Sorry my fellow Ohioans, but Chiropractic is NOT an Alternative Treatment to Opioids. 

     There is a campaign in Ohio by its Chiropractors to promote an agenda that is in my opinion, misguided. This campaign centers around the opioid epidemic. The opioid epidemic in the US is a serious matter. The state of Ohio where I practice has been hit harder than most states when it comes to overdose deaths. Due to this powerfully addictive drug and its derivatives such as heroin, and other dangerous synthetic knock-offs, treatment for opioid addiction now surpasses alcohol abuse in America. Studies show that opioid abuse kills an average of 130 people each day and costs the US economy an estimated $78 billion a year. Opioids are now responsible for more deaths than automobiles or guns, and are about equal to suicides in the US.

     Many local and national organizations, both government and private sector, are looking for ways to combat the effects of opioid abuse in America through different laws and addiction treatment avenues. As a chiropractor, what I find more important than treating the effects of opioid addiction is to focus on what caused the opioid addiction crisis in the first place. People will have different opinions when it comes to defining the causes of the opioid crisis, but a major gateway was caused by the medical community over-prescribing opioid painkillers. The availability of prescription painkillers peaked in 2012 at 81 prescriptions per 100 people. Recent efforts to curtail over-prescription have brought that number down to 59 prescriptions per 100 people as of 2017. It has been widely reported that prescription painkillers are a legal gateway to heroin abuse. Analysis from the Substance Abuse and Mental Health Services Administration states that as addicts need stronger painkillers to achieve the same effect. They may be unable to access pills through their healthcare provider or unable to afford illegally-sold pills. Some end up switching to heroin, a cheaper illegal opioid.

     What caused the overuse of prescription painkillers? This cause stemmed from the promotion of pain being labeled as the fifth vital sign in the early 2000s. The basic 4 vital signs are Body temperature, Heart rate or Pulse, Respiratory rate, and Blood pressure. In the 1990s a campaign led by a group called the The American Pain Society, pushed for pain to be added to the vital sign list because they said pain was being overlooked by doctors. The American Pain Society even copyrighted the phrase: “Pain: the 5th Vital Sign.” It has recently come to light that the supposedly “independent” American Pain Society was actually taking kickbacks from Big Pharmaceutical corporations such as Purdue Pharma which is the maker of Oxycontin. The American Pain Society took over 1 million dollars from Purdue Pharma to be their cheerleader in promoting pain and their opioid drug onto medical organization, and ultimately, on the American people. So, like a lot of things in our world, greed and the love of money can be found as the root cause of the cause.  

     So where does Chiropractic care fit in the whole “opioid epidemic” problem not only in Ohio but across the country? To a group of chiropractors, this does not include me personally, it still comes down to managing pain. The rationale involves the idea of finding alternative ways to managing pain besides using opioids. The effects of these alternatives should be non-addictive, natural, cost-effective, and have beneficial outcomes. Overall I think this is a noble campaign, but has some drawbacks. Firstly and most importantly: Chiropractic does not manage pain. And if it did, it would come nowhere near to the pain managing capabilities of medicine. This is not a negative dig at either chiropractic or medicine, but medicine is designed to treat pain, chiropractic was not. Secondly: Chiropractic is not a “pain managing alternative to medicine”. Chiropractic is not an “opioid alternative” either. I think I give a very powerful adjustment, but it pales in comparison to heroin flowing in the bloodstream. 

     Why doesn’t Chiropractic help manage pain when all the ads you see from chiropractors focus on alleviating pain, specifically of the spine? Who is telling the truth and who is propagating a lie? The other major problem I have with the campaign to promote Chiropractors as “Opioid Alternative” doctors is that it begs the question: “If Chiropractic is just good for pain, why would I bring my child to a chiropractor?” “My child doesn’t have back pain or an addiction to opioids!” The problem and solution to this potential Catch-22 dilemma starts and ends with the spine. But before looking to the spine, we have to answer “what is pain?” and “what is an opioid?”

     Pain is the body’s main signal to let you know that something went or is going wrong internally. Pain is like a smoke detector in your home. Pain is designed to alert you to a potential problem. Pain itself is not the problem, pain is the alarm to let you know of a problem. 

     What is an opioid? An opioid is a pain numbing drug. Opioids numb the sensation of pain by inhibiting the Central Nervous System. This inhibition occurs because the compounds found within opioids mimic neurotransmitters. Neurotransmitters are chemical compounds that are used by the nervous system to communicate with the body. Neurotransmitters such as endorphins and enkephalins have natural analgesic properties. This means they provide pain numbing relief, along with a feeling of calmness and sedation to our breathing and mood.

     Sticking with the smoke detector analogy, if your smoke detector starting going off one day, taking an opioid would be like trying to depress the sound of the alarm without really trying to locate the source of the smoke. The opioid would falsely mimic the pain numbing relief naturally provided by the neurotransmitters. But the fire still rages on. Depressing the alarm with an opioid is the wrong solution. If managing pain is the only solution, then the real problem will continue until there is nothing left to burn.

     So, back to the idea of chiropractic care for pain. Yes, chiropractors focus on the spine by the adjustment of a vertebral subluxation. And yes, pain is a natural signal that lets you know something is going wrong with the body. A subluxation is a great example of something going wrong with the body. But here is the problem: not all individual subluxations are predicated on the existence of pain in the spine. You could have spinal pain resulting from a subluxation OR have a subluxation presenting with no pain at all. If that wasn’t confusing enough, you could also have spinal pain and no subluxation. Let me repeat this because this is important to understand: not all individual subluxations are predicated on the existence of pain in the spine. You could have spinal pain resulting from a subluxation OR have a subluxation presenting with no pain at all. You could also have spinal pain and no subluxation. Even though pain is a great signal to let us know of a potential problem, pain is not the “end all be all” when it comes to indicating abnormal function.  

     If you have pain in the spine, there must be something wrong with the spine correct? Yes, but just because you have pain in the spine and it is indicating that something is going wrong, that ‘something going wrong’ might not be a subluxation. Vertebral subluxation is not causative of pain, but only correlative of pain. How is this possible? Let’s look at the definition of a subluxation again. To put it simply, a subluxation is when a bone of the spine misaligns and puts pressure on nerves effecting their function. But, pressure on what nerves? Not all nerves relay the feeling of pain. In fact, not all our nerves are designed to “feel” in the sense of the word.

     Nerves can be categorized into two groups: Function nerves and Feeling nerves. The function group can be further sub-categorized into the motor nerves which control skeletal muscles and the autonomic nerves which control blood vessels, organs, and glands. Both the motor and autonomic nerves make up around 90% of the total number of nerves. The other 10% of the nerves fall into the feeling nerve group. The feeling nerves are designated for communication, postural, temperature, and pain information. This “10% group” of nerves are the ones we feel, or experience through our consciousness. That old myth of how we only utilize 10% percent of our brains as some validity in the sense that we only are consciously aware of a small percentage of our nerves and ultimately our body at a given time. 

     Now if a subluxation is putting pressure on a nerve that senses pain, then that nerve will elicit the feeling of pain. But what if a subluxation is putting pressure on one of the function nerves, the motor and autonomic nerves that make up the other 90%? What would a pressure on those nerves feel like? I guarantee the pressure wouldn’t feel like pain. The pressure might feel like muscle weakness or tightness, or problems with breathing or digestion, or just an overall sense of fatigue or low energy. Again though, the pressure might not feel like anything at all. But would it be beneficial for you if that pressure wasn’t on that nerve? The pressure does effect the function of the nerve. When the nerve can’t function at its greatest potential, than you can’t function at your greatest potential. No matter who YOU are: a 5 month old baby, a 15 year old teenager, or a 55 year old adult. Everyone deserves to function at a healthier level. Using chiropractic for pain is really only using 10 percent of your potential for health. Utilizing chiropractic care for wellness is a great way to reach 100 percent of your optimal health expression. 

- Jarek Esarco, D.C.

Dr. Jarek Esarco is a pediatric and family wellness Chiropractor. He is an active member of the International Chiropractic Pediatric Association (ICPA). The ICPA is an organization of chiropractic family practitioners dedicated to advancing public awareness and the family wellness lifestyle. Dr. Jarek also has post-graduate certification in the HIO Specific Brain Stem Procedure technique through The TIC Institute. Dr. Jarek is happily married to his wife Regina. They live in Youngstown, Ohio with their daughter Ruby.

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