Knowledge Expansion Survey highlights unmet patient-provider demand for drug-free pain management methods Insight Article Patient Access Population Health Sign in to save Sherry McAllister M.S (Ed)., DC, CCSP The results of a Quest Diagnostics nationwide survey of physicians highlights an unintended and unfortunate consequence of the nation’s opioid epidemic: fear to treat patients taking opioids. More than eight physicians out of 10 (81%) admitted in the survey that they are reluctant to accept patients currently prescribed opioids, and 83% agreed that treating patients with chronic pain is much more challenging in light of the opioid crisis. Denying care to patients suffering from chronic pain is not the answer, regardless of whether they take opioids. We have learned that there is no single solution to this public health crisis, which kills more than 130 Americans per day. Rather, physicians, health systems, governments, public health officials and other stakeholders must consider a multimodal approach that includes prescription limits, education, expanded rehabilitation resources and other tools at our disposal to help prevent opioid use disorders. One such highly effective but less often considered opioid abuse prevention method is to direct patients toward more drug-free pain management options, such as chiropractic care. Through published research, national and international clinical guidelines and millions of satisfied patients, chiropractic care has been established as a viable first-line pain management opportunity, especially for patients with lower back pain. Physicians who seek to expand their referral networks or internal interdisciplinary care teams should include more Doctors of Chiropractic (DCs). DCs are eager to collaborate with primary care and other physicians and can be integrated into physicians’ care plans in numerous ways. Evidence-based pain management In its 125-year history, research published in a wide array of respected medical and scientific research publications has demonstrated how effective chiropractic care is in helping patients with pain relief. A major aspect of recent research has focused on how chiropractic care, which uses neither pharmaceutical medications nor surgery, helps patients avoid opioids. A 2019 analysis published in Pain Medicine, for example, reviewed clinical studies of patients with noncancer pain who received chiropractic care and those who did not. The study found that those receiving care had 64% lower odds of receiving an opioid prescription. An earlier study found that for adults managing low back pain, the likelihood of filling a prescription for an opioid was 55% lower for those receiving chiropractic care than for adults not receiving chiropractic care. Similarly, the Bulletin of the World Health Organization reviewed six sets of updated international guidelines for managing low back pain in 2019 and found all of them recommend avoiding medication as a first-line treatment. Instead, authors urged that after educating patients about low back pain and urging them to remain active, the next care options generally include therapies such as spinal manipulation. In the United States, DCs perform 94% of all spinal manipulations. International guidelines also prioritize psychological and complementary therapies, such as mindfulness-based stress reduction, yoga, acupuncture and tai chi, over medical and surgical interventions. The Lancet published a three-part series on low back pain, which included a call to action to meet the challenges associated with the prevention and management of the condition. Among the education and action items necessary to establish more effective, patient-centered care, The Lancet editors included spinal manipulation (chiropractic adjustment) among its recommended steps before prescribing opioids. Less costly than opioids Further research, including reports from one of the largest private health insurers in the United States, is demonstrating that chiropractic care, while more effective than drugs, can help reduce the enormous healthcare spending on pain management, which reaches as much as $635 billion per year for chronic pain alone. One of the most expensive chronic pain conditions to treat is back pain, which an estimated 80% of Americans experience at least once in their lives. As recommended by research and medical guidelines, a cost-effective care path typically begins when a patient consults a DC. This association was highlighted in a December 2018 presentation by David Elton, DC, senior vice president, clinical programs at Optum, a subsidiary of UnitedHealth Group, at the National Academies of Science, Engineering, and Medicine. Dr. Elton explained that conservative care for low back pain could save $230 million in annual medical expenditures for the insurer and reduce opioid prescribing by 26%. Optum’s goal in the following two years was to increase the use of conservative care pathways from 31% to more than 50% and increase the number of referrals from medical doctors to DCs from 2% to 10%. Finding a referral partner Physicians who have not referred to a DC before may be unsure of how to locate a qualified partner aligned with your group’s mission and values. Rest assured, there are more than 70,000 skilled and experienced DCs practicing in the United States. Increased numbers of DCs are working within medical practices to offer non-pharmacological care. Susan Welsh, DC, DACBSP, USF College of Medicine Neurosurgery, says, “Our department of Neurosurgery and Brain Repair includes chiropractic care and research to emphasize that doctors of chiropractic are front runners for neuro-musculoskeletal and spine care in our fully integrative patient-centered clinics. We have over 750 providers in the Morsani College of Medicine at USF and chiropractic is included as a first-line of treatment.” Here are a few other tips for developing your DC referral network: Check patients’ health plan networks. Most payers, including Medicare and Medicaid, have DCs in their networks. Some health plans, however, are quite restrictive with chiropractic care benefits, charging copays of $50 or more for visits. As most primary care physicians know, patients will be much more likely to follow through with a referral appointment if their out-of-pocket costs can be minimized. Identifying an in-network DC is essential. Reach out to the insurer. Online health plan directories can be outdated, so it may help if the physician contacts the patient’s health plan to recommend an active, in-network DC who can accept new patients. More health insurers, as evidenced by the Optum research, are recognizing chiropractic care’s patient outcome and cost advantages and will have several options available. Consult online databases. The Foundation for Chiropractic Progress, WebMD, Vitals.com and the American Academy of Spine Physicians have online DC directories to find qualified doctors. Using these vetted lists is an efficient way to find practicing DCs who are typically active in their industry and their communities. Tap your network. Email other physicians in the group for a referral recommendation. Ask colleagues at a local physician society, healthcare or business event about their experience with local DCs. Pick up the phone. Often the best way to find a referral partner is a face-to-face meeting. If there is a nearby chiropractic practice, simply pick up the phone to schedule a breakfast or coffee meeting to discuss your patients’ needs and learn about the DC’s practice and care approach. Both parties can often quickly identify a good fit and begin building a potential long-term relationship. Better outcomes without opioids Physicians who have not recently considered recommending chiropractic care for their chronic pain patients should consider recent research and surveys in developing their care plan. Not only can chiropractic care help prevent opioid misuse, it can assist prescribers when discussing patient's current opioid prescriptions and consider other non-pharmacological solutions that may help in their tapering and/or discontinued use, aiding them in experiencing the pain relief, function and mobility they have long sought.