Getting Insurance in Sync with Treatment

When his son, Sam, died of a heroin overdose after becoming addicted to opioids used in a sports injury, Greg McNeil started the non-profit Cover2 Resources to help other families like his. Now, Cover2 provides presentations, podcasts, and aggregates other help for people, families and organizations working toward non-opioid pain management.

In this podcast episode, Greg speaks with clinician/researcher Aaron McMichael, DC, and clinician/lobbyist Dr. Vern Saboe, DC, of Oregon. Their conversation focuses on what the research says about clinical best practices, how that matches up with the incentives provided by insurance coverage, and how doctors are affecting real change in regulation.

Study: Chiropractic Care May Lessen Drug Use

Dartmouth-Hitchcock primary care physician Dr. Louis Kazal, left, and D-H chiropractor Justin Goehl, second from left, step into the lobby of the Dartmouth-Hitchcock Heater Road clinic for a news conference after meeting with David Mara, N.H. Gov. Chris Sununu’s advisor on addiction and behavioral health, second from right, in Lebanon, N.H., Tuesday, June 26, 2018. Kazal and Goehl were part of a study in collaboration with Southern California University Health Sciences that showed patients receiving chiropractic care for non-cancer related back pain were less likely to use prescription opioid pain killers. At right is Dr. Mark Stagnone, president of the N.H. Chiropractic Association, and third from right is Dr. James Whedon, lead author of the study. (Valley News – James M. Patterson) Copyright Valley News. Reprinted with permission.

Valley News Staff Writer

Tuesday, June 26, 2018 (Valley News)

Lebanon — Researchers at Dartmouth-Hitchcock and the Geisel School of Medicine are highlighting a study that found that New Hampshire patients who received chiropractic care for lower back pain are significantly less likely to fill a prescription for an opioid than patients who didn’t see a chiropractor.

As a result, the Dartmouth researchers, among others, are pushing for expanding insurance coverage for chiropractic care.

The findings, which were published earlier this year in The Journal of Alternative and Complementary Medicine, further bolster guidelines from groups such as the American College of Physicians, which suggest that physicians should first treat patients suffering from lower back pain with therapies such as spinal manipulation, a common chiropractic treatment, before prescribing opioids.

Expanding access to such therapies — which are not always covered by health insurance — was the subject of a discussion some of the researchers had on Tuesday with David Mara, who serves as New Hampshire Gov. Chris Sununu’s adviser on addiction and behavioral health, at Dartmouth-Hitchcock Heater Road.

“I believe it’s all about access and if there are other options to pain medication it should be available to citizens of New Hampshire,” Mara said to reporters following the meeting.

He noted that some patients in New Hampshire have health insurance that covers chiropractic care, while others do not.

“We’re trying to do anything we can to stop more people from suffering from addiction,” Mara said.

Changing the way providers treat lower back pain has the potential to make a difference in overall opioid use, given that 59 percent of U.S. adults prescribed opioids reported having back pain, according to a 2008 study in the Journal of Pain and Symptom Management. (more…)

Chiropractic Better For Neck Pain

Bronfort et al. (2012), Annals of Internal Medicine
In a study funded by NIH’s National Center for Complementary and Alternative Medicine to test the effectiveness of different approaches for treating mechanical neck pain, 272 participants were divided into three groups that received either spinal manipulative therapy (SMT) from a doctor of chiropractic (DC), pain medication (over-the-counter pain relievers, narcotics and muscle relaxants) or exercise recommendations. After 12 weeks, about 57 percent of those who met with DCs and 48 percent who exercised reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group. After one year, approximately 53 percent of the drug-free groups continued to report at least a 75 percent reduction in pain; compared to just 38 percent pain reduction among those who took medication. (more…)

For Headaches

McCrory, Penzlen, Hasselblad, Gray (2001), Duke Evidence Report
“Cervical spine manipulation was associated with significant improvement in headache outcomes in trials involving patients with neck pain and/or neck dysfunction and headache.” (more…)

Chiropractic Compared to Other Treatments

Schneider et al (2015), Spine
“Manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain compared with usual medical care. 94% of the manual-thrust manipulation group achieved greater than 30% reduction in pain compared with 69% of usual medical care.” (more…)

For Acute and Chronic Pain

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (2017)
“Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence).” (more…)