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Opinion Despite the tired narratives, chiropractic is backed by evidence

Dr. Dwight Chapin, B.Sc., D.C., is the on-site chiropractor for The Globe and Mail and the Ontario Chiropractic Association’s 2018 Chiropractor of the Year.

Let’s say that one day, picking up your newspaper, you tweak your back, or wake up with a sore neck. You should call a chiropractor.

If you are looking for a cure for attention deficit disorder, asthma or lupus, you should not. There is no chiropractic treatment that will reverse these conditions.

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This may all seem painfully obvious. But it appears that confusion still exists regarding what a chiropractor can and cannot do.

To be clear, chiropractors are musculoskeletal experts who are governed by a very clear scope of practice that is defined by the diagnosis, prevention, and treatment of biomechanical disorders originating from the muscular, skeletal, and nervous systems. Chiropractors complete more than 4,200 hours of core competency training in this discipline. This is the profession’s specialty, where it is supported by research and where chiropractors are viewed as a trusted health care partner.

The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer pain recommends the optimization of nonopioid medication and non-drug therapy. This includes health care provided by chiropractors and other professionals who treat back, neck, and shoulder pain, before considering opioids.

Translation: back pain is best managed by a team approach to care, with the team consisting of a chiropractor, family doctor or nurse practitioner, and others such as a physiotherapist and registered massage therapist. Professionals aware of these current clinical guidelines, who are open to collaborating or even better, have existing professional relationships to help co-ordinate your care, will serve you well. You should be wary of clinicians who discourage collaboration.

People with back pain need timely access to non-drug pain management, provided by musculoskeletal experts, and chiropractors are answering this call. Lower back pain is still the number one cause of disability in Canada, and it is also one of the top-four reasons why people visit emergency departments. This contributes to overcrowding in hospitals, despite the fact that the majority of back-pain patients do not require hospital care and will be sent home. Back-pain patients are also more likely to end up with an opioid prescription. In recent articles in The BMJ and the Canadian Medical Association Journal, back pain is reported to be the most common diagnosis for opioid prescriptions by both emergency and family physicians and is reported in more than half of regular opioid users.

Chiropractors can provide a drug-free, alternative approach to Canada’s opioid crisis and help end overcrowding and hallway medicine in hospitals. Best-practice models of care are already widely in practice.

Yet, despite research in strong support of the chiropractic profession’s well-defined scope of practice and the trend of chiropractic integration into the mainstream, public confusion surrounding the scope and value of the profession continues.

Critics like to propagate an old narrative that the chiropractic profession is not evidence-based. Canada’s new guideline for opioid therapy and chronic non-cancer pain, which includes recommendations of first-line therapies provided by chiropractors, demonstrates this is not the case. This criticism is antiquated, revealing potential bias, and lacks awareness of current clinical studies.

Attempting to define any profession by the individual actions of a few is at best misleading. Not all practitioners can be painted with the same brush.

Stories of clinicians that breach the public trust are alarming and inexcusable, but unfortunately they do happen. Healthcare professionals across Canada, including chiropractors, rely on their regulatory body to govern their profession in the public interest and assure competent and ethical care. Such bodies set professional, evidence-based standards and best practices, monitor compliance with these standards and provide enforcement to ensure strong public trust.

This is a difficult and meaningful responsibility. Efforts from these organizations to improve must continue. Under the banner of evidence-based, patient-centred, interprofessional and collaborative care, the chiropractic profession will break through the same old narrative and protect public trust.

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