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Back pain, opioids and your alternatives

Dr. Steven Heidinger writes about opioids and chiropractics
Wellness Column by Dr. Steven Heidinger

If you haven’t heard, we have an opioid problem here in Canada…I’ll get back to that one in just a bit.

Did you know that if you have back pain and you decide to seek care for your pain, who you choose to see may affect your risk for opioid use and/or possible opioid abuse?

New research is showing that choosing to visit a chiropractor or a physical therapist, rather than a primary care physician, for a new onset of lower back pain substantially decreases short term and long-term use of opioid drugs.

Here are some facts about the opioid crisis that exists right now in Canada (from the government of Canada website, 2019 and the Canadian Centre on Substance Use and Addiction):

  • More than 9,000 opioid related deaths since 2016;
  • An average of 11 deaths per day in 2017 from opioid overdose;
  • 94 per cent opioid-related deaths are accidental;
  • Opioid pain relievers are used by 13 per cent of the Canadian population;
  • Two per cent of those prescribed use opioids for non-medical purposes.

Chronic pain, such as back pain, is one of the more common reasons for why opioids are prescribed.

The Canadian Guideline for Opioids for Chronic non-Cancer pain has its first recommendation being optimizing non-opioid and non-pharmacological therapy, instead of opioids for conditions such as back pain.

Non-pharmacological treatments for back pain include chiropractic, physical therapy, massage therapy and acupuncture.

One major problem, unfortunately, is that while research is telling us who back pain sufferers should be accessing for their issues, access is often limited to those who can afford the care.  Nearly all non-drug options for back pain are not publicly funded.  

There is a push toward evidence-based decision making in health care today. Most recent best evidence supports combining exercise and manual therapy as the best way to manage chronic, recurrent spinal pain. Gym memberships cost money. Manual therapy costs money.

I think things need to change.

The views and opinions expressed in this article are those of the author, and do not necessarily reflect the position of this publication.