Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain

Abstract

Background Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. Methods We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. Results Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/− 6.1 and the mean follow-up PDQ was 81.9 +/− 7.7, resulting in a mean improvement of −10.6 (95% CI 1.2 - −22.3, P = .08). Participants in the chiropractic team (mean change −25.0, P = .01) and those completing the study before COVID-19 (mean change = −22.6, P < .01) were found to have significantly greater improvement at follow-up. Conclusion This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

“…Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

“…A subsequent observational study of 216,504 opioid-naive patients with new-onset low back pain who received initial treatment from chiropractors versus primary care physicians had 90% lower odds of short-term opioid use (adjusted OR = 0.10; 95% CI, 0.09 to 0.10) and 78% lower odds of long-term opioid use (adjusted OR = 0.22; 95% CI, 0.18 to 0.26) [18,19]. Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

“…We obtained informed consent from participants before the start of each interview. Five members of our research team (PCE, ALB, MO, LM, JWB) developed the patient and GP interview guides (see Additional files 3 and 4, respectively) based on relevant literature [17][18][19][20][21][22][23][24]27] and our quantitative findings. Three of the five members (PCE, ALB, JWB) also have content expertise in the subject area of our study.…”

Pain catastrophizing mediates rapid benefits of accessing in‐person chiropractic care during the COVID‐19 lockdown

“…There is currently little data on the effects of re‐introducing specific services and novel initiatives to counteract the consequences of delaying the provision of care for non‐COVID conditions (Carrillo‐de‐la‐Pena et al, 2021 ). Previous evidence supports that the introduction of chiropractic services significantly reduces pain and disability (Garner et al, 2007 ; Goertz et al, 2018 ; Prater et al, 2020 ). In the present investigation, hands‐on chiropractic care resulted in minimal clinically important differences for both outcomes (approaching 30% from baseline), particularly after the first visit.…”

“…Nearly 12 million people in Spain suffer from spine pain (Cruz‐Sánchez et al, 2012 ), the most frequent reason to pursue chiropractic care (Beliveau et al, 2017 ). Access to chiropractic services has been linked to positive clinical outcomes for spine‐related conditions (Blanchette et al, 2016 ; Garner et al, 2007 ; Goertz et al, 2018 ; Prater et al, 2020 ). During the state of emergency in Spain, chiropractic services were not deemed essential and clinics were to remain shut (Asociacion Espanola de Quiropractica, 2020 ).…”