1. First-line Treatment as Primary Prevention of Opioid Misuse
Non-pharmacological treatments, including reassurance, exercise, chiropractic spinal manipulation, acupuncture and massage are recommended as first-line treatments for pain in numerous best practice guidelines including, among others, the American College of Physicians, (6) The Joint Commission and CDC. (7) Non-pharmacologic treatment measures such as exercise therapy, spinal manipulation, acupuncture and yoga are also recommended as alternatives to opioid prescribing in a 2018 report published by the Minnesota Department of Human Services.
Best practice guidelines recommend prioritizing conservative courses of chiropractic care, acupuncture, and massage before more invasive treatments. This
approach is more likely to result in better patient outcomes, with fewer side-effects. Care pathways and health system designs that steer pain patients toward non-drug options first would prevent exposure to high-risk therapies like opioids and other narcotics, injections, and surgery. Compelling new research shows that when patients with musculoskeletal problems seek the care of CIH providers, the likelihood of a prescription for pain medication of any kind is greatly reduced. (8)
2. Secondary Prevention of Opioid Misuse for at-risk Populations
A growing segment of the US population has faced addiction in the past. Many more are at risk for addiction, or are otherwise considered to be vulnerable populations at higher than average risk for poor outcomes with medication use (e.g. the elderly, pregnant women, children and adolescents). This creates additional need to ease patient access to non-pharmacological therapies, and provide safer pain management options for at risk populations. Integrative pain management can be critical to preventing relapse in addicts who face surgery, suffer from acute injuries, or are in need of chronic pain management. Integrative care wraps a team of healthcare providers and support services around pain patients, coordinating individualized pain management across providers and addiction specialists, preventing relapse or increased risk exposure with opioids.
3. Tertiary Prevention through Pain Management of Addicted Individuals Substance abuse problems are often an unintended consequence of inadequate pain relief
This can occur through the abuse of prescription pain relievers, as well as the use of illicit drugs to self-medicate. Back pain sufferers report higher rates of marijuana, cocaine, methamphetamine and heroin use than adults without back pain. (9) For those who are substance addicted, many continue to experience pain. Inadequate relief prevents some from pursuing substance abuse rehabilitation, makes recovery more difficult, and presents a persistent risk for relapse. Increasing awareness and access to non-drug pain treatment options may help some initiate rehabilitation, support those in rehabilitation, and provide an additional measure of prevention for relapse. CIH providers should be considered an important part of addiction teams, taking a multi-modal approach to both addiction recovery and pain management.