Oh, my aching back!

While people are discovering the many ways chiropractic care enhances well-being, doctors of chiropractic are commonly associated with a sore back. It doesn’t matter that modern chiropractic was born in 1895 when D.D. Palmer restored a janitor’s hearing with a spinal adjustment.

Back pain, and low back pain in particular, soon stole the stage with its effectiveness in relieving the often-crippling symptoms. With good reason, it seems. In the past year alone, according to the 2018 Gallup-Palmer College of Chiropractic study, “Managing Neck and Back Pain in America,” 25 percent of Americans sought professional health-care in treating their neck and back pain. And nearly two-thirds of us will experience severe enough pain to seek care in our lifetimes.

That is why the Foundation for Chiropractic Progress has designated low back pain as its focus in December. It is an issue escalated by the opioid epidemic as people want options to the prescription painkillers that often lead to addiction, abuse and overdose. Multidisciplinary health care is emerging, with medical organizations such as the American College of Physicians encouraging people to try chiropractic care before taking opioids or considering surgery. Americans have strong opinions of their own as well, as seen in the recent Gallup-Palmer College of Chiropractic study.

One in four – 28 percent – prefer drug- and surgery-free treatment, though eight out of 10 – 79 percent – want options. And one in five of those with significant back and neck pain take prescription painkillers. Medical physicians and doctors of chiropractic are the top choices – 62 and 53 percent, respectively – the latter chosen because they provided the most effective treatment, the study said.

Americans’ trust is well placed. According to a 2018 study of active-duty military personnel, participants experienced fewer back problems when treated with chiropractic and medical care. As Christine Goetz, who led the research, has noted, “This study provided the strongest evidence to date that chiropractic is safe, that it’s effective and that it can be integrated into a multidisciplinary health care setting.”

Americans also try to deal with pain on their own, applying heat or ice, practicing yoga, getting a massage or using over-the-counter pain relievers, which can also be risky when overused.

And there are effective actions you can take to complement your chiropractic care:

• Make lifestyle changes now that prevent back and neck pain. Good posture is a good place to start. Avoid becoming sedentary—breaking away from the desk for stretches and regular exercise. Drink plenty of water, and while you are at it, watch what you eat as well. Your doctor of chiropractic can suggest additional measures you can take specific to your situation.

• Seek treatment at the first sign of back pain. Watch for stiffness or decreased range of motion in the neck, a knot in the back muscle, loss of bladder or bowel control, loss of balance or coordination, muscle weakness or numbness and tingling in your extremities. While they may not seem related to the back, they often originate from the spine … your doctor of chiropractic’s area of expertise!

• Keep your healthcare professionals informed on what you are experiencing and what other treatments or prescriptions you are receiving. We are at the crossroads in addressing an issue dating back to the beginning of time. And recent studies – along with dialogues scheduled own the road – indicate that we are on the same page in pursuing relief.

By Sherry McAllister, DC

A recent study published in JAMA Open Network seems to confirm what I and my patients have known for years: health insurers are steering their members toward pharmacological, often opioid-based, management for chronic pain.

The study, “Coverage of Nonpharmacologic Treatments for Low Back Pain Among U.S. Public and Private Insurers,” shows that payer-imposed barriers to care such as $60 copays, visit limits and onerous medical necessity determinations, are disincentivizing their members away from   nonpharmacologic care, even though the care is widely covered. This is despite the substantial evidence supporting the effectiveness of chiropractic care and physical and occupational therapy for chronic pain. Meanwhile, according to an associated commentary in the publication, Christine M. Goertz, DC, Ph.D. and Steven Z. George, PT, Ph.D., cite research that the preferred generic opioid prescriptions cost members only $10 a month.

To that avail, I have a patient with chronic uncomplicated low back pain who finds great relief with chiropractic. Unfortunately, this patient can only receive care if all the allotted paperwork, authorization and deductible has been met. Problematic is that this patient typically needs one treatment every few months to contain her discomfort. This makes managing chronic pain extremely difficult, as many insurance companies allocate payments based on an acute phase patient, ultimately leaving the patient and doctor frustrated by the paperwork and high out-of-pocket costs. This is just one example of many I could share regarding the hurdles both parties are facing.

In light of the nation’s opioid epidemic, as recommended by the CDC, FDA and IOM, nonpharmacological clinical pathways need to be the first-line approach for chronic pain. However, study lead author James Heyward, MPH, a research data analyst at the Johns Hopkins Center for Drug Safety and Effectiveness, finds little collaboration within these health plans to prioritize evidence-based, nonpharmacologic care protocols after interviewing 43 medical and pharmacy health plan executives.

From the study:

“Overall, informants indicated a low level of integration between coverage decision making for nonpharmacologic and pharmacologic therapies, such as through the use of step therapy requirements that encourage use of physical therapy before initiation of long-acting or extended-release opioids.”

In my own practice, I have found that many of my patients’ primary care physicians opt for pharmacologic care options as a first choice to manage pain rather than a nonpharmacological approach simply because they are not familiar with the options. One of my patients mentioned that her primary care physician knew very little about chiropractic and instead gave her a number of reasons why taking a medication would be just as good of a choice to manage pain instead of opting for a drug-free approach. The primary care physician went as far as to say that my patient could just simply come back in when she needed a refill. If the primary care provider lacks the understanding, then the patient cannot be fully informed of the safe, effective, drug-free options that are available, which perpetuates the barriers to care and further fuels the reliance on prescription medications.

Steps to reverse the trend

While there are multiple drivers behind the country’s opioid public health crisis, this study indicates that health plans can take steps to help reverse the course. They include:

1.Copay reduction for evidence-based and effective interventions such as chiropractic care and physical and occupational therapy

2.Decrease unnecessary administrative obstacles such as medical necessity reviews for conservative, cost-effective care

3.Reconsider limitations on number of visits to encourage members to make such care part of their long-term, chronic pain management strategy, preventing the need for pharmacologic interventions

4.Increase collaboration and coordination between medical and pharmacy health plan leaders to help incentivize members to pursue nonpharmacologic interventions for chronic pain

5.The Centers for Medicare and Medicaid Services should seek input from the entire spectrum of healthcare providers and professionals, including doctors of chiropractic and physical and occupational therapists, as they design policies and guidelines for the newly passed “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act”

The bottom line is patients deserve and desire drug-free clinical pathways. A recent Gallup-Palmer College of Chiropractic survey report showed 79 percent of Americans want to explore all nonpharmacological treatments for pain before considering an opioid. It is up to all stakeholders, including physicians and health plans, to help remove barriers to evidence-based, effective and preferred therapies for chronic pain.

About the author:

Sherry McAllister, DC, is executive vice president of the Foundation for Chiropractic Progress and Foundation for Chiropractic Education. A not-for-profit organization, Foundation for Chiropractic Education (501c3) and the Foundation for Chiropractic Progress (501c6) provide information and education regarding the value of chiropractic care and its role in drug-free pain management

One minute, you’re thinking about how good that Italian sausage you just picked up is going to make your spaghetti dinner taste. The next, a blur of white racing in from the next lane drives any thought of dinner from your mind.

You’re in a crash; police car lights are flashing and first-responders want to know if you’re all right. It’s a dizzying experience as your mind inventories everything that happened and absorbs all that’s changed.

And as surely as you’ll send your vehicle to the shop to assess the damages, think about what you need to make sure you’re OK. If there are injuries, you’ll want to head to the hospital for medical attention. You’ll immediately want to see your doctor of chiropractic, too, even if you don’t notice obvious symptoms.

Ask Jess Caruso, who in a Palmer College of Chiropractic blog discussed the chiropractic care she received to treat the debilitating effects of a crash. She revealed that it was what led to her decision to become a doctor of chiropractic herself. She doesn’t even want to imagine what her life would be like today, she said, if she had continued to rely on prescription drugs for relief.

This is why the Foundation for Chiropractic Progress has designated August as its Personal Injury and Motor Vehicle Accidents Month. Consider these points if you are involved in a personal injury crash:

• With the incredible force involved in a crash, your body takes a real jolt. Even a low-speed fender-bender with a speed change of 2.5 miles can apply intense pressure to your spine, neck, and soft tissues. But the adrenaline of the moment might mask the collision’s effects. By waiting to see your doctor of chiropractic, what might have been averted by a simple adjustment could surface days or weeks later as chronic pain. The earlier you address it, the sooner your body can heal itself, naturally without drugs or surgery.

• For insurance purposes, it is important to document your injuries within three days, whether it is discovering a fractured wrist in the emergency room or neck pain caused by soft tissue injuries, most commonly known as whiplash, by your doctor of chiropractic. When you wait a week or longer to seek help, your case loses credibility as your need for chiropractic care increases.

• If you experience symptoms such as blurred vision, headaches, dizziness, neck stiffness, or pain in the lower back, shoulders, or arms at any time following a crash, immediately see your doctor of chiropractic. Again, the sooner you receive chiropractic care, the better chance you have of avoiding long-term chronic problems.

• The bottom line is that you want to do everything you can to protect your quality of life. Early intervention can decrease the inflammation and scar tissue that threatens your mobility by relieving pain and restoring range of motion. It’s the TLC you give your vehicle without a second thought; why would you think twice about doing the same for this complex mechanism we call the human body?

One of the fastest growing branches of chiropractic care has wrapped itself around sports. It comes as no real surprise. For years, professional athletes have embraced its preventative and restorative benefits, to the point of now including doctors of chiropractic on their healthcare crew.

What’s fueling the growth? Celebrity testimonials from the likes of golf great Tiger Woods, tennis legend Venus Williams, and football’s Tom Brady, who said, “As long as I see the chiropractor, I feel like I’m one step ahead of the game.”

But don’t underestimate studies such as the one measuring a markable increase in distance for golfers who received chiropractic care and the word-of-mouth power of those who’ve discovered for themselves the many benefits.

As the Foundation for Chiropractic Progress turns its attention to sports-oriented chiropractic care, our theme for July, here are a few things you might consider:

• Athletes, especially in high-impact sports such as football, hockey, and rugby, take a beating. Even the gentler sports, such as baseball, take their toll with repetitive strain. Many of us wondered how much longer Texas pitcher Nolan Ryan could stay on the mound before he retired at 46. But a doctor of chiropractic, by maintaining flexibility and range of motion, can lessen the risk of injuries and develop a stronger connection between the spine and the nervous system, leading to quicker recovery from minor injuries. The Olympic games is a great example. A doctor of chiropractic accompanied the Aruba team to the 1976 games, the USA team came aboard in 1980 during the winter games in Lake Placid, and in 2010, chiropractic care was fully integrated into treatment of athletes in the polyclinic at the winter games in Vancouver.

• Studies abound on the benefits of chiropractic care when there is a sports-related injury. A 2001 study by Duke University found almost immediate relief of headaches originating from the neck after spinal adjustment. Similar results were found on studies of shoulder and ankle injuries. Better yet, the treatment is drug-free and non-invasive, avoiding risk of addiction to a prescribed opioid painkiller.

• Finally, chiropractic care can enhance your performance. A 2012 study reported in the Journal of Manipulative and Physiological Therapeutics found that a group of national level judo athletes improved their grip strength by 16 percent following three visits to a doctor of chiropractic. And a 1997 report in the Journal of Vertebral Subluxation Research found that chiropractic care improved muscle strength and distance jumps among baseball players.

Want to stay on top of your game? Put a doctor of chiropractic on your team and see for yourself the difference it makes.