Chiropractic + Naturopathic Doctor • July/August 2018 • Cover: A National Pain Strategy

It’s a scenario that plays out every day in countless chiropractor offices across the country: A patient presents with chronic pain. However, the attending chiropractor finds himself with scarce information about the patient’s medical history. Without access to medical records, diagnostic imaging and other specialists treating the patient, it’s very difficult for a chiropractor to accurately diagnose the patient’s condition and develop the appropriate plan of treatment.

Chronic pain is complicated. “It comes with a variety of implications, which could include factors such as depression, disability – even sleep disturbance. In many instances, it requires more than one type of health-care provider,” says Dr. Gregory Stewart, past president of the World Federation of Chiropractic – North America Region (Canada), and owner of the St. Anne’s Rd Chiropractic clinic in Winnipeg. However, chiropractors often find themselves out of the patient record-sharing loop and left to “tease out the entire patient profile from the patient.”

“It’s not a matter of being excluded, we are not included … I don’t think [chiropractors] are top of mind when it comes to coming up with a solution,” Stewart says.

Despite this, Stewart is among a growing number of chiropractors that are hopeful the situation is about to change.

They are pinning their hopes on the efforts to develop a national pain strategy in Canada, which appears to have found new momentum.

The idea of a national pain strategy for Canada is nothing new. For instance, in 2012 the Canadian Pain Society called for such a strategy during the organization’s summit meeting in Ottawa. However, the federal government at that time failed to adopt the strategy put forward by the organization, which is made up of health-care practitioners, educators and patients from all over the country.

Media attention and public outcry over the recent opioid addiction crisis as well as the sustained efforts by research and advocacy groups clamouring for better pain management, have swung the spotlight back on a national pain strategy agenda. And, chiropractic has a role to play.

“Until recently, there’s been a lot of misunderstanding about chronic pain, resulting in pain being stigmatized and under-treated,” says Maria Hudspith, executive director of Pain BC, a not-forprofit organization working to improve the lives of people in pain. “Chronic pain must be a national priority if we’re going to tackle this serious – and costly – problem. Multi-modal treatment involving an interdisciplinary team approach is needed.”

Just last year, the Michael G. DeGroote National Pain Centre at McMaster University released the “Canadian Guideline for Opioids for Chronic Non-Cancer Pain.” The document recommended a step away from the use of pharmacological solutions and the adoption of alternative pain management methods such as spinal adjustment, acupuncture, massage therapy and even tai chi.

Dr. Demetry Assimakopoulos of The Pain & Wellness Centre in Vaughan, Ont., thinks we are closer than ever to having chiropractic becoming a part of a national pain strategy. Assimakopoulos is also the clinical coordinator at the University Health Network’s comprehensive integrated pain program - rehabilitation pain service. He also teaches a chronic pain management workshop for chiropractors through Pain BC.

“We have researchers publishing major high-profile papers in journals with a high-impact factor like The Lancet,” he says. “We have chiropractors actively sharing ideas and doing research with physicians on pain management…working collaboratively with other health-care providers within interdisciplinary teams in hospitals. In this regard, we are closer than ever.”

“The fact that we are at the table with other healthcare practitioners and taking the lead role to formulate a national initiative is amazing.”

Adams points to the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain as evidence of the changing attitudes of the health care community towards chiropractic.

“It identifies manual therapies including chiropractic as being part of the first-line options for the management of musculoskeletal conditions within inter- professional health-care teams,” Adams says. Assimakopoulos foresees an end to what he calls “turf wars” in the healthcare field.

“I believe chiropractors will be fully integrated into mainstream pain management,” he says. “Ultimately, all health-care professionals must put aside their biases to benefit patients. This involves abolishing ideology, utilization of common language, and understanding that pain patients require different treatments at different times.”

Stewart envisions a role for chiropractic that’s something akin to the collaborative collection of practitioners that attend to top-calibre Olympic athletes. These diverse disciplines will be consulting, coordinating and assisting one another, while leaning on their individual expertise in a patient-centered effort towards improving the patient’s health.

To accomplish this, Stewart says, at least three main factors need to be achieved. Chief of these is the inclusion of chiropractors in the development of a pain management strategy at the provincial as well as national level. There also has to be a “fundamental shift in the reimbursement of patients” in order to cut down the financial barriers to pain management.

“For instance, in Manitoba, the province pays $10 towards chiropractic care but there is still a significant amount left to be self-funded,” Stewart says. “It’s difficult for the unemployed or those on a fixed income to overcome the financial barrier. If we are to become the first line of care, that care has to be accessible in the early stages.”

A third element is the access to items such as diagnostic imaging and health records, and a system where referrals can be made without necessarily going through a family physician.

“Sharing of electronic health would be critical. This will help in dealing with comorbidity, decrease the need for additional tests and increase the accuracy of our diagnosis,” Stewart says.

While collaboration could be key to the development of a national pain strategy, Assimakopoulos believes evidence-based educational programs for chiropractors would expose the profession to the practice styles of other health-care providers.

“This will enable us as chiropractors to understand when our services are needed, and when they are not.”

NESTOR ARELLANO is a Toronto-based journalist who writes about health, technology and business. In his spare time he loves to explore bike paths in and around the city.