While cervical disc pathology can unquestionably produce radiculopathy, many patients presenting with arm pain, paresthesia or perceived weakness do not exhibit the clinical behavior of true nerve-root compromise. In these cases, failure to differentiate the primary pain generator may lead to unnecessary spinal injections, nerve ablation procedures or surgical consultation despite limited likelihood of benefit.
Is Chiropractic Slighted in New HHS Report on Pain Management?
On face value, the new draft report on pain management by the Dept. of Health and Human Services is another step in the right direction when it comes to addressing the opioid epidemic and prioritizing nondrug pain management options over OTC and prescription medication.
The good news: The report includes policy guidance and recommendations subject to a 90-day comment period. That means the chiropractic profession has time to provide input that will hopefully be reflected in the final version of the report. Why comment? You could be motivated by how chiropractic is currently characterized in the document.
Developed by a 29-member Pain Management Best Practices Inter-Agency Task Force established courtesy of the 2016 Comprehensive Addiction and Recovery Act, the report includes section 2.6: Complementary and Integrative Health (pp. 31-33), which specifically mentions massage, acupuncture, physical and occupational therapy, and other conservative pain management options (even aqua therapy).
And what about chiropractic? In the entire section, the word appears only as an adjective, not a noun – as in "chiropractic manipulation," and is not mentioned in isolation, but rather grouped with osteopathic manipulation, as in "osteopathic and chiropractic manipulation."
In fact, the section features separate descriptions of acupuncture, yoga, tai chi and mindfullness-based stress reduction, but not chiropractic. "Osteopathic and chiropractic manipulation" is mentioned under the heading, "Massage and Manipulative Therapies," and most of the discussion focuses on the benefits of massage.
Finally, the task force's first recommendation in the "Gaps and Recommendations" section of the report is to "[c]onsider complementary and integrative health approaches, including acupuncture, mindfulness meditation, movement therapy, art therapy, massage therapy, manipulative therapy [not chiropractic specifically], spirituality, yoga, and tai chi, in the treatment of acute and chronic pain, when indicated. [Italicized text added]
Ready to read the entire report and submit your comments? Click here now. Note that the public commenting period ends March 28, 2019.