The purpose of this recent investigation was to evaluate the association between chiropractic utilization and use of prescription opioids among older adults with spinal pain … at least this is what the abstract says. The actual paper tells us something a little different: The objective of this investigation was to evaluate the impact of chiropractic utilization upon the use of prescription opioids among Medicare beneficiaries aged 65 plus. That sounds to me much more like trying to find a CAUSAL relationship than an association.
Anyway, the authors conducted a retrospective observational study in which they examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. They measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following the diagnosis of spinal pain. Using Cox proportional hazards modeling and inverse weighted propensity scoring to account for selection bias, they compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription.
The adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients (hazard ratio 0.44; 95% confidence interval 0.40–0.49).
The authors concluded that, among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription.
The way this conclusion is formulated is well in accordance with the data. However, throughout the paper, the authors imply that chiropractic care is the cause of fewer opioid prescriptions. For instance: The observed advantage of early chiropractic care mirrors the results of a prior study on a population of adults aged 18–84. The suggestion is that chiropractic saves patients from taking opioids.
It does not need a lot of fantasy to guess why some people might want to create this impression. I am sure that chiropractors would be delighted if the US public felt that their manipulations were the solution to the opioid crisis. For many months, they have been trying hard enough to pretend this is true. Yet, I know of no convincing data to demonstrate it.
The new investigation thus turns out to be a lamentable piece of pseudo research. Retrospective case-control studies can obviously not establish cause and effect, particularly if they do not even account for the severity of the symptoms or the outcomes of the treatment.
20 Responses to The impact of chiropractic on opioid utilization: another fine example of pseudo-research
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Let us not forget today’s CDC published report on the EBP of dealing with chronic pain, especially spinal pain! https://mail.google.com/mail/u/0/#inbox/QgrcJHsTgsNlmqcshLgNJscqzQbKZWZbgWl?projector=1&messagePartId=0.2
so, why don’t you provide a proper link?
https://www.nytimes.com/2022/02/10/health/cdc-opioid-pain-guidelines.html?unlocked_article_code=AAAAAAAAAAAAAAAACEIPuomT1JKd6J17Vw1cRCfTTMQmqxCdw_PIxftm3iWka3DPDm8aiOQYCoyc-wDGaaEmYMMy2DWXAcdIMblqS-FzwuJbPkpgUE-ovp6A0twjEhkClLiSDCkwzo6fGvcx6yPrZW20b752lLfitkyLdWXpCqPA1XZ3JRJupJQxaQv-2H1czqrBF-J2jsJsnqt0XuAMTj8EYyWAufPtCAwve4nVK0GBtXRlHr1RSjrRntWD6rkfcAg0CFLOSXl34WpU-8oLcZpMf_65d0h8DZK41bYBCWVoL5OrBYkyQOXWn7Zss73OrX-c2T7pUBv50LvPT8IUIH0gOJ8&smid=url-share
Hey Mikey,
Have been back to Bali again after spending all that time in detention for working illegally?
Not yet but will return in 2023 or 2024 as I have no restrictions on my entry. Your comments are just fake news.
file:///C:/Users/USER/Downloads/noninvasive-nonpharm-pain-update%20(1).pdf
Mr Epstein,
Please read the following Wikipedia articles if you wish to understand your mistake:
File URI scheme
https://en.m.wikipedia.org/wiki/File_URI_scheme
You linked to a local file on your computer, which we cannot access:
file:///C:/ …
Uniform Resource Locator (URL)
https://en.m.wikipedia.org/wiki/URL
You need to link to the file on a globally accessible server computer, which we can access.
Pseudo research?
Because they didn’t account for severity or outcomes for almost 56,000 subjects from a data source which doesn’t supply that information?
Because you think they suggested causation?
Oh, the findings have limitations, but pseudo research?
no, because they DID imply causation.
I see. So any paper that “implies” causation we will now label as pseudo research. Maybe we should go back and look at your papers to see if you ever “imply” causation.
Honestly, if that is the biggest complaint you have of this paper…
“… However, a causal statement on this association usually should not be made from a retrospective study.”
— Encyclopedia of Research Design. Edited by: Neil J. Salkind. SAGE Research Methods.
only acceptable [to chiros] if it’s about chiropractic
I’ll ask SAGE to publish versions of its documents that include only very simple English with plenty of pictures; simple enough for wannabe ‘chiropractic paediatricians’ to understand.
Non-D. C..
This is one of the many reasons why you are a chiro and not a real doctor; you do not have the intelligence.
Not everything can be explained by chiro, in fact almost nothing can.
Ad hom.
The word association or it’s variant was used 25 times in this paper. One use referred to the AMA.
Oh, but they used the words “observed advantage” and it’s labeled pseudo research?
Geesh.
The word impact was used 4 times.
impact [noun]: A marked effect or influence.
impact on [verb]: Have a strong effect on someone or something.
— Lexico [my emphasis]
https://www.lexico.com/definition/impact
QUOTE
The objective of this investigation was to evaluate the impact of chiropractic utilization upon the use of prescription opioids among Medicare beneficiaries aged 65 plus.
…
To assess the impact of receiving chiropractic care early in an episode of care, we sub-analyzed for risk of opioid prescription fill in the Early, Delayed, and Late groups of Recipients.
…
Because chiropractors commonly treat pain conditions other than spine pain, chiropractic care may be expected to impact use of analgesics for both spinal and extraspinal conditions.
…
11. Whedon JM, Toler AWJ, Kazal LA, Bezdjian S, Goehl JM, Greenstein J.
Impact of chiropractic care on use of prescription opioids in patients with spinal pain. Pain Medicine. 2020;6.
END of QUOTE
QUOTE from Ref 11. above
Objective: Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.
Design and setting: We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012-2017.
END of QUOTE
If the best critique of this paper is their use of a couple of words, so be it.
as long as misleading statements are in favor of chiropractic, chiros never seem to mind much.
Oh my, they suggested chiropractic care may have an “impact” on opioid use.
Interestingly enough….
“Our results suggest that early physical therapy was associated with an approximate 10% reduction in the probability of any opioid use long term for patients with shoulder, neck, knee, and low back pain.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324326/
“ There is considerable convergence that early exposure to physical therapy reduces the odds of future opioid prescriptions.” https://journals.lww.com/painrpts/fulltext/2020/10000/physical_therapy_and_opioid_use_for.12.aspx
“ It’s time to recognize that physical therapy has a key role to play in the fight against opioid addiction. ” https://www.apta.org/apta-magazine/2018/10/01/moving-away-from-opioid-reliance
But to “imply/suggest” that chiropractic care may help…just label the study as pseudo-research rather than do a proper critique of the paper.