Chronic pain is at epidemic levels. The CDC estimates that 50 million Americans, just over 20 percent of the adult population, have chronic pain.1 About 20 million of them have "high-impact chronic pain" – pain severe enough that it frequently limits life or work activities. Chronic pain contributes to an estimated $560 billion each year in direct medical costs, lost productivity and disability programs.4 But we can change all that, beginning by changing patients' beliefs about pain.
Managing Chronic Pain: Where Opioid Therapy Has Gotten Us
Opioid therapy became a standard approach to managing chronic musculoskeletal pain despite a lack of high-quality data on benefits and harms.8 Even though there is a heightened awareness of the opioid crisis, the use and abuse of these drugs has been only moderately reduced. Many patients still receive opioids for chronic musculoskeletal pain, and more than 21 percent of patients who are prescribed opioids for chronic pain misuse them.10
Krebs and his research team compared opioid vs. non-opioid medications over 12 months.5 Two hundred-forty patients with moderate to severe chronic low back pain, or hip or knee osteoarthritis pain, participated. Opioids and non-opioids both reduced pain from baseline pain intensity scores; but opioids failed to provide better pain relief than the non-opioids at three, six, nine or 12 months.
Opioid use, both short-term and long-term, is associated with a high rate of multiple adverse effects. More than 500,000 Americans have died by overdosing on prescription opioids since 2000.1 Moreover, long-acting opioids are associated with a 90 percent increased risk for all-cause mortality compared with control medications.7 The risk of death increases more than 400 percent in the first 30 days of treatment with opioids.
Interestingly, other medications are not better options than opioids. According to a systematic review published in Annals of Internal Medicine, researchers found little to no benefit for NSAIDs, antidepressants, muscle relaxants, acetaminophen or anticonvulsants in patients with chronic low back pain.2
Rethinking Chronic Pain With Pain Neuroscience Education
In the past 20 years, we have learned a lot about chronic pain. One non-pharmacological approach, called pain neuroscience education, has demonstrated some impressive patient outcomes.
Pain neuroscience education is an educational strategy that focuses on teaching patients in pain how to change their beliefs regarding their pain. It consists of educational sessions explaining the neurobiology and neurophysiology of pain, and how pain is processed by the nervous system.
Malfliet and colleagues conducted a multi-center, randomized, clinical trial to compare pain neuroscience education and non-pain-contingent exercise with general education and pain-contingent exercise in individuals with chronic spinal pain (> 3 months).6 This study was published in JAMA Neurology.
Participants in the experimental group received pain neuroscience education and non-pain-contingent exercise (patients performed an exercise 10 times, regardless of the pain). Participants in the control group received traditional back and neck education, and pain-contingent exercise therapy (when participants reported pain during or after an exercise, the intensity or duration of the exercise was reduced).
Both groups experienced reduced pain at three, six and 12 months, but the pain neuroscience education and non-pain-contingent exercise group had greater improvements at all three follow-ups. This experimental group also experienced improved function and better mental health compared to controls at all three time points.
Tegner, et al., conducted a systematic review and meta-analysis to evaluate the effect of pain neuroscience education for patients with chronic low back pain.9 They systematically searched six databases and included seven randomized, controlled trials in their review. The pain neuroscience education group had reduced pain intensity and lower disability immediately after treatment and three months later, but the control groups did not.
The statistic "effect size" was used to demonsrtate treatment benefit. The larger the effect size, the larger the benefit. Pain neuroscience education combined with non-pain-contingent exercise training is effective in reducing pain, improving function and improving mental health in patients with serious chronic spinal pain. Adding pain neuroscience education with non-pain-contingent exercise to our current therapeutic package of care will offer considerable benefit to patients with chronic pain.
A Chiropractic Program on Pain Neuroscience Education
Over the past several years, a pain neuroscience education program designed for chiropractic clinics has produced dramatic patient outcomes.3 A typical patient in this population has had chronic pain for more than two years and has taken medication (usually opioids) without a significant reduction in pain. However, after pain neuroscience education, the average patient's pain is reduced by 54.2 percent.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
