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Commentary: VA Shows the Way to Treat Low Back Pain

November 5, 2020
The VA has been increasingly and successfully applying chiropractic to low back pain care – it's time for other specialties to take notice.

An estimated 65% of Veterans suffer from chronic pain, more than three times the rate of the general population.1 At the same time, Veterans are twice as likely to die from accidental prescription opioid overdose compared to non-Veterans.2

Minimizing opioid prescriptions can reduce the risk of misuse, overdose, and transition to illicit drugs. Understanding this addiction cycle, the Department of Veterans Affairs (VA) has become a recognized leader in pain management and opioid safety and has worked diligently to reduce the use of prescription opioids by 64% over a period of eight years3– a model which could be emulated by other health systems.

The slogan “Improvise, Adapt, Overcome” reflects the Marine Corps commitment to prevail under any circumstance and to be creative in the means needed to do so. This   approach is distinctive to all branches of the US military, which, when presented with a problem, do what is necessary to overcome it.

We can see this same determination and innovation in the VA’s integration of chiropractic care into its treatment of pain. VA facilities serve more than 5.7 million patients annually and more than half experience chronic pain – with musculoskeletal disorders (MSDs) cited as the number one source of the pain – specifically low back pain (LBP).4

VA facilities serve more than 5.7 million patients annually and more than half experience chronic pain – with musculoskeletal disorders cited as the number one source of the pain – specifically low back pain. (Image: iStock)

Chiropractic Care Is On The Rise and Is Making A Difference – Especially with Veterans

Chiropractic care is one of many treatments embraced by the VA in its efforts to overcome this highly prevalent condition. The department is expanding access to chiropractic care at its facilities based on positive results and because Veterans are demanding it. Chiropractic care’s rising popularity is mirrored in the non-military population where more and more people are reaping its benefits.

The VA first began offering chiropractic care at its facilities in 1999.5 Growth was steady but has since accelerated. Between 2004 and 2017, the VA increased its number of chiropractic clinics by approximately 9.4% annually, and the number of Veterans receiving on-station chiropractic care increased approximately 18% annually. As of June 2019, there were approximately 180 chiropractic physicians providing patient care at 101 VA facilities.6

That level of growth would not be possible if chiropractic care were ineffective. A previously published article in Practical Pain Management cited a large multi-site (military and naval medical centers) comparative effectiveness study which found that adding chiropractic care to usual medical care resulted in better participant outcomes.7

Clinicians and leaders at the VA are likewise recognizing that chiropractic care is a safe, drug-free way for Veterans to manage their neck and back pain. A 2018 article by VA Secretary Robert Wilkie specifically mentioned chiropractic care, yoga, acupuncture, and other non-pharmacological pain treatment options included in the department’s opioid reduction initiatives that may reduce reliance on opioids without increasing pain or causing other health problems.”8

The efforts are paying off. The VA announced in July 2020 that it reduced prescription opioid use in patients within its healthcare system by 64%, from more than 679,000 Veterans in the fiscal year 2012 to 247,000 in the fiscal year 2020 through the third quarter. The VA cited “an interdisciplinary approach to care focused on a Veteran’s Whole Health by using non-pharmacological, complementary pain management treatments, self-care, skill-building, and support to transition from a biomedical to a biopsychosocial model of pain care.”3

Why and How the VA is Integrating Chiropractic in Care Teams

Access to chiropractic care got an additional boost in 2018 with the Consolidated Appropriations Act, which expanded the availability of chiropractic services into VA hospitals. The same year, the US House of Representatives introduced a bill to expand Medicare coverage of chiropractic services.

The more studies VA and other military health officials perform about managing chronic pain in Veterans, the stronger the evidence for its use as a pain modality.

This was verified again in 2019 when the results of three clinical trials sponsored by the US Department of Defense concluded chiropractic care improved fitness measures among active duty service members with LBP. The trials found that after just eight chiropractic visits over four weeks, those receiving chiropractic demonstrated a 5% increase in isometric strength, compared to a 6% decrease in the non-care control group. Balance increased 28% in the chiropractic group, compared to no change in the control group. Endurance increased 14% in the chiropractic group, compared to a 10% decrease in the control group.9

Chiropractic care also integrates well with other pain management approaches. Healthcare officials at the VA developed such an integrated way of caring for Veterans, called the Patient Aligned Care Team (PACT). A PACT includes a patient’s primary care provider, nurse care manager, and clinical associates, which may include mental health professionals, doctors of chiropractic (DCs), dietitians, pharmacists, and other specialists. In these PACTs, chiropractic clinics are administratively aligned in physical medicine, primary care, pain medicine or other service lines consistent with local facility needs. 

Expanding Care Access is Key

As a DC for nearly 25 years, I have treated many Veterans, and on numerous occasions, collaborated with other healthcare providers to design multidisciplinary care plans that resulted in optimal outcomes. My colleagues and I hope that the military adoption of chiropractic care continues and becomes more readily available in more VA facilities in 2021.

Just as important, we encourage other parts of the healthcare industry to learn from the VA’s success with chiropractic care and be motivated to expand its access as a part of their offerings. For example, as patients seek care from their primary care physician looking for assistance for LBP and neck pain, making a non-pharmacological and non-surgical specialist referral will help patients avoid opioids and the adverse side effects and other health risks, such as misuse or overdose. It puts the patient in control of their healing by learning new stretches, exercises, and the best way to perform activities of daily living.

The Future of Healthcare Delivery Must Be Integrated, Coordinated And Patient-Focused

Patients are interested in asserting more control over their care, even more so since the COVID-19 pandemic began, according to one survey.10 They’re becoming as much partners as patients, weighing the pros and cons of different treatment options, performing research, deciding on objectives, and insisting that providers treat them as equals in the journey toward their health goals.

Chiropractic care can be a valuable part of their healthcare environment, especially when the emphasis is on finding and correcting the root cause of disease rather than treating symptoms alone. Such has been the focus of chiropractic care throughout its 125-year history. DCs have been integral to helping Veterans build and sustain their well-being through not only spinal adjustments (also referred to as spinal manipulative therapy) but also promoting optimal health and prevention through education, coaching and encouraging good choices.

What works for our Veterans can work for other patients as well. Long-term pain relief, specifically for low back pain, can often be accomplished without pharmaceutical intervention or surgery. It’s time we follow the lead of the VA and make chiropractic care an integral part of treatment for chronic pain – regardless of where a patient is treated –so they can overcome the daily challenges of living with chronic pain.

Last updated on: November 5, 2020
Continue Reading:
Updated NASS Guidelines on Multidisciplinary Low Back Pain Treatment
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