More Chiropractic Equals Less Opioid Use
A study published in the Journal of Manipulative and Physiological Therapeutics (JMPT) on March 28, 2016, showed that when there was more spent on chiropractic services, or more chiropractors in an area, there was overall less opioid usage.
Recently, there have been a number of studies and articles showing that there is a growing problem with opioid usage and addiction in the United States. According to the CDC, nearly 2 million Americans abused or were dependant on prescription opioids in 2014. Between 1999 and 2014, 165,000 people died from prescription opioids. In response to this problem, the CDC issued their new "Guideline for Prescribing Opioids for Chronic Pain."
The purpose of the JMPT study was twofold: to see if either the ratio of chiropractors to the general public, or the amount spent on chiropractic services had a correlation with opioid use among younger, disabled Medicare beneficiaries.
This study looked at the number of chiropractors per 1,000 Medicare beneficiaries as well as per-capita spending for chiropractic care on Medicare beneficiaries in the year 2011. The results showed that more chiropractors, or more spending on chiropractic services was associated with a decrease in the usage of opioid medication in younger, disabled Medicare beneficiaries.
"When people choose chiropractic, there is a less chance that they will turn to opioid pain medications," states Dr. George Curry, president of the International Chiropractors Association. "Chiropractic has always offered drug free choice to a population that is being continually bombarded with pharmaceutical advertising."
The Foundation for Chiropractic Progress (F4CP) issued a release on the problem of opioid usage on April 4, 2016, which stated, "With 72 percent of doctors prescribing opioids for back pain and 67 percent prescribing these potentially addictive drugs for chronic joint pain, the F4CP points to the value of evidence-based, drug-free chiropractic care as a safe and effective alternative for pain management often resulting from back, neck, musculoskeletal conditions and headaches."
The F4CP release continued, "Given the high prevalence of these musculoskeletal conditions -- an estimated 126.6 million Americans (one in two adults) validated by a March 2016 report from the United States Bone and Joint Initiative (USBJI) – the care provided by doctors of chiropractic (DCs) becomes even more important."
Older Americans Taking
The headline above comes from a March 21, 2016, Reuters news story published in response to a pre-released study on this subject published in the April 2016 issue of JAMA Internal Medicine. This article, and several others on this same subject, reported on the growing usage of medication by the increasing elderly population.
The study showed that 87.7% of the population 62 to 85 years old used at least one prescription medication in 2010-2011. This was up from 84.1% in 2005-2006. Even more alarming was that the study showed that people using five or more prescription medications increased from 30.6% to 35.8% in the same five year period.
The Reuters article begins by noting that people using multiple medications, known as polypharmacy, was associated with an increase in major drug interactions in older Americans. Dr. Dima M. Qato, the study's lead author from the University of Illinois at Chicago, commented, "That's a concern from a public health standpoint, because it's getting worse."
The study showed that because of the increase in polypharmacy, the percentage of people at risk for serious or even life-threatening drug interaction has gone from 8 percent in 2005-2006 to 15 percent in 2011-2012.
Dr. Qato also stated in a CBS interview on this issue, "Many of these potentially deadly drug interactions involve prescription and non-prescription medications and supplements that are not commonly used, but are increasingly being used by older adults. While it is not known how many older adults in the U.S. die of drug interactions, the risk seems to be growing and public awareness is lacking."
"It is time to take the next leap forward. We need to create systems that support an ongoing process of monitoring medications," said Michael A. Steinman, M.D., of the University of California, San Francisco, in an accompanying editorial. "Such systems would help us periodically assess the benefits, harms and ongoing need for each of a patient's medications, as well as the reasonableness of the medication regimen as a whole. These systems could also help physicians with deprescribing, for example by supporting gradual down-titration of a medication and monitoring patients for adverse drug withdrawal reactions after a drug is stopped."
"As much as we need to support reforms in medication monitoring, we seriously need to examine the culture of taking so many medications," says Robert Braile D.C. chairman of the International Chiropractors Association Public Relations Committee. "Americans represent about 5% of the world's population, yet we consume about 50% of the prescription medication in the world. This, coupled with the fact that the U.S. ranks far below many other nations in almost all health statistics except spending, should lead us to question whether or not the culture of a pill for every ill is a healthy and prudent direction."
Corrected Under Chiropractic Care
The March 31, 2016, issue of the Journal of Pediatric, Maternal & Family Health documented the case of a woman who was 35 weeks into her pregnancy with a breech presentation who was helped and gave birth normally due to chiropractic care.
The usage of chiropractic care by women who are pregnant has been increasing. The most common reason that woman seek chiropractic is for musculoskeletal pain, specifically back pain. However, more women are turning to chiropractic with breech pregnancies after reading information about a chiropractic procedure known as the "Webster Technique."
In this case, a 37-year-old woman went for a chiropractic consultation and possible care at 35 weeks of her second pregnancy. She was suffering from right hip and pelvic pain. Additionally, an ultrasound examination performed the week prior showed that her baby was in the frank breech position.
The history revealed that the woman gave birth to her first child after being induced at 37 weeks into her pregnancy. The baby was born vaginally in the posterior position but showed significant bruises on his head.
A chiropractic examination was performed using structural analysis and palpation of the spine and pelvis. Subluxations were noted and adjustments along with the Webster Technique was utilized. Pillows and a specialized adjusting table were used to accommodate her pregnancy. Care was rendered three times over a five day period prior to her delivery.
The patient reported that after the first visit she felt the baby had changed position. She stated that her "…baby was sitting in the pelvis and was moving differently." As a result of the chiropractic care, the woman's baby was delivered normally, in the head-down vertex position, with no complications.
In their discussion, the authors explain the results by stating, "The use of the Webster Technique during pregnancy has been well documented in the peer-reviewed and non peer-reviewed literature." They describe the Webster Technique as "…a specific chiropractic analysis and adjustment to establish neuro-biomechanical balance and function in the pelvis via the correction of sacral subluxation."
The authors' conclusion stated, "This case report provides supporting evidence on the effectiveness of chiropractic care via Webster Technique during pregnancy with positive outcomes."
Health Issues Caused
by Birth Trauma Helped by Chiropractic
On March 21, 2016, the Journal of Pediatric, Maternal & Family Health published a case study showing chiropractic helping an infant with multiple health issues resulting from a traumatic birth.
The study begins by noting that about 5% of all births in the U.S. are either by forceps or by vacuum extraction. They report that forceps delivery is associated with an increased death rate during birth, and that vacuum extractions are associated with increased head injuries, facial paralysis, and other head and nerve problems. Chiropractors are interested in this problem from a standpoint of the effect these types of births have on the upper portion of the neck.
In this study, a 6-week-old baby boy was brought to the chiropractor for consultation and possible care with problems of infantile colic, acid reflux, restlessness, inability to relax and/or lay on his back, difficulty sleeping and general irritability. The baby's mother described her son as being fussy, restless, always tense and frustrated. She reported that in the first six weeks of life he was screaming and could not be comforted during all his waking hours. While sleeping, the infant would moan and whimper.
The baby had been given a medical diagnosis of acid reflux and infantile colic and he was given the label of a "high needs baby." With this diagnosis, the infant was prescribed and given a generic form of the medication Zantac for his colic and reflux.
A history of the birth process revealed that infant's mother did not experience any contractions prior to the beginning of labor. After only 17 minutes, it was reported that the baby's heart rate had decreased. Because of this, an episiotomy was performed and the baby was pulled out with the aid of vacuum extraction. This resulted in a large bruise on the infant's skull from the vacuum extraction.
A chiropractic examination of the infant revealed the presence of multiple vertebral subluxations, including several in the upper neck region. Chiropractic adjustments were performed specific to the subluxations, and the age and size of the infant.
After the first adjustment, the mother reported that her son had the longest nap he had experienced since birth. The parents also reported that within the first week, the infant had six large bowel movements within 36 hours of being adjusted, was less fussy, less gassy, sleeping more soundly and peacefully, showed improved postural alignment of the neck and entire body, and appeared to be much happier, more comfortable, and demonstrated an overall improved demeanor. After several more visits, the child no longer had any of the digestive issues or other health concerns seen on the initial evaluation.
Loss of Normal Forward
Neck Curve Associated with Multiple Health Issues
The Annals of Vertebral Subluxation Research published a literature review paper on March 28, 2016, that showed a connection between the loss of a normal neck curve and many types of adverse health issues.
The author begins by describing forward head posture as the condition whereby the head is projected forward of the middle of the neck. This situation would be similar to holding a bowling ball out in front of you instead of up against your body. Even though the weight of the bowling ball does not change, it is harder to hold the ball further away from your body.
This forward projection means the neck has to support the head that is out in front, and not normally balanced, resulting in more stress to the spine and neck muscles. This condition has become more prevalent with the increase use of technologies such as computers and smart phones.
The author explains how common this can be: "People spend an average of 2-4 hours per day with their heads tilted reading and texting on smart phones and similar devices. Cumulatively, this is 700-1400 hours a year of excess spine stress."
This situation can lead to acceleration of cervical spinal degeneration, and degeneration of the intervertebral disks. This situation can also lead to a loss or reversal of the normal forward curve in the neck. This forward curve is essential to absorb shock of normal day-to-day activities. A loss or reversal of the neck curve has been show to lead to a number of health issues beyond just pain conditions.
The study also points out that abnormal head posture and curvature changes in the neck can lead to changes in normal cerebrospinal fluid (CSF) flow. The brain's pumping of CSF is essential for normal central nervous system function. The study notes that altered CSF flow has been associated with conditions such as multiple sclerosis, Parkinson's disease and dementia.
In an overview discussion, the author noted, "Forward head posture and a decreased cervical curve affect the biomechanics of the spine. This can accelerate cervical spine degeneration, contribute to cervical myelopathy, affect proprioception, and contribute to neurodegenerative diseases."
In the conclusion, the study author explains that head posture and the curvature of the neck is often overlooked as a causative factor in many health issues and can have a profound effect on the function of the human body: "The body is more complex than merely the sum of its chemical processes. They do not occur in a vacuum. Biomechanics influence the body as well and warrant further investigation in some pathology."
Major League Baseball
Pitchers Depend on Chiropractic
As baseball season begins, more Major League Baseball players are turning to chiropractic to help their game. One such story released April 9, 2016, in the Duluth News Tribune carries the headline, "Twins pitchers now well-adjusted: Gibson, May opt for chiropractic care to remain ready for the mound."
The article centers on Minnesota Twins pitcher Kyle Gibson, and begins by describing what he will do after the opening game of the season, "...the durable young right-hander will connect with perhaps the most important member of his support team this year: his chiropractor."
The article goes on to explain that even though the 28-year-old is in the prime of his career, he suffered some back problems toward the end of last season. Gibson described the problem by saying, "There were a couple starts where I didn't sit down in between innings because if I sat down, my hips just got tight."
The article also reported that the Twins 26-year-old relief pitcher, Trevor May, also suffered back problems. At first, May only sporadically went to the chiropractor with limited results. However, upon getting more regular adjustments, May's condition improved. He commented, "We found that baseball players get skeletally out of line. They do one motion one way much harder (than most people), and my hips were really, really out of line. Seeing a chiropractor consistently has helped me make sure I'm getting readjusted and staying in line as much as possible."
The Twins are not the only MLB team with pitchers who see chiropractors. The Florida Marlins pitchers Adam Conley, Jarred Cosart, and Wei-Yin Chen also receive chiropractic care to improve their game. Chen, who just signed an 80 million dollar contract with the Marlins commented how chiropractic helps him by saying that he "...noticed a huge difference in recovery time between pitching days."
"A properly functioning nervous system is essential for pitchers to perform at their highest level," says Dr Lucas Matlock, president of the Florida Chiropractic Society and a chiropractor who cares for the trio of Marlin's pitchers. "Chiropractic care removes interference from the nervous system, through specific adjustments of subluxations, which then allows athletes to perform at their highest level." Dr. Matlock continued, "For some, chiropractic care could make the difference in their career."
A comment from Dr. Matlock on social media posed the question, "What does the Miami Marlins pitcher Adam Conley and his beautiful family do immediately after he pitches a 5 inning, 81 pitch, 2 hitter you ask? Go right to their chiropractor of course, to ensure his body will recover as quickly and completely as possible."
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