FEATURE STORY / OPIOIDS
“ We ’ ve looked carefully at the benefits of opioids . There is no dose-responsive effect . If you are likely to receive a benefit in pain or an improvement in function , you will get that same level of improvement whether you are prescribed a low- or a high-dose opioid .
But the story changes when you look at serious harms . There is a direct and consistent dose-response relationship . Higher doses , higher risk of addiction , higher risk of overdose , higher risk of fatal overdose . And what are those risks ? We know now that the typical risk of addiction is not less than 1 %— it ’ s much closer to 10 % and the risk of developing opioid misuse is upwards of 24 %.
There is no significant difference in pain relief or functional improvement when you compare an opioid to an NSAID or to an anti-depressant . One way of looking at this totality of evidence is that if opioids were a new drug being brought on to market currently for the indication of treating chronic non-cancer pain , they would almost certainly be pulled .”
While the new Canadian guideline will acknowledge that it is appropriate to prescribe opioids for some chronic pain patients , they will advise maximizing NSAIDs and non-pharmaceutical pain relief options first . 10 It is also important to note that while the population-wide
One way of looking at this totality of evidence is that if opioids were a new drug being brought on to market currently for the indication of treating chronic non-cancer pain , they would almost certainly be pulled .
benefits of opioids are not clinically significant , there will be individual patients who will find them helpful and for whom the benefits will outweigh the risks . As always , patient preferences and clinical expertise are two important prongs of evidence-based practice .
THE SEARCH FOR SOLUTIONS
The solution to the opioid crisis must address the root causes , and not just the symptoms . In most cases , people become addicted to prescription opioids while following doctor ’ s orders . Opioids are prescribed for a variety of reasons : to relieve suffering quickly , to offer cost-effective pain relief for patients with limited extended health coverage , due to patient preferences , and as follow-up care for patients whose opioid prescriptions began in the emergency room .
In January 2017 , Dan Malleck wrote in The Globe and Mail : “ Although some people seek fentanyl or OxyContin to get some form of high , the prevalence and potency of these drugs came out of medical necessity . Pain needed to be treated . But the first approach to pain treatment is to mask it — give it a painkiller . That painkilling went from being a first response to a major strategy to deal with pain .”
Chiropractors can and should come into play long before people find themselves on long waiting lists for specialist consultations , all the while suffering with MSK pain that interferes with their activities and quality of life . Chiropractic care offers pain relief , improves mobility , treats underlying causes and helps patients learn self-management strategies without putting them at risk of opioid dependence .
Specifically , the literature supports that spinal manipulation therapy is effective in relieving chronic low back pain and improving short-term function and it is recommended by numerous clinical practice guidelines including the Bone and Joint Decade Task Force on Neck Pain and the American College of Physicians .
Dr . Gregory Taylor , Canada ’ s Chief Public Health Officer from 2014 to 2016 , spoke on CBC ’ s The National about the importance of exploring different types of therapy for pain : “ Chiropractors have a lot of great success in treating chronic low back pain through manipulation . I had that experience myself and had good resolution of my own back pain seeing a chiropractor , so I think it behooves us to explore all different modalities rather than just resorting to
22 SPRING 2017