You’ve heard of the troublesome class of pain medications called opiods. They attach to nerve cells to interrupt the pain signals in the brain and are often used to provide relief from moderate to severe pain in short-term situations such as surgery or to manage long-term chronic conditions such as cancer. But any benefits these presecriptions can provide has been overshadowed by a national afflication.

PUBLIC HEALTH EMERGENCY

As the U.S. Department of Health and Human Services (HHS) explained, “In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates. Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive."

A public health emergency was declared in 2017 as a result of the consequences of widespread opiod addiction. The declaration as been renewed every 90 days since, most recently on June 25, 2024.  

Among all opiods, fentanyl has received the most attention, having caused 71,000 deaths in 2021 alone. Fifty to 100 times more powerful than morphine, fentanyl is commonly manufactured and sold illegally. Meanwhile, other highly addictive prescriptions are still legally administered as the standard treatment for pain-related care, including procedures such as getting a tooth pulled. Examples include codeine, morphine, oxycodone, and Percocet. Another is tramadol, which is an opiod sold under the brand name Ultram.

Tramadol is a traditional prescription used for moderate to severe pain related to lower back and sciatic pain, which are issues I commonly see in the chiropractic office. Serious side effects of tramadol include hallucinations, seizures, and the obvious concern of addiction. It can also increase suicidal tendencies in pateints prescribed this drug.

Many of you know the pain of sciatica: radiating pain that originates in the lower back or buttocks and typically extends down the back of the thigh and calf often extending into the foot and toes. The standard medical treatment may be an anti-inflammatory drug and muscle relaxer initially. However, when the pain persists due to the cause of the pain not being addressed, then other pain medications such as tramadol (Ultram) may and often are incorporated in the patient’s treatment plan.

While it is true that the drug may provide some relief, again, it does not address the cause, which sets the stage for long-term use and addiction.

But there is another way.

AN OPIOD ALTERNATIVE

Recent research has demonstrated that chiropractic adjustments significantly reduce dependency on pain medications for patients suffering from lower back and sciatic symptoms. This study specifically evaluated the use of the drug tramadol for these symptoms in comparison with chiropractic spinal adjustments/manipulation.

A study recently published in the British Medical Journal titled “Chiropractic Spinal Manipulation and Likelihood of Tramadol Prescription in Adults with Radicular Low Back Pain: A Retrospective Cohort Study Using US Data” evaluated data collected from over 115 million patients in 2023. The age of the patient population ranged from 18-50 with a mean age of 35 years.

The findings of the study were surprising to many in the medical community. There was “significant” reductions in pain and symptoms as well as the use of the drug tramadol in the chiropractic spinal adjustment/manipulation group compared to the medical treatment group.

The use of physical therapy evaluations, lumbar radiography, and non-steroidal anti-inflammatory drugs was used equally in both groups, so this variable had no impact on the results.

Another interesting aspect of this study was that the pain relief lasted. The study authors note; “A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the [Chiropractic Spinal Manipulation] cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up.” This study highlights the long-term pain relief received by patients receiving chiropractic spinal adjustments for lumbar radicular (sciatic) symptoms when compared with the health risks of long-term pain medication (specifically tramadol) use.

This study also highlights the importance of cooperative management of patient care between different health care specialists. In light of this, all patients treating with their primary physician or pain management specialist should be referred for chiropractic evaluation and management when suffering from lower back pain and sciatic symptoms, especially before being prescribed any form of opioid drugs for pain management.

While these drugs can be highly effective if necessary when used for an extremely short duration, it is time to change the standard treatment for pain if we ever want to end the opiod-related emergency declaration that still rages on, seven years later. In light of the crisis and frequency of addition, it is imperative that egos and personal and professional biases be put aside in order to provide the best quality care for every patient that suffers from these unfortunate and all-too-common, life-altering symptoms. The interprofessional cooperative care of patients is essential today more than ever before in order to improve the quality of outcomes in a patient’s case management and care.

If you or someone you love is suffering with lower back or sciatica related pain, schedule a free consultation with our office to learn more about an alternative to opiods for pain relief.