Medical Provider Letter
This letter is intended to be sent to medical providers to encourage them to refer for chiropractic treatment before medications and higher risk treatments. Consider starting with doctors you know, or those your patients see and mention you have patients in common. Most doctors are still unaware of guidelines recommending chiropractic and non-drug treatment as first-line pain treatment.
[Date]
[Provider Name]
[Address]
RE: Recommended Evidence-Based Alternative Options to Opioids
Dear [Provider],
As you know, opioid abuse and addiction continues to cause significant harm to our community. However, state and national guidelines have highlighted an underutilized solution to helping you manage your patients with acute and chronic pain: nonpharmacologic treatment. Please review this brief summary of recent guidelines that recommend providers increase utilization of nonpharmacologic treatments first to help end the opioid epidemic.
Calls have come from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the Institute of Medicine (IOM) for a shift away from opioid use toward nonpharmacologic approaches to address chronic pain.
Based on the latest research, the American College of Physicians recently released guidelines for the treatment of back pain recommending nonpharmacologic treatment like chiropractic spinal manipulation as first-line treatment before medications.
Governor Kasich’s Opiate Action Team of medical experts created guidelines for acute pain treatment to help reduce opiate addiction and death in Ohio, recommending nonpharmacologic treatments first: “Chiropractic treatment, acupuncture/ acupressure, nutrition, exercise, massage and wellness programs need to be considered first when patients experience musculoskeletal injuries.”
Providers in multiple disciplines and throughout the health care continuum are now advocating chiropractic care as a leading alternative to pharmacologic treatment for painful neuromusculoskeletal conditions. For the overwhelming number of people who suffer with chronic pain, chiropractic care offers a drug-free, non-invasive and cost-effective alternative to opioid drugs.
Chiropractic is the largest, most regulated and best recognized of the complementary and alternative care professions. In fact, patient surveys reported in the Annals of Internal Medicine show that chiropractors are used more than any other alternative provider group and patient satisfaction with chiropractic care is very high. Patient use of chiropractic in the United States has tripled in the past two decades, and most insurance plans cover chiropractic care.
Local doctors of chiropractic can help you provide the best care to your patients seeking relief from painful neuromusculoskeletal conditions. For more information on treatment guidelines or to help your patients find a local doctor of chiropractic go to: [oscachiro.org].
Together we can help provide the best care to our community and help stop the opioid epidemic.
Sincerely,
[Dr. Smith]
Identifying appropriate patients for nonpharmacologic pain treatment education and access
1. Hospitals should already be assessing pain according to existing Joint Commission standards.
2. Identify red flags (malignancy, progressive neurological deficits, etc.) to rule out the need for emergency/urgent medical care. (Chiropractic physicians will confirm the absence of red flags during their initial evaluation.)
3. The most common conditions to address with chiropractic and nonpharmacologic treatments are neuromusculoskeletal conditions including back pain, neck pain, and headaches. Other painful NMS conditions of the extremities should be considered as well.
4. Patients assessed and found to have a history of substance addiction or at risk of opioid abuse should especially be prioritized for education and urgent access to nonpharmacologic options.
>> Higher risk populations for opioid abuse or pharmacologic adverse effects include pregnant females, elderly, injured workers, veterans, mental health patients, patients with gastrointestinal disease, and patients with renal or hepatic dysfunction.
Increasing patient education on chiropractic and nonpharmacologic options
1. Identified patients should be provided with a brochure or literature discussing the safety and efficacy of chiropractic and nonpharmacologic options for pain while being treated in the hospital. (Literature available by request)
2. Identified patients should be provided with a brochure or literature discussing the safety and efficacy of chiropractic and nonpharmacologic options for pain when discharged from the hospital. Educational language could be automatically included in discharge instructions for identified conditions. (Literature available by request)
3. The hospital should host patient education events with chiropractic physicians or nonpharmacologic treatment providers discussing the appropriate use of these options. (Speakers available by request)
Increasing patient access to nonpharmacologic options in hospital and through referral
1. Chiropractic physicians may be provided hospital privileges to provide inpatient treatment (as of 2015, 3.6% of chiropractic physicians hold staff privileges at a hospital with VA hospitals showing significant growth). Appropriate departments in which chiropractic physicians have been utilized include the ER, orthopedics/sports medicine/physical rehabilitation, work injury, and pain management.
2. As part of their educational literature, patients should be given information on how to find a local chiropractic physician. (Available by request)
Increasing provider education on nonpharmacologic options
1. The hospital should provide educational literature and learning resources to providers that include a description of nonpharmacologic options, benefits and risks, current treatment guidelines, indications and contraindications, and common questions and answers. (Available by request)
2. The hospital should host provider education events with chiropractic physicians discussing the appropriate use of these options. (Speakers available by request)