The Journal of Contemporary Chiropractic published the results of a case study on May 18, 2020, documenting the improvement under chiropractic care of a U.S. veteran with lower back pain who had previously been using opioids for ten years to manage his pain.
In the opening of the study, the authors clearly state their objective. “To demonstrate the ability for a patient with chronic mid and low back pain to make significant improvements, both in pain score and quality of life, under chiropractic care, even after a decade of management using daily opioids.”
It is obvious to everyone that there is an opioid problem in the United States and around the world. This awareness has caused a shift in the thought of how to best address back issues. Because of this, the American College of Physicians (ACP) updated their Clinical Practice Guideline for the Treatment of Chronic Low Back Pain in 2017 to state that their first recommendation for chronic lower back pain (LBP) was to use spinal manipulation, exercise, and multidisciplinary rehabilitation prior to pharmaceutical intervention as a first line of defense. Only after several trials of unsuccessful conservative management for LBP was medical treatment with opioids to be considered.
In this case, a 50-year-old male veteran went to the chiropractor, seeking help for chronic mid and low back pain that radiates into his legs. He had been seeing medical physicians through the Veterans Affairs, who had been treating him with opioids in the form of hydrocodone and morphine for the past 10 years. He was forced to discontinue activities such as biking and weightlifting due to his pain. During flair-ups, he was given a cane and crutches to help him get around.
The man’s pain was so unremitting that he stated that he was also having “fatigue and lack of desire to do things.” The only care that he was offered during this 10-year period was in the form of opioid therapy. Eventually, he sought care at the Veterans Affairs Medical Center chiropractic clinic.
The chiropractic evaluation of the man’s spine showed a full range of motion, but with pain being created in almost all movements. MRI’s of the man’s lower back showed a disc protrusion in the lower lumbars. Chiropractic care was then started to address his spinal issues. He was also given some home exercises and procedures to follow.
After his sixth visit, the man reported on a re-evaluation that he felt improvement and was able to move better with less pain. After 3 months of chiropractic care, he reported a 50% reduction of pain as well as a “significant increase in his functionality and quality of life.” He was able to discontinue the use of opioid medications and only occasionally utilized an over-the-counter drug as needed.
In the discussion, the authors of the study stated, “This case report portrays the ability for a patient with chronic thoracic and low back pain for over a decade, who was previously medically managed for 10 years with daily opioids, to achieve significant improvements with autonomous management of pain, increased functionality, and improved quality of life with a trial of 6 visits of chiropractic care.”