The years since the opioid epidemic was exposed have seen the release of multiple guidelines recommending conservative care, including chiropractic, for managing pain. While it remains unclear whether such guidelines have moved the needle toward nondrug options, a new study suggests that since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, one result has been an increase in non-opioid pain medication use.
Published in JAMA Network Open (Goldstick JE, et al., 2022;5(6):e2216475), the study used claims data (2011-2018) from adults (ages 18 and older) with two years of continuous commercial insurance enrollment, and no cancer or palliative care claims. Researchers constructed seven cohorts (four pre-CDC guideline, three postguideline), each covering a two-year period. The primary outcome measure: "receipt of any nonopioid pain medication prescriptions (analgesics or antipyretics, anticonvulsants, antidepressants, and nonsteroidal anti-inflammatory drugs)" during the follow-up period (year one of each cohort was considered the baseline period; year two the follow-up).
Data were analyzed in March 2022, revealing that among nearly 16 million patients who qualified for inclusion in one or more cohorts, "[while] the proportion with past-year opioid exposure decreased ... nonopioid pain medication prescribing odds were higher by 3.0% (95% CI, 2.6%-3.3%) in postguideline year 1, by 8.7% (95% CI, 8.3%-9.2%) in postguideline year 2, and by 9.7% (95% CI, 9.2%-10.3%) in postguideline year 3 than the preguideline pattern-based estimates."
While the study authors conclude that their findings demonstrate the effectiveness of the CDC guideline (increased guideline-concordant opioid prescribing), DCs will be the first to point out that they're missing the point. By all accounts, chronic pain continued to be managed with medication. (After all, if nondrug options had been used more, one would expect prescribing rates to go down or at the least, stay static.)
In a press release from the Foundation for Chiropractic Progress, released in September during National Drug-Free Pain Management Awareness Month, F4CP President Sherry McAllister, DC, commented: [S]imply replacing one drug with another is not the answer to safe, effective, long-term pain management. Instead, patients suffering from acute or chronic pain should seek out natural, drug-free methods first to improve symptoms and quality of life without the risk of dangerous pharmacologic side effects or dependency." Wise words indeed – now who's willing to listen?
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