F4CP Lauds CDC Opioid Prescribing Guidelines, Chiropractic is Safer, Non-Drug Approach for Pain Relief

"CDC recommends conservative care and alternative options prior to prescription painkiller treatment."

www.yes2chiropractic.org

 

In response to the new federal guidelines issued by Centers for Disease Control and Prevention (CDC) regarding opioid prescribing, the Foundation for Chiropractic Progress (F4CP), the voice for the chiropractic profession, notes that many individuals are prescribed opioids for pain associated with musculoskeletal conditions, including low back and neck pain. Individuals utilizing opioids may be unaware of the effectiveness of alternative care, which includes chiropractic.

“The growing opioid epidemic is finally gaining the attention it deserves," states Sherry McAllister, DC, executive vice president, F4CP, referencing a report which found that in 2014, the increased utilization of opioids led to 28,647 deaths – or 61 percent of total drug overdose fatalities in the U.S. "Chiropractic care is a hands-on, non-invasive approach documented to yield improved clinical outcomes, reduced costs and high levels of patient satisfaction.”

According to a report published by the Agency for Healthcare Research and Quality (AHRQ), spinal manipulative therapy effectively and significantly reduced pain and improved function for patients with chronic nonspecific low back pain. Today, doctors of chiropractic (DCs) perform 94 percent of spinal manipulations in the U.S. Additionally, an earlier BMC Musculoskeletal Disorders study on upper cervical chiropractic care for neck pain, headache, mid-back, and low back pain concludes that 9.1 out of 10 patients indicated a very high level of patient satisfaction.

“Collectively, we need to implement changes across the health care continuum, and the care provided by a doctor of chiropractic is the key to effectively managing pain and avoiding opioid drug treatment," adds Dr. McAllister, who notes that Americans consume 80 percent of the world’s opioid supply, despite comprising less than five percent of the global population. “Health care providers across all disciplines should consider safe and effective conservative care options prior to prescribing addictive and potentially fatal opioids – which have yet to be deemed effective for long-term pain management.”

Under the new guidelines, the CDC encourages doctors to utilize conservative care prior to prescription painkiller treatment, and prescribe painkillers only after considering non-addictive pain relievers, behavioral changes and alternative options. Additionally, the CDC recommends doctors prescribe the lowest effective dose possible, and only continue prescribing the drugs if patients show substantial improvement.

Doctors of chiropractic, who receive a minimum of seven years of higher education, are specifically trained to diagnose, evaluate and provide non-pharmaceutical care and rehabilitation to individuals suffering from acute and chronic musculoskeletal pain, headaches and general health concerns.

The F4CP is a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, and cites chiropractic care as an integral part of the solution in mitigating opioid misuse, abuse and dependency.

Alexis Lignos

Marketing Director at Foundation for Chiropractic Progress

201-641-1911 (52)

alexis@f4cp.com

For more information about chiropractic care or to find a doctor in your area, visit: www.F4CP.org/findadoctor.

About Foundation for Chiropractic Progress

A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) informs and educates the general public about the value of chiropractic care.

Visit www.f4cp.com; www.yes2chiropractic.org; call 866-901-F4CP(3427). 

Social media: Facebook, Twitter, LinkedIn, Pinterest, YouTube.

Neck Pain – Management Strategies: Vol 15 Iss 5 The In Good Hands Newsletter from Chiro-Trust.org

“To the best of our ability, Life in Motion Chiropractic and Wellness agrees to provide our patients convenient, affordable, and mainstream Chiropractic care. We will not use unnecessary long-term treatment plans and/or therapies.”

www.Chiro-Trust.org

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When you make an appointment for a chiropractic evaluation for your neck pain, your doctor of chiropractic will provide both in-office procedures as well as teach you many self-help approaches so that as a “team”, together WE can manage your neck pain or headache complaint to a satisfying end-point. So, what are some of these procedures? Let’s take a look!

In the office, you can expect to receive a thorough history, examination, x-ray (if warranted), and a discussion about what chiropractic care can be done for you and your condition. Your doctor will map out a treatment plan and discuss commonly shared goals of:

• Pain reduction

• Posture/alignment restoration

• Prevention of future episodes.

Pain reduction approaches include (but are not limited to):

  - joint mobilization and/or manipulation

  - muscle/ligament stretching techniques

  - inflammation control by the use of physical therapy modalities (such as electrical stimulation), ice, and possibly anti-inflammatory vitamin / herbal therapies. 

Your chiropractor will also teach you proper body mechanics for bending, lifting, pulling, pushing and help you avoid positions or situations where you might re-injure the area. 

Posture/alignment restoration can include methods such as wall stand and/or stork exercises, respiratory "re-training", spinal stabilization exercises, and/or foot orthotic inserts. 

The third goal of future episode prevention is often a combination ongoing treatments in the office and strategies you can employ at home. This includes (but is not limited to):

• Whether you should use ice, heat, or both at times of acute exacerbation

• Avoiding positions or movements that create sharp/lancinating pain

• DOING THE EXERCISES that you've been taught ON A REGULAR BASIS

• Eating and an “anti-inflammatory” diet (lean meats & lots of fresh fruits/veggies).

Let’s talk exercise! Your doctor of chiropractic will teach you exercises that are designed to increase range of motion (ROM), re-educate a flat or reversed curve in the neck, and strengthen / stabilize the muscles in the neck. Studies show that the deep neck flexor muscles – those that are located deep, next to the spine in the front of the neck – are frequently weak in patients with neck pain. These muscles are NOT voluntary so you have to “trick” them into contracting with very specific exercises. Your doctor will also teach you exercises that you can do EVERY HOUR of your work day (for 10-15 seconds) that are designed to prevent neck pain from gradually worsening so you aren't miserable by the end of work. 

Along these lines, he/she will discuss the set-up of your work station and how you might improve it – whether it’s a chair, desk, computer position, a table/work station height issue, or a reaching problem; using proper “ergonomics” can REALLY HELP! 

Posture & Ergonomics Training

Your doctor will also advise you not to talk on the phone pinching the receiver between your head and shoulder, to face the person you are talking to (avoiding prolonged head rotation), to tuck in your chin as a posture training exercise, and more. 

Chiro-Trust.org

ChiroTrust™ members are a group of Doctors of Chiropractic worldwide who have taken “The ChiroTrust Pledge” and are dedicated to providing conservative, mainstream chiropractic care to patients without sales pressure, long-term recommendations, unnecessary therapies or excessive costs.

Dangers of Forward Head Posture

Neutral posture is observed when a plumb line passes through the center of the ear, shoulder, hip, knee and just in front of the ankle (Illustration - LEFT). Forward Head Posture [FHP] is present when the head at rest is positioned in front of the center of the shoulder. The movement of this much weight (About ten pounds) in front of the plumb line causes a shift in the body's Center of Mass, or balance point.

The good news is that the human body has an exquisite self-balancing system to compensate for shifts of the Center of Mass. The bad news is that these compensatory changes can be quite extreme (Illustration - RIGHT ) and cause severe structural stresses and even changes in organ systems.

There is a predictable pattern of compensation as the body realigns the Center of Mass. This is called the Trinity of Forward Head Posture [FHP].

1. Head moves forward of the shoulders. This changes the body's center of mass and center of gravity, triggering a response in the body's balance system.
2. To counter-balance the mid and upper back drifts backward, the shoulders rotate inward.
3. In response to that movement, the pelvis tilts forward

Several major studies have concluded that FHP is a direct indicator of a person's overall health:

• Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture; however, many symptoms, including pain, may be moderated or eliminated by improved posture.¹
• Hyperkyphotic (hi-per-kie-fah-tick) posture [excessive curvature of the thoracic spine, commonly referred to as hunchback] predicts increased mortality. Interventions specifically targeted at improving hyperkyphotic posture could result in reduced mortality rates.²

What is Kyphosis?

• Researchers found that even mild forward head carriage is “detrimental” to a person’s “overall health”. They concluded that the farther the head/neck moved in front of the seventh (7^th) cervical vertebrae “all measures of health status showed significantly poorer scores” and that this forward translation increased a person’s pain and decreased their ability to function!³
• Researchers at the University of Leeds in the UK found a direct cellular connection between muscles in the neck and a part of the brainstem - called the nucleus tractus solitarius (NTS) - which plays a essential role in regulating heart rate and blood pressure. This finding quite possibly explains why an injury to the muscles of the neck (i.e. whiplash) can at times change a person’s blood pressure and heart rate. It stands to reason that repetitive use injury to these same muscles (i.e. slouched posture at your desk and/or computer, cell phone, tablet use) may very well adversely alter these vital signs too!

Poor Posture Alters Your Vital Signs

Major Effects of Forward Head Posture

- For every one inch the head sits forward of the shoulders, an additional 15-30 pounds of tension is placed on the muscles in the back of the neck.

The Physics of Forward Head Posture

- It has been estimated that a person with Forward Head Posture uses 30% more body energy to keep the body erect.

- As the body shifts, certain muscle groups get stretched and become weak, and other groups shorten, and become weak. This results in degenerative changes that twist and distort the spine and subsequently shorter stature.

 

<sup>There is nothing good about poor posture and regardless of the activity (work or play) posture affects your overall performance. At least 85% of the back/neck pain related issues that enter my office derive from improper posture. Poor bodily usage directly impacts the biological, psychological, and social aspects of our daily lives leaving us dysfunctional, exhausted, and in pain. Implementing proper body mechanics is simply a mindful adherence to good habits that must be practiced with moment to moment awareness.  

Even though poor posture is not self-correcting it can be reversed. A chiropractor near you utilizing manual therapy, therapeutic exercise, and lifestyle advice can help you overcome upper crossed syndrome [see image above] and return you to a neutral posture in no time</sup>

¹ Lennon J, Shealy N, Cady, RK, Matta W et al. Postural and Respiratory Modulation of Autonomic Function, Pain, and Health. American Journal of Pain Management. 1994;4 (1):36-3

² Journal of the American Geriatrics Society. Volume 52, Issue 10, pages 1662–1667, October 2004

³ Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005 Sep 15;30(18):2024-9.

⁴ The Journal of Neuroscience, 1 August 2007, 27(31):8324-8333

A Best Evidence Synthesis Regarding the Classification and Treatment of Neck Pain

Endorsed by the United Nations on 30 November 1999 and officially launched on 13 January 2000 at the headquarters of the World Health Organization in Geneva, Switzerland the Bone and Joint Decade (BJD) is an international group of healthcare professionals that address the substantial effect that bone and joint disorders have on society, the healthcare system, and the individual. The goal of the BJD is to “improve the health- related quality of life for people with musculoskeletal disorders throughout the world by raising awareness and promoting positive actions to combat the suffering and costs to society associated with musculoskeletal disorders”.[1] This patient centered organization’s motivation has been the establishment of initiatives capable of delivering best-evidence multi-disciplinary healthcare on a global scale.

This focus was evident with establishment of The Task Force on Neck Pain and Its Associated Disorders in 2000. This fifty (50) member Task Force, with members from nine (9) countries, and representing nineteen (19) clinical and scientific disciplines/specialties was mandated with the task of publishing a report outlining the best current evidence regarding the risk and prognosis of neck pain, its assessment/diagnosis, and the effectiveness and safety of invasive and non-invasive treatment methods for neck pain. During this process they were to also identify problems with the current literature so that future studies could be developed. The goal of this seven year project was to empower the public, especially individuals who suffer from neck pain or at risk of developing it. This collaborative effort that included eight (8) universities in four (4) countries and eleven (11) professional organizations who were nonfinancial sponsors produced a document that has changed approaches and views regarding neck pain as well as its prevention, diagnosis, treatment, and management.[2]

Below is the roster of the 13-member Scientific Secretariat who conducted the screening process of 31,878 research citations on neck pain of which 1,203 articles were found to be relevant. 46% (552) of those were found to be “scientifically admissible” for utilization in this synthesis of best-evidence. Aside from this, various other members of the Task Force also conducted four (4) original research projects during its seven year tenure, two that examined vertebrobasilar stroke, one that compared the outcomes of various forms of neck pain treatment, and another that examined work absenteeism due to neck pain.

As Primary Spine Practitioners, the doctors at Life in Motion Chiropractic and Wellness have found this study to be an invaluable guideline for providing our patients with or triaging them to the most effective treatment available for their neck pain.

Eugene J. Carragee, MD, FACS	Linda Carroll, PhD
J. David Cassidy, DC, PhD, DrMedSc	Pierre Côté, DC, PhD
Stephen W. Greenhalgh, MA, MLIS	Jaime Guzman, MD, MSc, FRCP(C)
Scott Haldeman, DC, MD, PhD, FRCP(C)	Sheilah Hogg-Johnson, PhD
Lena Holm, DrMedSc	Eric L. Hurwitz, DC, PhD
Margareta Nordin, PT, DrMedSc, CIE	Paul Peloso, MD, MSc, FRCP(C)
Gabrielle van der Velde, DC, PhD (Candidate) “In other words, one finds much more information than any individual clinician would be able to find, download, print, read, and digest/assimilate should he/she be devoted to such tasks full-time for years. More specifically, the fact that not only whiplash and nontraumatic disorders but also headaches, arm pain, and generalized symptoms of cervical origin are included in the review is a major strength of this work. Similarly, it’s very useful having both nonsurgical and surgical treatments in the same publication. Moreover, grading treatments according to the likelihood of helpfulness; reporting on prognostic factors and using “suspected etiology” to evaluate treatments are some other examples of the clinical orientation and practicality of this report.” Federico Balagué MD Department of Rheumatology, Physical Medicine and Rehabilitation, Hôpital Fribourgeois – Freiburger Spital Site de Fribourg – Freiburg, Freiburg, Germany Service de Rhumatologie, Médecine Physique et Rééducation, 1708, Fribourg, Switzerland

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[1] "Background & Goals." THE BONE AND JOINT DECADE. World Health Organization, 13 Jan. 2000. Web. 25 Apr. 2014. <http://bjdonline.org/home/bjd-goals/>.

[2] Haldeman, Scott, Linda Carroll, David Cassidy, Jon Schubert, and Ake Nygren. "The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders - Executive Summary." SPINE 33.4S (2008): S5-S7. Print.