providing treatment , and includes patients on opioid therapy . Six of the seven PCLBP sites across Ontario feature chiropractors in key clinical roles . Both of these programs support inter-professional primary care teams delivering better care to patients experiencing LBP .
The OCA advocated for the primary care component to this strategy and a strong role for chiropractors in the interprofessional teams being assembled through the Low Back Pain Strategy . The OCA is working towards extending the PCLBP pilot and instituting a more sustainable , long-term and broader musculoskeletal health care program .
The PCLBP pilot in particular provides an integrated approach to low back pain and opioid use reduction . It serves some of Ontario ' s most vulnerable patients who have financial barriers which limit access to multidisciplinary care . These patients suffer from significant co-morbidities including diabetes and other chronic diseases , mental health and addictions issues and cooccurrence of other types of MSK pain .
Along with reducing rates of opioid and NSAID use , the PCLBP pilot sites are reporting reductions in specialist referrals , unnecessary diagnostic imaging and visits to emergency departments for pain . They are demonstrating how much better health care can be when there are strong links between primary health care providers , specialists and MSK providers like chiropractors .
Discussing Opioids While Staying in Scope
If your patients ask you about their use of opioids , it is important to keep this section of the CCO ’ s Standard of Practice S-001 : Chiropractic Scope of
Practice in mind :
∞∞
“ In responding to general healthrelated questions by patients that relate to controlled acts outside the chiropractic scope of practice ( such as prescribing a drug as defined in the Drug and Pharmacies Regulation Act , 1990 , performing surgery and administering vaccinations ), a member shall :
advise the patient that the performance of the act is outside the chiropractic scope of practice and the patient should consult with a health professional who has the act within his / her scope of practice ;
∞∞ respond in a professional , accurate and balanced
∞∞ manner in the context of providing primary health care to the patient consistent with the chiropractic scope of practice ; and
encourage the patient to be an active participant in his / her own health care which allows the patient to make fully informed decisions concerning his / her health care .”
It is outside the chiropractic scope to suggest a reduction in opioid use . If your patient independently expresses a desire to reduce their use of opioids , it is best to advise them to continue their current use until they can speak with their physician , nurse practitioner or pharmacist about changing their medication . An abrupt change in opioid use can trigger withdrawal symptoms :
“ Long-term regular use of these drugs should be reduced gradually with medical supervision . People who are physically dependent on opioids will experience withdrawal symptoms if they stop using the drug abruptly . Withdrawal symptoms can include agitation , insomnia , muscle aches , abdominal cramping , diarrhea and vomiting .” 15
It is best to speak about how you can assist them with pain reduction ( e . g . through manual care , heat / ice , stretches , positioning , exercises , etc .) and addressing the root cause ( s ) of their pain if it is an MSK issue .
This is also an excellent opportunity to communicate with your patient ’ s primary care practitioner about a collaborative strategy for shared care of the patient . For advice and resources , please refer to our clinical notes templates and the Collaboration and Referral Resource Kit .
26 SPRING 2017