ON Chiropractic increasing the risk of adverse cardiovascular events . Opioids also have adverse psychomotor , endocrine , gastrointestinal , and immunologic effects . Longacting opioids , included in chronic pain guidelines and recommended for patients with frequent or constant pain , are of particular concern because the prolonged drug levels might increase toxicity . Their more frequent use has been associated with an increase in deaths from opioid overdose ." 5
MSK PAIN : THE HEART OF THE OPIOID CRISIS
Key drivers of Canada ’ s increasing use of opioids include their use as a first-line treatment for chronic pain , specifically for mechanical back pain , and a lack of funded services for non-pharmacological approaches 6 . Half of legitimate prescriptions of opioids in the US are for management of back pain and other MSK conditions 7 and current research indicates that Canadian prescription trends are similar .
In its white paper , A Better Approach to Pain Management : Responding to Canada ’ s Opioid Crisis , the Canadian
Chiropractic Association writes ,
“ One in five Canadians suffers from chronic non-cancer pain , with back pain as the leading condition . In reality , the burden of chronic back pain is a silent epidemic in Canada . Too often , people suffer in silence with little recourse . Every year , over 11 million Canadians suffer from back pain and other musculoskeletal conditions , such as arthritis , which rival cardiovascular disease as an overall health burden in terms of direct and indirect costs … Among the general populations , up to 85 % of workers will suffer from back pain at least once in their lifetime . Often , that back pain will reoccur or become chronic . ”
A 2015 study of patients receiving longterm opioid therapy for non-cancer pain at the Pain Management Centre at Hamilton General Hospital found that 64.8 % of the patients studied had presented with chronic low back pain ( LBP ). 8
A 2000-2001 Healthcare for Communities survey ( a large , nationally representative household survey ) found that “ arthritis and back pain were the most prevalent chronic physical health conditions among users of opioids , with 63 % of regular users of opioids reporting arthritis and 59 % reporting back pain .” Using opioids to address chronic MSK pain is problematic , particularly because current research now indicates that it is not an effective solution .
OPIOIDS : A BAD FIT FOR MOST CHRONIC PAIN
A
2016 systematic review and meta-analysis found that " opioid analgesics provide modest shortterm pain relief for people with chronic low back pain ( LBP ) who tolerate the medicine , but the effect is not likely to be clinically important within guidelinerecommended doses " ( emphasis added ). 9
This review challenged the commonlyheld view that opioids are powerful analgesics for chronic LBP . It found that :
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There is currently no evidence to support the long-term use of opioid analgesics in low back pain at any dose ,
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Clinically significant pain relief is not likely to be achieved even at higher doses , and
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These higher doses have been associated with misuse , physical dependence , hyperalgesia , and clinically significant hormone changes .
A 2015 study of patients receiving longterm opioid therapy for non-cancer pain at the Pain Management
Centre at Hamilton General Hospital found that 64.8 % of the patients studied had presented with chronic low back pain ." 8
Dr . Jason Busse , a chiropractor and researcher , is working with the Michael G . DeGroote National Pain Centre to assemble current research evidence and develop a new Canadian opioid guideline . In a presentation at the national Opioid Conference in November 2016 , he described his team ’ s conclusions from examining 104 clinical trials on opioids :
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