicine in nine countries: A cross-sectional multinational survey. Complement Ther Med 2022; 71:102889. [PMID: 36162719 DOI: 10.1016/j.ctim.2022.102889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/22/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Traditional, complementary, and alternative medicine (TC&AM) play an exceptional role in health care around the world as many patients has sought a holistic approach. SETTING In this study, a multinational survey was developed and administered to obtain experience, attitude, and promotion information with regard to the international use of TC&AM among nine countries: Germany, United States, Japan, China, Malaysia, Vietnam, Russia, Kazakhstan, and United Arab Emirates (UAE). The survey was administered via online to members of SurveyMonkey Audience, a proprietary panel of respondents who were recruited from a diverse population worldwide. RESULTS A total of 1071 participants has completed the survey. The participants were in favor of the treatments and therapies as well as expressed positive attitudes and also have used herbal medicine treatment more than acupuncture therapy and also used the modalities to promote metabolism rather than treating musculoskeletal diseases. Moreover, participants mentioned that TC&AM should be applied for treating and managing infectious diseases, such as COVID-19. Additionally, participants recommended using Facebook channel to promote its treatments and therapies. CONCLUSION Based on the results, this study provides initial insights on TC&AM that may influence the non-users globally and perhaps inspire a need for further research including more countries in different continents.
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Affiliation(s)
- Bo-Young Youn
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Seunghwan Moon
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Kyungyul Mok
- Department of Global Public Health and Korean Medicine Management, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Chunhoo Cheon
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Youme Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Sunju Park
- Department of Preventive Medicine, College of Korean Medicine, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 34520, the Republic of Korea.
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Yong Cheol Shin
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, the Republic of Korea.
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Emary PC, Brown AL, Oremus M, Mbuagbaw L, Cameron DF, DiDonato J, Busse JW. The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study. BMC Health Serv Res 2022; 22:1313. [PMID: 36329472 PMCID: PMC9635131 DOI: 10.1186/s12913-022-08632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Emerging evidence suggests that access to chiropractic care may reduce the likelihood of initiating an opioid prescription for spinal pain; however, the impact of chiropractic care for patients already prescribed opioids is uncertain. We undertook a sequential explanatory mixed methods study to evaluate the association between initiating chiropractic care and continued opioid use among adult patients attending an Ontario community health centre (CHC) and receiving opioid therapy for chronic non-cancer spinal pain. METHODS We conducted a retrospective cohort study of 210 patient records between January 1, 2014 and December 31, 2020. We used generalized estimating equations, adjusted for patient demographics, co-morbidities, visit frequency, and calendar year, to evaluate the association between receipt versus non-receipt of chiropractic services and continued opioid use (e.g., unique opioid fills, number of refills, and dosages) up to one year following the index chiropractic visit. We also completed follow-up interviews with 14 patients and nine general practitioners from the CHC and integrated these data with our quantitative findings. RESULTS Over 12-month follow-up, there were lower rates of opioid fills (incidence rate ratio [IRR] = 0.66; 95% confidence interval [CI], 0.52-0.83) and refills (IRR = 0.27; 95% CI, 0.17-0.42) among chiropractic recipients (n = 49) versus non-recipients (n = 161). Although patients who did and did not receive chiropractic care began the study with the same dose of opioids, recipients were less likely to be prescribed higher-dose opioids (i.e., ≥ 50 mg morphine equivalents daily) compared to non-recipients at three months (odds ratio [OR] = 0.14; 95% CI, 0.04-0.47), six months (OR = 0.14; 95% CI, 0.05-0.40), nine months (OR = 0.19; 95% CI, 0.07-0.57), and 12 months (OR = 0.22; 95% CI, 0.08-0.62). Interviews suggested that patient self-efficacy, limited effectiveness of opioids for chronic pain, stigma regarding use of opioids, and access to chiropractic treatment were important influencing factors. CONCLUSION We found that continued prescription opioid use among patients with chronic non-cancer spinal pain who received chiropractic care was lower than in patients who did not receive chiropractic care. Four themes emerged in our qualitative interviews to help provide a richer understanding of this association. Randomized controlled trials are needed to establish the effect of chiropractic care on opioid use for chronic spinal pain.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
- Chiropractic Department, D'Youville University, Buffalo, NY, USA.
- Private Practice, 1145 Concession Road, N3H 4L5, Cambridge, ON, Canada.
| | - Amy L Brown
- Private Practice, 1145 Concession Road, N3H 4L5, Cambridge, ON, Canada
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare- Hamilton, Hamilton, ON, Canada
- Centre for the Development of Best Practices in Health, Yaundé, Cameroon
- Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Douglas F Cameron
- Private Practice, 1145 Concession Road, N3H 4L5, Cambridge, ON, Canada
| | - Jenna DiDonato
- Chiropractic Department, D'Youville University, Buffalo, NY, USA
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, ON, Canada
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Whalen WM, Hawk C, Farabaugh RJ, Daniels CJ, Taylor DN, Anderson KR, Crivelli LS, Anderson DR, Thomson LM, Sarnat RL. Best Practices for Chiropractic Management of Adult Patients With Mechanical Low Back Pain: A Clinical Practice Guideline for Chiropractors in the United States. J Manipulative Physiol Ther 2022; 45:551-565. [PMID: 37341675 DOI: 10.1016/j.jmpt.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/12/2023] [Accepted: 04/12/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this paper was to update the previously published 2016 best-practice recommendations for chiropractic management of adults with mechanical low back pain (LBP) in the United States. METHODS Two experienced health librarians conducted the literature searches for clinical practice guidelines and other relevant literature, and the investigators performed quality assessment of included studies. PubMed was searched from March 2015 to September 2021. A steering committee of 10 experts in chiropractic research, education, and practice used the most current relevant guidelines and publications to update care recommendations. A panel of 69 experts used a modified Delphi process to rate the recommendations. RESULTS The literature search yielded 14 clinical practice guidelines, 10 systematic reviews, and 5 randomized controlled trials (all high quality). Sixty-nine members of the panel rated 38 recommendations. All but 1 statement achieved consensus in the first round, and the final statement reached consensus in the second round. Recommendations covered the clinical encounter from history, physical examination, and diagnostic considerations through informed consent, co-management, and treatment considerations for patients with mechanical LBP. CONCLUSION This paper updates a previously published best-practice document for chiropractic management of adults with mechanical LBP.
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Affiliation(s)
| | - Cheryl Hawk
- Clinical Sciences, Texas Chiropractic College, Pasadena, Texas
| | | | - Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, Washington
| | - David N Taylor
- Clinical Sciences, Texas Chiropractic College, Pasadena, Texas
| | | | | | - Derek R Anderson
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, Washington
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Grabowska W, Burton W, Kowalski MH, Vining R, Long CR, Lisi A, Hausdorff JM, Manor B, Muñoz-Vergara D, Wayne PM. A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research. BMC Musculoskelet Disord 2022; 23:844. [PMID: 36064383 PMCID: PMC9442928 DOI: 10.1186/s12891-022-05783-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date. BODY: Systematic review was conducted following PRISMA guidelines. Databases searched included PubMed, Embase, Cochrane Library, PEDro, and Index of Chiropractic Literature. Eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. Risk of bias was also assessed using the 8-item Cochrane Collaboration Tool. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis. CONCLUSION Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.
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Affiliation(s)
- Weronika Grabowska
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Wren Burton
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA.
| | - Matthew H Kowalski
- Osher Clinical Center for Integrative Medicine, Brigham and Women's Healthcare Center, 850 Boylston Street, Suite 422, Chestnut Hill, MA, 02445, USA
| | - Robert Vining
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, 1000 Brady Street, Davenport, IA, 52803, USA
| | - Anthony Lisi
- Yale University Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel Aviv Sourasky Medical Center, Dafna St 5, Tel Aviv-Yafo, Israel
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, 1200 Centre Street, Boston, MA, 02131, USA
| | - Dennis Muñoz-Vergara
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
| | - Peter M Wayne
- Brigham and Women's Hospital and Harvard Medical School Division of Preventive Medicine, Osher Center for Integrative Medicine, 900 Commonwealth Avenue, 3rd Floor, Boston, MA, 02215, USA
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Emary PC, Brown AL, Oremus M, Mbuagbaw L, Cameron DF, DiDonato J, Busse JW. Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis. J Manipulative Physiol Ther 2022; 45:235-247. [PMID: 36008170 DOI: 10.1016/j.jmpt.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center. METHODS In this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings. RESULTS There were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors. CONCLUSION Patients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care.
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Affiliation(s)
- Peter C Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Chiropractic Department, D'Youville University, Buffalo, New York; Private practice, Cambridge, Ontario, Canada.
| | - Amy L Brown
- Private practice, Cambridge, Ontario, Canada
| | - Mark Oremus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare-Hamilton, Hamilton, Ontario, Canada; Centre for the Development of Best Practices in Health, Division of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Jenna DiDonato
- Chiropractic Department, D'Youville University, Buffalo, New York
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Waterloo, Ontario, Canada; Department of Anesthesia, McMaster University, Waterloo, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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11
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Acharya M, Chopra D, Smith AM, Fritz JM, Martin BC. Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas. J Chiropr Med 2022; 21:67-76. [PMID: 35774633 PMCID: PMC9237579 DOI: 10.1016/j.jcm.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022] Open
Abstract
Objective The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis. Methods A retrospective cohort study was conducted using data from Arkansas All Payers' Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated. Results A total of 40 929 individuals were included in the final sample, with an average age of 41 years and 65% being women. Only 5% and 6% received PT and chiropractic service, respectively, within the first 30 days. Sixty-four percent had incident opioid use, and 4% had LTOU in the follow-up period. PT was not associated with incident opioid use (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.98-1.18) or LTOU (OR, 1.19; 95% CI, 0.97-1.45). Chiropractic care decreased the odds of opioid use (OR, 0.88; 95% CI, 0.80-0.97) and LTOU (OR, 0.56; 95% CI, 0.40-0.77). Conclusion In this study we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, LTOU in newly diagnosed LBP.
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Affiliation(s)
- Mahip Acharya
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Divyan Chopra
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Allen M. Smith
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas,Corresponding author: Bradley C. Martin, PharmD, PhD, 4301 West Markham Street, Slot 522, Little Rock, AR 72205
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12
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Ward KL, Smith M. Association Between Chiropractic Utilization and Opioid Prescriptions Among People With Back or Neck Pain: Evaluation of the Medical Expenditure Panel Survey. J Manipulative Physiol Ther 2022; 45:315-322. [PMID: 36195475 DOI: 10.1016/j.jmpt.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 07/23/2022] [Accepted: 08/17/2022] [Indexed: 10/06/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the association between patients in the United States seeing a chiropractor and receiving an opioid prescription for back or neck pain. METHODS Medical Expenditure Panel Survey (Years 2012 to 2015) respondents for longitudinal panels 17 to 19 who participated in all 5 rounds were at least 18 years of age, did not have cancer, and reported back or neck pain. We defined chiropractic users as participants reporting at least 1 chiropractic visit for back or neck pain and opioid users as participants reporting purchase or receipt of a prescription classified as Multum Lexicon "60" and "191" for back or neck pain. We adjusted for socioeconomic and clinical variables using multiple logistic regression. RESULTS The sample contained 4686 people, 21% of whom reported an opioid prescription for back or neck pain. Among opioid users, 14% reported a chiropractic visit for back or neck pain compared to 31% of nonopioid users. The adjusted odds ratio for chiropractic use among opioid users compared to nonopioid users was 0.46 (95% confidence interval, 0.36-0.57). CONCLUSION Patients with back or neck pain who saw a chiropractor had approximately half the odds of reporting an opioid prescription compared to those who did not see a chiropractor.
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Affiliation(s)
- Krista L Ward
- Research Department, Life Chiropractic College West, Hayward, California.
| | - Monica Smith
- Research Department, Life Chiropractic College West, Hayward, California
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13
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Whedon JM, Kizhakkeveettil A, Toler AWJ, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S. Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries. Spine (Phila Pa 1976) 2022; 47:E142-E148. [PMID: 34474443 PMCID: PMC8581066 DOI: 10.1097/brs.0000000000004118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We combined elements of cohort and crossover-cohort design. OBJECTIVE The objective of this study was to compare longterm outcomes for spinal manipulative therapy (SMT) and opioid analgesic therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP). SUMMARY OF BACKGROUND DATA Current evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain. METHODS We examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP. RESULTS SMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% confidence interval 2.64-2.69, P < .0001). CONCLUSION Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy.Level of Evidence: 3.
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Affiliation(s)
- James M Whedon
- Southern California University of Health Sciences, Whittier, CA, USA
| | | | - Andrew WJ Toler
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Serena Bezdjian
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Daniel Rossi
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Sarah Uptmor
- Southern California University of Health Sciences, Whittier, CA, USA
| | | | - Jon D Lurie
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Eric L. Hurwitz
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Ian Coulter
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Scott Haldeman
- Southern California University of Health Sciences, Whittier, CA, USA
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14
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Whedon JM, Uptmor S, Toler AWJ, Bezdjian S, MacKenzie TA, Kazal LA. Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study. Chiropr Man Therap 2022; 30:5. [PMID: 35101064 PMCID: PMC8802278 DOI: 10.1186/s12998-022-00415-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/21/2022] [Indexed: 12/28/2022] Open
Abstract
Background The burden of spinal pain can be aggravated by the hazards of opioid analgesics, which are still widely prescribed for spinal pain despite evidence-based clinical guidelines that identify non-pharmacological therapies as the preferred first-line approach. Previous studies have found that chiropractic care is associated with decreased use of opioids, but have not focused on older Medicare beneficiaries, a vulnerable population with high rates of co-morbidity and polypharmacy. The purpose of this investigation was to evaluate the association between chiropractic utilization and use of prescription opioids among older adults with spinal pain. Methods We conducted a retrospective observational study in which we examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. We measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following diagnosis of spinal pain. Using Cox proportional hazards modeling and inverse weighted propensity scoring to account for selection bias, we compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription. Results The adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients (hazard ratio 0.44; 95% confidence interval 0.40–0.49). Conclusions Among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00415-7.
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Affiliation(s)
- James M Whedon
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA.
| | - Sarah Uptmor
- Arizona Personal Injury Centers, Phoenix, AZ, USA
| | - Andrew W J Toler
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA
| | - Serena Bezdjian
- Southern California University of Health Sciences, 16200 Amber Valley Drive, Whittier, CA, 90604, USA
| | - Todd A MacKenzie
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
| | - Louis A Kazal
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH, 03755, USA
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15
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Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries. Spine (Phila Pa 1976) 2021; 46:1714-1720. [PMID: 33882542 PMCID: PMC8629350 DOI: 10.1097/brs.0000000000004078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT versus SMT with regard to risk of adverse drug events (ADEs) among older adults with cLBP. SUMMARY OF BACKGROUND DATA We examined Medicare claims data spanning a 5-year period on fee-for-service beneficiaries aged 65 to 84 years, continuously enrolled under Medicare Parts A, B, and D for a 60-month study period, and with an episode of cLBP in 2013. We excluded patients with a diagnosis of cancer or use of hospice care. METHODS All included patients received long-term management of cLBP with SMT or OAT. We assembled cohorts of patients who received SMT or OAT only, and cohorts of patients who crossed over from OAT to SMT or from SMT to OAT. We used Poisson regression to estimate the adjusted incidence rate ratio for outpatient ADE among patients who initially chose OAT as compared with SMT. RESULTS With controlling for patient characteristics, health status, and propensity score, the adjusted rate of ADE was more than 42 times higher for initial choice of OAT versus initial choice of SMT (rate ratio 42.85, 95% CI 34.16-53.76, P < 0.0001). CONCLUSION Among older Medicare beneficiaries who received long-term care for cLBP the adjusted rate of ADE for patients who initially chose OAT was substantially higher than those who initially chose SMT.Level of Evidence: 2.
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Whedon JM, Kizhakkeveettil A, Toler A, MacKenzie TA, Lurie JD, Bezdjian S, Haldeman S, Hurwitz E, Coulter I. Long-Term Medicare Costs Associated With Opioid Analgesic Therapy vs Spinal Manipulative Therapy for Chronic Low Back Pain in a Cohort of Older Adults. J Manipulative Physiol Ther 2021; 44:519-526. [PMID: 34876298 DOI: 10.1016/j.jmpt.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The purpose of this study was to compare Medicare healthcare expenditures for patients who received long-term treatment of chronic low back pain (cLBP) with either opioid analgesic therapy (OAT) or spinal manipulative therapy (SMT). METHODS We conducted a retrospective observational study using a cohort design for analysis of Medicare claims data. The study population included Medicare beneficiaries enrolled under Medicare Parts A, B, and D from 2012 through 2016. We assembled cohorts of patients who received long-term management of cLBP with OAT or SMT (such as delivered by chiropractic or osteopathic practitioners) and evaluated the comparative effect of OAT vs SMT upon expenditures, using multivariable regression to control for beneficiary characteristics and measures of health status, and propensity score weighting and binning to account for selection bias. RESULTS The study sample totaled 28,160 participants, of whom 77% initiated long-term care of cLBP with OAT, and 23% initiated care with SMT. For care of low back pain specifically, average long-term costs for patients who initiated care with OAT were 58% lower than those who initiated care with SMT. However, overall long-term healthcare expenditures under Medicare were 1.87 times higher for patients who initiated care via OAT compared with those initiated care with SMT (95% CI 1.65-2.11; P < .0001). CONCLUSIONS Adults aged 65 to 84 who initiated long-term treatment for cLBP via OAT incurred lower long-term costs for low back pain but higher long-term total healthcare costs under Medicare compared with patients who initiated long-term treatment with SMT.
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Affiliation(s)
- James M Whedon
- Health Services Research, Southern California University of Health Sciences, Whittier, California.
| | - Anupama Kizhakkeveettil
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Andrew Toler
- Eastern Medicine Department, Southern California University of Health Sciences, Whittier, California
| | - Todd A MacKenzie
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jon D Lurie
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Serena Bezdjian
- Health Services Research, Southern California University of Health Sciences, Whittier, California
| | - Scott Haldeman
- Southern California University of Health Sciences, Whittier, California
| | - Eric Hurwitz
- Southern California University of Health Sciences, Whittier, California
| | - Ian Coulter
- Southern California University of Health Sciences, Whittier, California
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17
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Green BN, Dunn AS. An Essential Guide to Chiropractic in the United States Military Health System and Veterans Health Administration. JOURNAL OF CHIROPRACTIC HUMANITIES 2021; 28:35-48. [PMID: 35002576 PMCID: PMC8720651 DOI: 10.1016/j.echu.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this article is to provide an essential overview of chiropractic services in United States military and veterans' health care systems. METHODS We reviewed literature, legislation, and policies from 1936 through September 2021 pertaining to chiropractic services in the United States military and veterans' health systems. Using these sources and our combined experience in these systems, we identified fundamental themes in the delivery of chiropractic care in the health care systems of the Department of Defense (providing health care for active duty service members) and the Department of Veterans Affairs (providing health care for veterans) in main topic areas. RESULTS We identified 7 main topic areas relevant to the 2 systems: populations served by chiropractors; health care systems; integration; utilization and supply of chiropractic care; vetting of chiropractors; roles and evaluation of chiropractors; and oversight and leadership. Key information about chiropractic care in these systems was synthesized into the main topic areas. Benefits of high-quality within-system chiropractic care to active-duty service members and veterans are presented. The assets that within-system chiropractors bring to the Department of Defense and Department of Veterans Affairs health care systems are discussed for each main topic area. CONCLUSION This article contains an essential overview of chiropractic services in the Department of Defense and the Department of Veterans Affairs. It offers clarity regarding the integration of chiropractic services into these health care systems and includes a 1-page brief of talking points that may help better inform ongoing discussions of chiropractic services in these 2 different but intertwined environments.
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Affiliation(s)
- Bart N. Green
- National University of Health Sciences, Lombard, Illinois
| | - Andrew S. Dunn
- Chiropractic Department, VA Western New York Healthcare System, Buffalo, New York
- Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca Falls, New York
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18
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Eovaldi BJ, McAlpine B. Increased Utilization of Spinal Manipulation by Chiropractors to Tackle the Opioid Epidemic. Med Care 2021; 59:1039-1041. [PMID: 34432765 DOI: 10.1097/mlr.0000000000001633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Benjamin J Eovaldi
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
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Emary PC, Oremus M, Mbuagbaw L, Busse JW. Association of chiropractic integration in an Ontario community health centre with prescription opioid use for chronic non-cancer pain: a mixed methods study protocol. BMJ Open 2021; 11:e051000. [PMID: 34732481 PMCID: PMC8572393 DOI: 10.1136/bmjopen-2021-051000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Emerging evidence from a number of primary care centres suggests that integration of chiropractic services into chronic pain management is associated with improved clinical outcomes and high patient satisfaction as well as with reductions in physician visits, specialist referrals use of advanced imaging and prescribing of analgesics. However, formal assessments of the integration of chiropractic services into primary care settings are sparse, and the impact of such integration on prescription opioid use in chronic pain management remains uncertain. To help address this knowledge gap, we will conduct a mixed methods health service evaluation of an integrated chiropractic back pain programme in an urban community health centre in Ontario, Canada. This centre provides services to vulnerable populations with high unemployment rates, multiple comorbidities and musculoskeletal disorders that are commonly managed with prescription opioids. METHODS AND ANALYSIS We will use a sequential explanatory mixed methods design, which consists of a quantitative phase followed by a qualitative phase. In the quantitative phase, we will conduct a retrospective chart review and evaluate whether receipt of chiropractic services is associated with reduced opioid use among patients already prescribed opioid therapy for chronic pain. We will measure opioid prescriptions (ie, opioid fills, number of refills and dosages) by reviewing electronic medical records of recipients and non-recipients of chiropractic services between 1 January 2014 and 31 December 2020 and use multivariable regression analysis to examine the association. In the qualitative phase, we will conduct in-depth, one-on-one interviews of patients and their general practitioners to explore perceptions of chiropractic integration and its impact on opioid use. ETHICS AND DISSEMINATION This study was approved by the Hamilton Integrated Research Ethics Board at McMaster University (approval number 2021-10930). The results will be disseminated via peer-reviewed publications, conference presentations and in-person or webinar presentations to community members and healthcare professionals.
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Affiliation(s)
- Peter C Emary
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Chiropractic, D'Youville College, Buffalo, New York, USA
- School of Public Health Sciences, Private Practice, Cambridge, Ontario, Canada
| | - Mark Oremus
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lawrence Mbuagbaw
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Global Health, Stellenbosch University, Cape Town, South Africa
| | - Jason W Busse
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
- Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Ontario, Canada
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Johnson CD, Green BN. Looking back at the lawsuit that transformed the chiropractic profession part 8: Judgment impact. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:117-131. [PMID: 34544159 PMCID: PMC8493530 DOI: 10.7899/jce-21-29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/07/2021] [Accepted: 04/21/2021] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This paper is the eighth in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to discuss the possible impact that the final decision in favor of the plaintiffs may have had on the chiropractic profession. METHODS This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the eighth of the series that discusses how the trial decision may have influenced the chiropractic that we know today in the United States. RESULTS Chiropractic practice, education, and research have changed since before the lawsuit was filed. There are several areas in which we propose that the trial decision may have had an impact on the chiropractic profession. CONCLUSION The lawsuit removed the barriers that were implemented by organized medicine against the chiropractic profession. The quality of chiropractic practice, education, and research continues to improve and the profession continues to meet its most fundamental mission: to improve the lives of patients. Chiropractors practicing in the United States today are allowed to collaborate freely with other health professionals. Today, patients have the option to access chiropractic care because of the dedicated efforts of many people to reduce the previous barriers. It is up to the present-day members of the medical and chiropractic professions to look back and to remember what happened. By recalling the events surrounding the lawsuit, we may have a better understanding about our professions today. This information may help to facilitate interactions between medicine and chiropractic and to develop more respectful partnerships focused on creating a better future for the health of the public. The future of the chiropractic profession rests in the heads, hearts, and hands of its current members to do what is right.
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Cupler ZA, Daniels CJ, Anderson DR, Anderson MT, Napuli JG, Tritt ME. The chiropractor's role in primary, secondary, and tertiary prevention of suicide: a clinical guide. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:137-155. [PMID: 34658386 PMCID: PMC8480373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To provide the practicing chiropractor foundational knowledge to enhance the understanding of relevant primary, secondary, and tertiary public health measures for suicide prevention. METHODS A descriptive literature review was performed using keywords low back pain, neck pain, psychosocial, pain, public health, suicide, suicide risk factors, and suicide prevention. English language articles pertaining to suicide prevention and the chiropractic profession were retrieved and evaluated for relevance. Additional documents from the Centers for Disease Control, Veterans Health Administration, and the World Health Organization were reviewed. Key literature from the clinical social work and clinical psychology fields were provided by authorship team subject matter experts. CONCLUSION No articles reported a position statement regarding suicide prevention specific to the chiropractic profession. Risk, modifiable, and protective factors associated with self-directed violence are important clinical considerations. A proactive approach to managing patients at-risk includes developing interprofessional and collaborative relationships with mental health care professionals.
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Hawk C, Amorin-Woods L, Evans MW, Whedon JM, Daniels CJ, Williams RD, Parkin-Smith G, Taylor DN, Anderson D, Farabaugh R, Walters SA, Schielke A, Minkalis AL, Crivelli LS, Alpers C, Hinkeldey N, Hoang J, Caraway D, Whalen W, Cook J, Redwood D. The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med 2021; 27:850-867. [PMID: 34314609 DOI: 10.1089/acm.2021.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To develop evidence-based recommendations on best practices for delivery of clinical preventive services by chiropractors and to offer practical resources to empower provider applications in practice. Design: Clinical practice guideline based on evidence-based recommendations of a panel of practitioners and experts on clinical preventive services. Methods: Synthesizing the results of a literature search for relevant clinical practice guidelines and systematic reviews, a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice drafted a set of recommendations. A Delphi panel of experienced practitioners and faculty, primarily but not exclusively chiropractors, rated the recommendations by using the formal consensus methodology established by the RAND Corporation/University of California. Results: The Delphi consensus process was conducted during January-February 2021. The 65-member Delphi panel reached a high level of consensus on appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice. Interprofessional collaboration for the successful delivery of clinical preventive services was emphasized. Recommendations were made on primary, secondary, tertiary, and quaternary prevention of musculoskeletal pain. Conclusions: Application of this guideline in chiropractic practice may facilitate consistent and appropriate use of screening and preventive services and foster interprofessional collaboration to promote clinical preventive services and contribute to improved public health.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, Texas, USA
| | | | - Marion W Evans
- University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - James M Whedon
- Southern California University of Health Sciences, Whittier, California, USA
| | | | | | | | | | - Derek Anderson
- VA Puget Sound Health Care System American Lake Division, Tacoma, Washington, USA
| | | | | | | | | | | | | | | | | | | | | | - Jason Cook
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
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Scott R, Nahin RL, Weber W. Longitudinal Analysis of Complementary Health Approaches in Adults Aged 25-74 Years from the Midlife in the U.S. Survey Sample. J Altern Complement Med 2021; 27:550-568. [PMID: 33877882 DOI: 10.1089/acm.2020.0414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: Complementary health approaches include herbal products and mind-body practices. Several studies have identified predictors for complementary health approach use, yet there are two gaps: (1) How does use change? (2) Do factors associated with use influence this change over time? Using the Midlife in the United States (MIDUS), we examined how sociodemographic factors affected use longitudinally, and whether these associations differed between new and continued/discontinued use of herbal products, meditation, chiropractic, and massage therapy. Design: MIDUS is a national probability sample of adults aged 25 or older that has collected more than 20 years of longitudinal data, including the use of complementary health approaches. We employed the Andersen Model as a framework to identify predisposing, enabling, and health need factors associated with complementary health approach use based on previously identified and hypothesized factors. We ran Chi-square analyses to first test bivariate associations between our independent variables and four modalities to further guide logistic regression models. Results: Each of the four approaches examined saw substantial increases in prevalent use. However, only about 25% to 38% of individuals continued use from one wave to the next, whereas only 2%-9% of individuals who did not use a given approach in a wave reported use in the subsequent wave. Age, spiritual importance, and previous wave one use were all significantly associated with new use across all four modalities. Previous wave one use was associated with continued/discontinued use for all modalities. Age and education were significantly associated with discontinued use of chiropractic. Conclusion: We present the first longitudinal analysis of complementary health approaches in a nationally representative sample. These data distinguish between new and continued/discontinued use of complementary health approaches over time and provide insights into the interpretation of complementary health approach prevalence data, as well as important predictors of use.
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Affiliation(s)
- Remle Scott
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Richard L Nahin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Wendy Weber
- Clinical Research in Complementary and Integrative Health Branch, National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
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Rosa J, Burke JR. Changes in Opioid Therapy Use by an Interprofessional Primary Care Team: A Descriptive Study of Opioid Prescription Data. J Manipulative Physiol Ther 2021; 44:186-195. [PMID: 33879351 DOI: 10.1016/j.jmpt.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/20/2020] [Accepted: 01/20/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The purpose of this study was to describe changes in opioid-therapy prescription rates after a family medicine practice included on-site chiropractic services. METHODS The study design was a retrospective analysis of opioid prescription data. The database included opioid prescriptions written for patients seeking care at the family medicine practice from April 2015 to September 2018. In June 2016, the practice reviewed and changed its opioid medication practices. In April 2017, the practice included on-site chiropractic services. Opiod-therapy use was defined as the average rate of opioid prescriptions over all medical providers at the practice. RESULTS There was a significant decrease of 22% in the average monthly rate of opioid prescriptions after the inclusion of chiropractic services (F1,40 = 10.69; P < .05). There was a significant decrease of 32% in the prescribing rate of schedule II opioids after the inclusion of chiropractic services (F2,80 = 6.07 for the Group × Schedule interaction; P < .05). The likelihood of writing schedule II opioid prescriptions decreased by 27% after the inclusion of chiropractic services (odds ratio, 0.73; 95% confidence interval, 0.59-0.90). Changes in opioid medication practices by the medical providers included prescribing a schedule III or IV opioid rather than a schedule II opioid (F6,76 = 29.81; P < .05) and a 30% decrease in the daily doses of opioid prescriptions (odds ratio, 0.70; 95% confidence interval, 0.50-0.98). CONCLUSION This study demonstrates that there were decreases in opioid-therapy prescribing rates after a family medicine practice included on-site chiropractic services. This suggests that inclusion of chiropractic services may have had a positive effect on prescribing behaviors of medical physicians, as they may have been able to offer their patients additional nonpharmaceutical options for pain management.
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Affiliation(s)
- John Rosa
- Rosa Chiropractic and Physical Therapy Center, Rockville, Maryland
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25
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Leach RA. Full-Coverage Chiropractic in Medicare: A Proposal to Eliminate Inequities, Improve Outcomes, and Reduce Health Disparities Without Increasing Overall Program Costs. JOURNAL OF CHIROPRACTIC HUMANITIES 2020; 27:29-36. [PMID: 33324134 PMCID: PMC7729103 DOI: 10.1016/j.echu.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this article is to discuss evidence that supports the resolution of inequities for Medicare beneficiaries who receive chiropractic care. DISCUSSION Medicare covers necessary examinations, imaging, exercise instruction, and treatments for beneficiaries with back pain when provided by medical doctors, osteopaths, and their associated support staff such as nurse practitioners, physician assistants, clinical nurse specialists, and physical therapists. However, if the same patient with back pain presents to a chiropractor, then the only service that is covered by Medicare is manipulation of the spine. Current evidence does not support this inequity in Medicare beneficiary service coverage. There is no evidence to show an increase in serious risks associated with chiropractic treatment of neck or back pain in Medicare beneficiaries. Chiropractors support national public health goals and endorse safe, evidence-based practices. Chiropractic care for Medicare beneficiaries has been associated with enhanced clinical outcomes such as faster recovery, fewer back surgeries a year later, reduced opioid-associated disability, fewer traumatic injuries and falls, and slower declines in activities of daily living and disability over time. Further evidence points to lower costs, fewer medical physician visits for low back pain, less opioid-related expense, and less back-surgery expense with chiropractic utilization. Use is lower among vulnerable populations: seniors, lower income women, and black and Hispanic beneficiaries who may be most affected by current inequities associated with the limited coverage. In this era of evidence-based and patient-centered care, beneficiaries who receive chiropractic care are very satisfied with the care they receive. CONCLUSION The current evidence suggests a need for change in US policy toward chiropractic in Medicare and support for HR 3654. Ending inequities by providing patients full coverage for chiropractic services has the potential to enhance care outcomes and reduce health disparities without increasing program costs.
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Affiliation(s)
- Robert A. Leach
- Corresponding author: Robert A. Leach, DC, MS, Food Science, Nutrition and Health Promotion, Mississippi State University, 214 Russell Street, Starkville, MS 39759
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Daniels CJ, Cupler ZA, Gliedt JA, Walters S, Schielke AL, Hinkeldey NA, Golley DJ, Hawk C. Manipulative and manual therapies in the management of patients with prior lumbar surgery: A systematic review. Complement Ther Clin Pract 2020; 42:101261. [PMID: 33276229 DOI: 10.1016/j.ctcp.2020.101261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Pain and disability may persist following lumbar spine surgery and patients may subsequently seek providers trained in manipulative and manual therapy (MMT). This systematic review investigates the effectiveness of MMT after lumbar surgery through identifying, summarizing, assessing quality, and grading the strength of available evidence. Secondarily, we synthesized the impact on medication utilization, and reports on adverse events. METHODS Databases and grey literature were searched from inception through August 2020. Article extraction consisted of principal findings, pain and function/disability, medication consumption, and adverse events. RESULTS Literature search yielded 2025 articles,117 full-text articles were screened and 51 citations met inclusion criteria. CONCLUSION There is moderate evidence to recommend neural mobilization and myofascial release after lumbar fusion, but inconclusive evidence to recommend for or against most manual therapies after most surgical interventions. The literature is primarily limited to low-level studies. More high-quality studies are needed to make recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
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Hinkeldey N, Okamoto C, Khan J. Spinal Manipulation and Select Manual Therapies: Current Perspectives. Phys Med Rehabil Clin N Am 2020; 31:593-608. [PMID: 32981581 DOI: 10.1016/j.pmr.2020.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Touch is fundamental to the doctor-patient relationship. Touch can produce neuromodulatory effects that mitigate pain and put patients at ease. Touch begins with a confident handshake and continues throughout the physical examination. Touching patients where they hurt is a clear indication that a provider understands their complaint. Touch often continues as a function of treatment. This article updates evidence surrounding human touch and addresses mechanisms of action for manual therapy, the impact of manual therapy on pain management, health care conditions for which manual therapy may be beneficial, treatment plans with dose-response evidence, and the impact of manual therapy on the health care system.
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Affiliation(s)
- Nathan Hinkeldey
- VA Central Iowa Health Care System, 3600 30th Street, Des Moines, IA 50310, USA; Palmer College of Chiropractic, 1000 Brady Street, Davenport, IA 52803, USA.
| | - Casey Okamoto
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
| | - Jamal Khan
- Minneapolis VA Health Care System, 1 Veterans Drive, Minneapolis, MN 55417, USA; Department of Rehabilitation Medicine, 500 Boynton Health Service Bridge, Minneapolis, MN 55455, USA
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