This article was published by Dr. Erik in the Telegraph Journal online in spring 2017
Opioid addiction has been a significant problem over the last decade. This is one of the greatest health challenges we’ve faced in our communities. In Canada, approximately 2500 people a year die of opioid overdoses, and tens of thousands more suffer deleterious health deficits from addiction, yet a clear solution to solving this problem has not yet been laid out.
Narcotic addiction begins with low back pain. Fifty percent of all non-cancer prescriptions for narcotics is for low back pain, even though clinical guidelines recommend against it. Once considered merely a benign condition, low back pain has lead to one of society’s greatest health challenges. Unfortunately, too frequently low back pain is not managed according to best practice guidelines, and it is costing us dearly.
McMaster University published guidelines on prescription narcotics for chronic non-cancer patients, in April 2017. The number one and strongest recommendation was to avoid all use of opioids until all conservative avenues have been exhausted. It also strongly advised against the use of opioids in individuals with a history of substance abuse whatsoever.
Even clearer, a recent paper on the management of low back pain, published in March 2017, provided an even greater spotlight on how we can help remedy the opioid problem. In this particular guideline, the American College of Physicians recommended against ALL pharmaceutical interventions, in lieu of, heat, massage, spinal manipulation, and acupuncture for pain lasting less than six weeks. It strongly advised against common treatments such as ultrasound and TENS. For chronic cases lasting longer than six weeks, the advice was to still favour non-pharmacologic treatment with a focus on exercise, multi-disciplinary rehabilitation, acupuncture, spinal manipulation, and psychotherapy. Most prescriptions of opioids is for low back pain of a chronic nature.
For low back pain, your provider should include a full-body biomechanical analysis, assessment of skeletal and muscular imbalance, and look at work/home habits, diet, stress and other emotional issues. This should lead into an active care program where the patient is facilitated to take care of themselves. Hold your provider accountable, and never just accept the status quo, because chances are you’re receiving the wrong treatment.
If we were to focus on an outcomes and results-based functional approach, rather than to simply manage pain, we would see a reduction in prescription narcotic dependency, especially among our most vulnerable. Considering how common low back pain is, this should not be viewed as a challenge, but as an exceptional opportunity to make a difference.
Dr. Erik Klein is a health policy expert, published author, and practicing chiropractor in Saint John, and Hampton. Dr. Erik is the CEO of ‘Town Health Solutions’ an award winning network of clinics in Atlantic Canada. He can be reached at drerikceo@townhealthsolutions. For further information, please go to www.townhealthsolutions.com, or search on Facebook.