The FDA, CDC, and IOM have recommended the use of non-drug treatment like chiropractic for pain before opioids.

  • CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016: “Several nonpharmacologic and nonopioid pharmacologic treatments have been shown to be effective in managing chronic pain in studies ranging in duration from 2 weeks to 6 months.”
  • FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain (May 2017): “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly musculoskeletal pain and chronic pain… Complementary therapies – e.g., acupuncture, chiropracty. HCPs should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.

Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain: “Providers should first consider non-pharmacologic and non-opioid therapies.”

Ohio Opiate Action Team Guidelines for Acute Pain Management: “Non-pharmacologic therapies should be considered as first-line therapy for acute pain…” (ice, heat, exercise, massage, acupuncture/acupressure, chiropractic adjustment…)

The American College of Physicians updated medical guidelines for back pain based on the latest research. Chiropractic and non-drug treatments were recommended as a first line approach for acute and chronic back pain (rather than medication).

The Joint Commission, which accredits most US hospitals, established new pain management standards to include nonpharmacologic options: “The hospital should promote nonpharmacologic modalities…physical modalities (for example, acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, and physical therapy)…”

The Ohio Bureau of Workers Compensation established a new rule requiring injured workers to complete a course of at least 60 days of conservative treatment, including chiropractic, before lumbar fusion surgery could be approved.

Cleveland Clinic Spine CarePath highlights spinal manipulation as a first-line approach for back pain. After a 4-week trial, physical therapy may be attempted if needed.

Attorneys General from 37 states submitted a letter to insurers requesting better coverage of non-drug alternatives to opioids including chiropractic.

Rhode Island passed a law requiring insurers to cover non-drug alternatives to opioids including chiropractic.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis recommended Medicare and private insurers remove cost-prohibitive restrictions for chiropractic and other alternatives to opioids: “Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery…have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.”

Consumer Reports published an article on chiropractic as a safe and effective alternative to medication for back pain. Their survey of more than 3,500 back-pain sufferers concluded, “Nearly 90 percent of people who tried spinal manipulation found it helpful.”

The Journal of the American Medical Association published a systematic review and meta-analysis of existing research that concluded chiropractic manipulation is effective and low risk.

A study examining very large Medicare datasets found that in geographic locations with more doctors of chiropractic providing spinal manipulation, there were fewer patients taking opioid drugs.

Analysis of New Hampshire All Payer Claims Database of roughly 33,000 adults registered as having low back pain. Likelihood of filling a prescription for an opioid analgesic was 57 percent lower in the chiropractic-using population.”

A Gallup survey reported 78% of Americans prefer to try other options like chiropractic to address their physical pain before they take pain medication prescribed by a doctor.

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