“The fact that we are at the table with other health-care practitioners and taking the lead role to formu-late 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 commu-nity towards chiropractic. “It identifies manual therapies including chiroprac-tic as being part of the first-line options for the man-agement of musculoskeletal conditions within in-ter-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 bi-ases to benefit patients. This involves abolishing ideology, utilization of common language, and un-derstanding that pain patients require different treatments at different times.” Changes and challenges 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 & Well-ness 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 Net-work’s comprehensive integrated pain program -re-habilitation 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.” Dr. Vincent Adams of Adams Chiropractic Inc., in P.E.I., agrees. www.canadianchiropractor.ca Stewart envisions a role for chiropractic that’s some-thing akin to the collaborative collection of practition-ers that attend to top-calibre Olympic athletes. These diverse disciplines will be consulting, coordinating and assisting one another, while leaning on their in-dividual 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 in-come to overcome the financial barrier. If we are to become the first line of care, that care has to be ac-cessible in the early stages.” A third element is the access to items such as diag-nostic 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 develop-ment 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.” July/August 2018 Canadian Chiropractor 21
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