First off this topic comes directly from the recent publication of Dynamic Chiropractic, basically a newspaper for chiropractors. I am summarizing it here because it is important to understand what is and isn’t working to treat chronic pain in any patient population. This post goes right along with two of our most recent on chiropractic care and pain medication use.
The Department of Veterans Affairs has been all over the news recently with issues of cooked books, delays in patients seeing doctors, insufficient personal, unwarranted bonuses, and punishment of whistle blowers. Just as terrible is that the treatment of chronic pain suffers, according to some reports the VA gives out prescription painkillers such as percocet, oxycontin, and hydrocodone to veterans like they were candy. While the VA has initiated programs to reduce their prescribing of these painkillers the VA will still treat over 650,000 veterans this year with opiates. It is my assertion that the use of opiates is partly out of pressure in the VA to get patients in and seen as soon a possible and partly due to an inability to effectively treat chronic musculoskeletal conditions. The most common procedures to treat chronic spine pain in the VA include pain medications and steroid injections, opiate pain medications have their obvious downsides and recent evidence found that epidural injections are no better than placebo to manage pain.
The “Department of Defense admits that 20 percent of disabled vets and 30 percent of hospitalizations stem from low back pain, which has become the largest disabling condition among active forces.” A 2010 study found that the top reason for medical evacuation from Iraq and Afghanistan was musculoskeletal disorders, not combat injuries. A different study found that only 13% of soldiers who left their units for back pain as their primary diagnosis returned to service. The US military and the VA system have been relying on practices to treat back pain that have a poor track record for success. Chiropractic has been woefully left out of both the VA and active duty health services for far too long, it has only been within the past 10 years that chiropractors have started to be hired to work in VA facilities and within the past 5 years or so in hospitals on military bases as civilian physicians. Chiropractic care has the largest potential to help the epidemic of chronic spine pain that is plaguing the veterans community. In 1998 an editorial published jointly by the American College of Physicians and Surgeons with The American Society of Internal Medicine in the Annals of Internal Medicine said that spinal manipulation is the “treatment of choice” for adults with low back pain. The evidence is in favor of chiropractic care for chronic spine pain and it is beyond time that policy and practices shift towards chiropractic care.
The VA system is hiring chiropractors, but they could do far better to hire far more. Chiropractors are a cheaper alternative to MD’s and DO’s whose primary care options include things that are less effective than chiropractic or not effective at all. If you want to do for our Veterans call your congressman and senators and ask they look into expanding chiropractic in both the VA and active duty military hospitals.