Drug deaths: Chiropractors part of c21 Pain Solution?
Posted on 08. Oct, 2017 by Dr Joseph Ierano in Read
Intro: chiro v drugs
Reimbursement for Non-Opioid Pain Treatments
A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies. (emphasis mine)
The above is from a FRESH HOT OFF THE PRESS USA government paper, viewable here. Very promising indeed.
No Pain All Gain
In the 21st Century, all types of doctors, including medical, chiropractic and physical therapy, will work together to treat musculoskeletal pain with 3 objectives in mind:
- to do least harm, whilst administering benefit,
- add future prevention strategies, and
- increase functional wellbeing
Thus, not just hiding or masking symptoms and dysfunction to some other level. Nice idea… fingers crossed!?
Largely because we stated that we “did not treat pain” – purposefully disagreeing with medical goals of merely suppressing symptoms without understanding cause – for years chiropractors were ridiculed by the “medical authorities” as ineffective compared with medical treatments – mainly consisting of drugs, drugs and maybe some injected drugs, then copious cases of useless back surgery. “Treating joints and spines is useless” they conjectured, as it is unrelated to any health problem. And dangerous. Sounds like I am making this up? Its all true.
Did I mention spinal manipulation is allegedly dangerous? We are in the MIDST OF A PRESCRIPTION AND OVER-THE-COUNTER DRUG DEATH EPIDEMIC, (proof below) but if you ask the majority of medical doctors why they dont refer to chiropractors, it is because they are deemed an unacceptable risk. Fake “news”, say I. This academic agrees…
We were “not a jot” of assistance to anything, cried one (maybe two) expert(s). Staunch opponents argued that all we were was dangerous. In reality everything has a risk involved, chiropractic being very low on the scale. Supremely low, but they won’t agree with the evidence.
Why do people keep coming back to me for pain relief? And then why when they’re out of pain do they get a check-up periodically? Research needed…
The Sceptic is Beyond Sin
In witch-hunt times, a sceptic was a sinner against many natural “laws” of God. Today we consider scepticism more altruistic. And rightly so. Ignorance is not bliss. But there is a type of scepticism that infiltrates the INTERNET today. You can see opposing views around most companies or organisations: Apple, VW, Catholics, Jews, Muslims and razors v electric shavers any old time. Exhausting, really. But thats the nature of the human beast/mind.
As Ben Goldacre wrote in his entertaining book: “I Think You’ll Find its a Bit More Complicated than That”, there are many sides to every story.
Let me declare: chiropractic needs research so badly now more than ever. Because for years we advocated there was poor research guidelines for
- antibiotic use: now epidemic prescription abuse
- opioid abuse: epidemic
- antipsychotic abuse: epidemic
- Back Pain surgery: damaging and failing almost every time.
It came about that chiropractors may be guilty of forgetting to prove their own assertions whilst busy pointing the finger (rightly so) at medical harm, and believing they were “natural” or a self evident truth (wrongly).
(Incidentally, who wrote this book – Beyond Antibiotics – over ten years ago? A chiropractor, medical doctor and a PhD)
SO when we said that chiropractic
- helps the immune system
- reduces colic
- prevents communicable diseases and the like
- subluxation is a definable and quantifiable entity,
we were either downright wrong or terribly premature in our conjecture. The research, even if promising, was not conclusive.
It so happens that the truth is that there is some basic level scientific evidence that we do help many types of pain syndromes and neuromuscular dysfunction. And yes the subluxation can be supported as an entity but in no way is it yet sufficiently quantifiable, like say, a stroke lesion in the brain?
The Pendulum Swings
NOW what is happening?
Gradually, we were suddenly ok for back pain… neck and thoracic pain.
Just observe…
What the physical therapists are saying about opioid overuse…
How can physical therapy help fight this epidemic? The answer is pretty simple. A study done in 2012 showed that early physical therapy intervention for low back pain versus delayed intervention caused a decrease in:
- The use of opioid medications
- Un-necessary x-rays or MRIs
- Injections
- Surgery
- Cost by $2700.00 per case.
(Fritz et al, 2012)
What the chiropractors are saying:
Conservative Care First: A Common Sense Approach
The American Chiropractic Association (ACA) encourages patients and health care providers to first exhaust conservative forms of pain management, when appropriate, before moving on to riskier, potentially addictive treatments such as opioids. To this end, ACA delegates met in Washington, D.C., in 2016 and adopted a policy statement proposing a solution to the dual public health concerns of inadequate pain management and opioid abuse. ACA’s policy statement supports:
1. The investigation of non-pharmacologic interventions for pain treatment across a variety of patient populations and healthcare delivery setting
2. The promotion of evidence-based non-pharmacologic therapies within best practice models for pain management
3. The improvement of access to providers of non-pharmacologic therapies
4. Interprofessional education to augment the training of pain management teams
5. And public health campaigns to raise awareness of drug-free treatment options for pain syndromes.
For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). Emphasis Added.
This Gallup Poll stated many revelations on Americas drug problems creating morbidity and mortality among LEGAL drug users, such as:
- Half of U.S. adults who’ve never been to a chiropractor are uncertain whether chiropractors are trustworthy and whether chiropractic care is dangerous or expensive
Non Drug Pain Care
Here is a book (Spears 1950) from my collection I dug up today while moving stuff:
Dr Spears ran the only chiropractic HOSPITAL I have ever heard of.
This report stated:
Dr. Spears was a true chiropractic pioneer and crusader, fighting the medical and local power establishment for the right to practice chiropractic.
After Leo Spears’ death, his nephews, Drs. Dan and Howard Spears, took over the direction of the hospital. It’s been estimated that the Spears Chiropractic Hospital contributed in excess of $5 million in free services over the years.
He also included ways of curbing PAIN syndromes in his book:
Including working with CHILDREN:
Just one of a “million” examples of chiropractic through history conducting pain relief through application of specific manual treatments, not DOGMA, which BJ Palmer, hero to many, was tainted with, though his efforts were second to NONE in creating a systematic approach to the treatment of an offending vertebral join lesion he promoted as “subluxation”.
Did BJ Palmer and the chiropractors through history really understand pain more than we care to admit, even though he set up his stance for what is today being hijacked as “vitalism” and non-therapeutic care? Vitalism is NOT new – the idea that the body is self healing – nor is it necessary for a therapeutic effect when delivering tried and testing health interventions? All too often one sees that the “innate” preferences of people today are actually unhelpful or killing them!
Well its not the first time medical mainstream bungled up the treatment of pain or defining its nature. In this report we find the shocking neglect for anaesthesia in infants:
The study that got infant pain horribly, horribly wrong
MEDICAL HISTORY
So you know that nightmare where you are awake during surgery, and you can feel everything but can’t do anything about it?
Well, this was the terrifying reality for many babies up until the end of the 20th century, thanks to a study that got infant pain terribly, terribly wrong.
There’s no denying that neonatal anaesthesia is tricky, and the possibility of overdose has always made doctors extremely cautious.
But it was a journal article on nerve maturation published in Child Development in 1941 that truly stepped up the horror.
After testing infants’ reactions to being repeatedly jabbed with a blunt pin, researchers concluded: “Even when there is sensitivity, it is reasonable to assume that neural mediation does not extend above the level of the thalamus.”
Doctors equated a lack of myelination in babies’ nerve fibres with an inability to feel pain.
At least, this must have been what they told themselves when they decided to forgo anaesthesia altogether, performing major surgery on fully conscious infants with nothing more than muscle relaxants.
This carried on for years until ‘baby saviour’ Dr Kanwaljeet Anand — now professor of paediatrics and anaesthesiology at Stanford University — looked into the immoral misconception.
He found that babies’ stress hormones were much higher in those undergoing surgery without any anaesthesia or analgesia, which ultimately led to more postoperative complications and other long-term consequences.
The painful — not to mention seriously messed-up — practice was finally declared unethical by the American Academy of Pediatrics in 1987.
[—end of excerpt.]
IN conclusion.
Working with goals of modern medical physicians and physical therapists, chiropractors can manage many pain conditions and syndromes with evidence based conservative care and utilising their own specific brand of spinal adjusting and additional modalities to enhance neuromuscular-spinal function.
Therefore chiropractic, as opposed to Mr Singh’s assertions that we “trick”, is good to “treat” many daily health problems, such as:
- back pain
- neck pain
- neck related headaches
- nerve pain in arms and/or legs
- shoulder and joint problems that do not require surgery
- and, allegedly and anecdotally a general feeling of better movement and well being on a non-symptomatic basis?
Responsible
This year alone, I have sent people to surgical consultation with prompt diagnosis and assessment after trial of conservative care, one immediately who I deemed would not respond to care (the neurologist missed the damage to his neck by a kick, reported in another blog here). A good neurosurgeon is paramount to good chiropractic practice.
Responsible health care begins with addressing the most debilitating conditions in society that cause morbidity and mortality and alleviating them with minimal harm. World Health Organisation deemed that musculoskeletal pain was in the top causes of human suffering.
Yes, “musculoskeletal disorders are the second most common cause of disability worldwide” and drugs are failing to offer a safe solution. Don’t get me started on NSAIDs and heart attack and Paracetamol overdose and now, Lyrica…
Dr Joe