The War on Chiropractic Must End to Improve Painkiller Addiction

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May 23, 2017 | 43,878 views

Story at-a-glance

  • The U.S. Food and Drug Administration (FDA) has urged doctors to get information about nondrug options for treating chronic pain, including cognitive behavioral therapy, physical therapy, chiropractic care and acupuncture
  • With no other knowledge of how to treat pain, most physicians treat it with prescription painkillers, and now we have an epidemic of prescription drug abuse and related deaths
  • Patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks compared to those who took medication

By Dr. Mercola

In the U.S., painkiller addiction is so rampant that 91 Americans die every day from an overdose of prescription opioids or heroin.1 Prescription opioids such as oxycodone (OxyContin), hydrocodone (Vicodin), morphine and methadone are widely prescribed for pain relief.

Initially, they were intended to treat severe pain following surgery or injury or pain due to illnesses such as cancer. However, they're now increasingly prescribed for many types of pain, including chronic back pain or pain from osteoarthritis. Opioid prescriptions nearly quadrupled in the U.S. between 1999 and 2013, despite reported pain levels remaining stagnant.

Meanwhile, the CDC reports, "Deaths from prescription opioids — drugs like oxycodone, hydrocodone and methadone — have more than quadrupled since 1999," rising right along with the numbers of prescriptions.2

The problem with opioids is that many people start taking them for mild to moderate pain, only to develop a tolerance, which means you need to take more to get the same relief. Physical dependence can also develop, leading to symptoms of withdrawal if you try to cut back or quit the drugs cold turkey.

Ironically, opioids can even lead to an increased sensitivity to pain, causing patients to reach for more and more of the drugs. Addiction and overdose, which can be fatal, are all-too-common next steps. In fact, up to 1 out of 4 Americans receiving long-term opioid prescriptions struggle with addiction, according to the CDC.3

FDA Calls on Doctors to Rethink How They Treat Pain

In 2016, the CDC released updated guidelines for prescribing opioids for chronic pain. Notably, they listed non-opioid therapy as the preferred treatment for chronic pain.4 In an Education Blueprint for Health Care Providers released in May 2017, the U.S. Food and Drug Administration (FDA) similarly proposed changes in how doctors treat pain.

Specifically, the FDA urged them to get information about non-drug options including cognitive behavioral therapy, physical therapy, chiropractic care and acupuncture,5,6 noting:

"A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly musculoskeletal pain and chronic pain. HCPs [health care providers] 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."

It's about time. According to a study published in the Annals of Internal Medicine and funded by the National Institutes of Health (NIH), patients with neck pain who used a chiropractor and/or exercise were more than twice as likely to be pain-free in 12 weeks compared to those who took medication.7

So, too, is the case with acupuncture. researchers concluded that acupuncture has a definite effect in reducing chronic pain such as back pain and headaches — more so than standard pain treatment.8

Many Physicians Have Little Training on How to Treat Pain

The FDA's proposed guidelines are long overdue, as a 2013 study revealed new physicians learn shockingly little about how to treat pain, despite it being one of the most common, and most debilitating, medical conditions around. The study, which surveyed undergraduate medical schools in Europe, found that even when compulsory pain courses are in place, they represent just 12 hours of the six-year program — or 0.2 percent.9

Further, most of the schools actually have no required courses on pain that all students must take. This means that 12 hours of pain study represents a best-case scenario; at 82 percent of medical schools without compulsory pain courses, the students may be receiving even less or no pain training at all.

Even when the pain courses are compulsory, there is no consistency in what topics are covered, and most of the schools included only classroom-based teaching, not practical-based or placement-based teaching that could offer future physicians valuable hands-on experience.

The researchers called for a major overhaul to address the urgent public health need to adequately manage chronic pain. With no other knowledge of how to treat pain, most physicians treat it with prescription painkillers, and now we have an epidemic of prescription drug abuse and related deaths.

Why Ending the War on Chiropractic Is Essential

The fact that the FDA highlighted chiropractic care as an option health care providers should be familiar with when it comes to treating pain represents a major step forward — one that has the potential to save lives if it means people can resolve their pain using chiropractic instead of prescription drugs.

Unbeknownst to many, there has been a systematic and deliberate campaign by the American Medical Association (AMA) to destroy complementary medicine like chiropractic care. In 1984, the U.S. Supreme Court found the AMA guilty of an illegal conspiracy to contain and eliminate the chiropractic profession, and ordered the AMA to cease its illegal boycott of chiropractors.

The belief that chiropractors are dangerous or selling a bogus treatment persisted for decades, even as a sizable portion of low back pain patients (more than 30 percent, according to one study) sought out chiropractic care.10 Now, as research continues to confirm its benefits, even public health agencies are taking notice.

For instance, a study published in JAMA revealed, "Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function and with transient minor musculoskeletal harms."11

In April 2017, meanwhile, the American College of Physicians (ACP) released new guidelines for the treatment of chronic low back pain, which suggest clinicians and patients should select non-pharmacologic treatment, such as acupuncture, massage, superficial heat or spinal manipulation.12

The potential benefits of the latter are finally catching on, including among some conventional physicians. Dr. Aaron Carroll, a professor of pediatrics at Indiana University School of Medicine, wrote in The New York Times:13

"A physician like me might suggest any number of potential treatments and therapies [for low back pain]. But one I never considered was a referral for spinal manipulation. It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer."

Chiropractic Offers Benefits Beyond Pain Relief

One of the major benefits of choosing chiropractic over a drug solution is that the former can help relieve your pain while offering you whole-body benefits. For instance, research by Dr. Dean Harrison and others suggests chiropractic treatments can help prevent progressive spinal degeneration, i.e., osteoarthritis or disc disease.

Just like regular dental care will prolong the useful life of your teeth, getting regular chiropractic treatments can do the same for your spine. Further, contrary to popular belief, chiropractic can be used to optimize wellness, not just treat pain.

According to Dr. Billy DeMoss, a chiropractor with a practice in Newport Beach, California, "Chiropractic is like brushing your teeth." It's something you need to do on a regular basis to maintain the life of your spine, because regular activities, such as chronic sitting, can contribute to its functioning less than optimally.

Granted, some chiropractors focus primarily on pain and injuries and do not have the full skill set required to address issues like allergies or disease. So it's important to make sure the chiropractor you choose has the appropriate vitalistic philosophy and is skilled at providing pain relief as well.

While many will only consider chiropractic when they have back or neck pain, the point to remember is that its scope actually goes far beyond that. DeMoss said:

"I try to get people to understand that your nervous system and your brain control every function of your body. When we have a condition in chiropractic we call subluxation, which is misalignment or dysfunction in the spine as far as mobility is concerned, it can cause nerve interference, which will interfere with the expression of intelligence that flows over the spinal cord and nerves.

It can contribute [to] not only causing pain that most people perceive as a chiropractic problem but also can cause organs not to function 100 percent."

Why You Should Be Wary of Back Surgery

If you're not offered a prescription drug to treat your back pain, many conventional health care providers will turn to offering surgery like spinal fusion or epidural steroids. Dr. David Hanscom, an orthopedic surgeon with a practice in Seattle, is unusual in that he tells most of his patients they don't need surgery. He's written a book detailing his novel approach to chronic pain treatment, called "Back in Control: A Surgeon's Roadmap Out of Chronic Pain." According to Hanscom:

"There's maybe a 20 percent to 25 percent success rate of spinal fusion for back pain. And the downside of a failed spine surgery is terrible. It's really bad. These people are condemned to live their entire lifetime, 30 to 40 more years, in chronic pain."

Golden State Warriors coach Steve Kerr knows this all too well. He's still on medical leave after having back surgery in 2015 for a ruptured disk. Kerr experienced leaking cerebrospinal fluid (CSF) as a result of the surgery, which led to another surgery.

CSF leakages can cause a range of symptoms, from headaches and problems with hearing to balance problems, nausea and vomiting. Kerr told The Washington Post, "I can tell you if you're listening out there, stay away from back surgery. I can say that from the bottom of my heart. Rehab, rehab, rehab. Don't let anyone get in there."14

Epidurals for Back Pain Can Lead to Permanent Disability and Pain

Epidural spine injections have a similarly dismal track record for treating back pain. In an excerpt from Cathryn Jakobson Ramin's book "Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery," it's explained how such injections can lead to a life of disability and pain:15

"In roughly [6] percent of epidural steroid injections (a number that sounds small but is not, because thousands of injections are delivered every day), the needle nicks the dura mater, the sturdy sleeve surrounding the spinal cord, allowing cerebrospinal fluid to leak out.

Typically, this is not terribly serious. It results in a severe headache, which goes away after the patient lies flat for a couple of days … But when the needle actually punctures the dura mater, it's a different story.

Then the payload of glucocorticoid and anesthetic may be delivered into a region of fragile nerve tissue called the subarachnoid space. From there, the cerebrospinal fluid, bearing its toxic load, circulates to the brain, where the cortisone solution efficiently strips the insulating (and essential) myelin layer of neurons.

One result is 'adhesive arachnoiditis,' a condition so grossly debilitating that neurologist Dewey Nelson described it as akin to 'having a blowtorch up your rectum. It binds the nerves, like gunky cooked spaghetti, and the result is unrelenting pain that may last for a lifetime.'"

Tips for Choosing a Wellness Chiropractor

If your pain is mild or moderate, it makes far more sense to try noninvasive, non-drug and nonsurgical options for pain relief first. Along those lines, if you're considering chiropractic care, especially a wellness chiropractor who can help you relieve pain while looking out for your holistic health, you'll want to be sure you're choosing a skilled provider.

Consider asking a friend or health care provider for a recommendation. A friend who knows both you and the chiropractor may be able to judge whether your health philosophies and personalities are compatible. Also, many chiropractors will agree to a no-cost consultation to determine whether you are a good match. To make this visit as productive as possible, here are a few things to consider:

1. Does the practice focus on vertebral subluxation and wellness? Physical, biochemical, and psychological stress may result in spinal subluxations that disrupt nerve function and compromise your health. If you're looking for a wellness chiropractor, it's essential that this be the focus.

Some chiropractors confine their practice to the mechanical treatment of back and neck pain, and this is something you need to be aware of beforehand if you're looking for benefits that go beyond this.

2. Does the doctor "walk the talk?" If he or she is overweight, looks unhealthy, or does not live a healthy lifestyle, this speaks volumes regarding their commitment to wellness.

3. Do the two of you "click?" Do you like each other? Do you communicate well? Avoid a doctor who seems rushed, talks down to you or seems disinterested in listening to your concerns.

4. Does the doctor use objective assessments of nerve function? Since your care is not based just on addressing pain, your chiropractor should be using some form of objective assessment of your nerve function, as spinal subluxations can sometimes be asymptomatic.

Noninvasive instruments that measure the electrical activity in your muscles, and/or a thermal scanner that evaluates the function of your autonomic nervous system can be used, for example.

5. What treatment techniques are used? Chiropractic techniques include low-force adjustments by hand and more forceful adjustments using instruments. Ask which technique would be used on you and, if you have a preference, make sure the doctor is willing to use it. Many chiropractors are also trained in other complementary techniques, so ask what else your doctor may have in his or her tool bag.

Additional Non-Drug Solutions for Pain Relief

The health risks associated with prescription opioids are great and addiction and overdose happen far more often than you might think. So if you have chronic pain of any kind, please understand that there are many safe and effective alternatives to prescription and even over-the-counter painkillers — alternatives that do not carry these steep risks. The pain remedies that follow are natural, providing excellent pain relief without any of the health hazards that pain medications often carry.

Astaxanthin: One of the most effective oil-soluble antioxidants known, astaxanthin has very potent anti-inflammatory properties. Higher doses are typically required and one may need 8 milligrams or more per day to achieve this benefit.

Ginger: This herb is anti-inflammatory and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.

Curcumin: Curcumin is the primary therapeutic compound identified in the spice turmeric. In a study of osteoarthritis patients, those who added only 200 milligrams of curcumin a day to their treatment plan had reduced pain and increased mobility.16

In fact, curcumin has been shown in over 50 clinical studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects.

Boswellia: Also known as boswellin or "Indian frankincense," this herb contains powerful anti-inflammatory properties, which have been prized for thousands of years. This is one of my personal favorites, as I have seen it work well with many rheumatoid arthritis patients.

Bromelain: This protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind that most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.

Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used a topical preparation for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards.

Evening Primrose, Black Currant and Borage Oils: These contain the fatty acid gamma-linolenic acid (GLA), which is useful for treating arthritic pain.

Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmit pain signals to your brain.

Dietary Changes and Additional Pain Relief Options

When treating chronic pain, you need to look at the underlying causes of the pain. Toward that end, there's a good chance you need to tweak your diet as follows (all tips that can be used alongside chiropractic and other forms of complementary care):

  1. Start taking a high-quality, animal-based omega-3 fat like krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they positively influence prostaglandins.) The omega-3 fats EPA and DHA contained in krill oil have been found in many animal and clinical studies to have anti-inflammatory properties, which are beneficial for pain relief.
  2. Reduce your intake of most processed foods as not only do they contain sugar and additives, but also most are loaded with omega-6 fats that upset your delicate omega-3 to omega-6 ratio. This, in turn, will contribute to inflammation, a key factor in most pain.
  3. Eliminate or radically reduce most grains and sugars (especially fructose) from your diet. Avoiding grains and sugars will lower your insulin and leptin levels. Elevated insulin and leptin levels are one of the most profound stimulators of inflammatory prostaglandin production. That is why eliminating sugar and grains is so important to controlling your pain.
  4. Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain. This satisfies your body's appetite for regular sun exposure.

[+]Sources and References [-]Sources and References

  • 1, 2, 3 U.S. CDC, Opioid Overdose, Understanding the Epidemic
  • 4 JAMA. 2016;315(15):1624-1645.
  • 5 STAT News May 10, 2017
  • 6 U.S. FDA May 2017
  • 7 Annals of Internal Medicine January 3, 2012 vol. 156 no. 1 Part 1 1-10
  • 8 Archives of Internal Medicine 2012 Sep 10:1-10 [Epub ahead of print]
  • 9 The APPEAL Study 2013
  • 10 Med Care. 2012 Dec; 50(12): 1029–1036.
  • 11 JAMA. 2017;317(14):1451-1460.
  • 12 Annals of Internal Medicine April 4, 2017
  • 13 The New York Times May 1, 2017
  • 14 Forbes April 29, 2017
  • 15 Kevin MD April 29, 2017
  • 16 Springerplus. 2013; 2: 56.