Everett Chiropractic Center Blog

February 3, 2018

The Opioid Crisis: Who Is/Is Not Guided By The Guidelines?

As far back as 1994, spinal manipulation has been a leading approach for managing low back pain in national care guidelines, and chiropractic care was the only approach that was also noted to improve function. (AHCPR Clinical Guideline #14: Acute Low Back Pain for Adults)

The 2017 American College of Physicians guidelines continued to point to spinal manipulation as a preferred initial non-drug therapy selection for chronic low back pain, along with other chiropractic services such as exercise, mindfulness, and low-laser therapy. (Annual of Internal Medicine; February 24, 2017)

So what percent of medical providers recommend spinal manipulation? Two. (OPTUM Insurance Study 2012 (retrospective review of 16,000,000 musculoskeletal cases)

“259 MILLION opioid painkiller prescriptions were written in 2012 – enough for one bottle for every adult in the U.S. 2016 data suggests that opioid problem is WORSENING, not improving.” (Centers for Disease Control; https://www.cdc.gov/vitalsigns/opioid-prescribing)

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May 12, 2017

All NSAIDs Linked to Increased MI Risk: Medscape Article

Published in Medline, by Pauline Anderson, May 10, 2017

Use of nonsteroidal anti-inflammatory drugs (NSAIDs), including naproxen, considered by some as one of the safest drugs in this class, is associated with a significantly increased risk for myocardial infarction (MI), results of a new patient-level meta-analysis show.

The analysis showed the heightened MI risk occurred as early as the first week of use and the risk was greater with higher doses.

“This new research on NSAIDs reinforces what physicians know already, that patients should use the smallest possible dose for the shortest possible time,” Michèle Bally, PhD, an epidemiologist in the Department of Pharmacy and Research Center, Centre hospitalier de l’Université de Montréal, Quebec, Canada, told Medscape Medical News.

Even though the research suggests the increased MI risk lessened over time, “the findings were not conclusive enough about longer duration,” said Dr Bally.

But for most patients, the risk is very small, she noted. “If you average people with different baseline heart risks, the risk specifically due to an NSAID is only about 1% per year, so out of 100 people treated continuously for a year, there will be one extra heart attack.”

The research was published online May 3 in BMJ.

Although previous studies have linked both traditional and cyclooxygenase-2 (COX-2) selective NSAIDs to increased MI risk, the timing of the risk, the effect of dose and treatment duration, and the comparative risks between different drugs are poorly understood, the researchers note.

The recently reported Prospective Randomized Evaluation of Celecoxib Integrated Safety Vs Ibuprofen Or Naproxen (PRECISION) study found that at moderate doses, celecoxib was noninferior to ibuprofen or naproxen with regard to cardiovascular safety.

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