Chronic pain is a significant public-health issue – and it's only getting worse. Fortunately, more people are turning to conservative, nonpharmaceuctical care over opioids; with chiropractic one of the most frequently utilized nondrug choices.
"Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019," published in JAMA Network Open,1 reveals all this and more.
Fewer Opioids, More Nondrug Care
"This study provides evidence of a large increase in exclusively using nonpharmacologic treatments in 2016 to 2019 among persons with chronic pain. ... Exclusive opioid use for chronic pain significantly decreased from 2014 (14.43%; 95% CI, 12.95%-16.01%) to 2017 (10.57%; 95% CI, 9.56%-11.63%), while nonpharmacologic treatments significantly increased from 2014 (18.50%; 95% CI, 16.64%-20.47%) to 2017 (22.50%; 95% CI, 20.78%-24.29%). By 2019, any opioid use decreased to 15.52% (95% CI, 13.99%-17.14%), while any nonpharmacologic use increased to 43.84% (95% CI, 41.44%-46.27%)."
In fact, nonpharmacologic treatment surpassed opioid treatment among adults with chronic, nonsurgical pain. Note: While this was not the case with surgical pain, "exclusive use of nonpharmacologic treatments [for surgical pain] increased in 2019 (aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011."
People Are Increasingly Turning to Chiropractic, But...
"The most prevalent nonpharmacologic clinicians were chiropractors and physical therapists. [Per previous research,] chiropractic care increased from 6.9% in 1990 to 8.4% in 2012. Our study shows that use of chiropractic care continued increasing through 2019 (chronic pain, 25.6%; surgical pain, 8.9%)."
Use of chiropractic and physical therapy for chronic pain surpassed overall opioid use by the end of the study period. That being said, "Although PT was more costly, it was preferred among persons with greater disability and worse health," according to the study.
Note: The least utilized treatments for chronic and surgical pain: acupuncture and massage therapy, which the study authors speculate is "likely due to poor coverage from private and public payers."
Important Policy Takeaways for Health Care and Insurance
"Our study holds broad clinical and policy relevance, including expanding the reimbursement for nonpharmacologic health care professionals and equalizing direct access – without a physician referral – [our emphasis] between these professionals in some circumstances. Administrators and health care professionals may benefit from education on the effectivecpharmacologic treatments and which licensed professionals can be consulted to deliver such treatments."
Reference
- Pritchard KT, et al. Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019. JAMA Netw Open, 2022; 5(11):e2240612.
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