Manitoba clinic avoiding opioids in chronic pain management

Chronic back pain is often met with an opioid prescription, but the powerful painkillers carry a risk of addiction. 

Winnipeg's Mount Carmel Clinic is helping people avoid opioids through non-pharmacological interventions they may not have otherwise been able to afford, such as chiropractor services.

"Back pain affects people regardless of your demographic in life or what it is you are doing, but we know that opioids are being prescribed a lot for back pain," said Steven Passmore, the primary investigator examining the outcomes related to the integration of chiropractic services at the clinic.

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At a summit last November in Ottawa, politicians were urged by many public health experts and doctors to declare a public health emergency and find a solution to escalating — and deadly — rates of drug addiction.

Provinces have responded differently to the opioid epidemic. Ontario moved to de-list high-strength opioid painkillers for people on social assistance at the start of February. In British Columbia and Nova Scotia, the College of Physicians and Surgeons created a mandatory prescribing program to curb the problem.

A UN report said that Canada is the second-highest per-capita consumer of prescription opioids. Doctors prescribe drugs like oxycodone, fentanyl and morphine for pain management but some experts say that opioids are prescribed too readily.

In the 1990s, opioids quickly emerged as one of the main interventions used to manage chronic non-cancer pain, with back pain being one of the leading reasons," according to the Canadian Chiropractic Association.

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Passmore, who is also an assistant professor in the Faculty of Kinesiology at the University of Manitoba, said there are times when opioid prescriptions are necessary but, particularly when it comes to long-term back pain, other options need to be looked at.

"Currently opioids are prescribed for pain management but we've recognized there are some potential issues with that, and so considering non-pharmacological alternatives are a great addition to the primary care physician's tool box," he said. "Referral to a chiropractor will actually help potentially avoid the necessity to prescribe opioids."

However, for a lot of people that means there's a huge hurdle: money.

If you don't have third-party benefits through an employer, or coverage that's issued as result of an automobile accident or workers compensation, or the personal financial resources to be able to pay out of pocket for health care services, Passmore said, "you are someone who runs the risk of not being able to have access to chiropractic services."

Mount Carmel Clinic's program, which was started in 2011 and is funded by the province, specifically provides chiropractic services to people who otherwise could not access them in Point Douglas.

"The patient themselves doesn't have to worry about the financial burden that is associated with that," Passmore said.

A study of the service published in the Journal of the Canadian Chiropractic Association last year showed most people suffered from chronic pain and there was a significant reduction in pain for the patients.

After the course of care was completed, 96 per cent of cases didn't need a referral to another healthcare provider.

"It appears that following a relatively brief course of chiropractic intervention we can help people to modulate their pain so they are better able to carry out the activities of daily living," Passmore said.

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While the outcomes are looking good for pain reduction, Passmore said more research needs to be done to see how chiropractic services can be used to reduce opioid prescriptions.

"If we can exhaust our non-pharmacological options first then that could lead to successful health-care intervention for Canadians," he said.

After the national opioid summit, Manitoba committed to improving data collection and expanding naloxone distribution as part of the cross-country response. Passmore said the data from the clinic could be important to a multi-disciplinary approach.

In British Columbia at a pain management summit over the weekend experts are calling for a national strategy to address chronic pain while avoiding the dangers of over-prescribing addictive opiates.