As the opioid crisis wears into another year, and with some reports claiming a resurgence in opioid mortality following the initial waves of the COVID_19 pandemic, responsible management of pain and injury is surely front of mind for many practitioners. However, just what role chiropractic may play in the reduction of opioid use has remained largely speculative.
A case report published in the Journal of Contemporary Chiropractic has recently shed some light on a positive outcome gained through chiropractic management of a severe injury. While it is a single case report, and is thus limited in that we can’t make sweeping generalisations based on it alone, it does create room for some interesting conversations around what can happen when we chiropractic care (ie. Nervous system care) is introduced for traumatic brain injury, and rehabilitation.
The case in question covers that of a 21-year old female who suffered a severe fracture through her right ischium and a traumatic brain injury (TBI) with whiplash when she fell from a single floor and landed on her right leg before falling to the ground and hitting her head.
Upon presentation to emergency, it was discovered that her TBI was severe and carried a risk of brain haemorrhage and that her fracture would require surgery (including pelvic bolts and plates) to correct. She also had a dislodged right hip. Initial management by her orthopaedic specialist and a physiotherapist saw her discharged after four months, having regained approximately 40% of her capacity for activities of daily living.
She still had pain, TBI and vestibular symptoms, and difficulties with some activities of daily living.
One year after the accident, enter chiropractic
At this point, she presented for chiropractic care. At this point, she had right hip pain, low back pain, TBI symptoms, headache, and was on slow release morphine taken twice daily. She now had no allied health support and hadn’t done so for six months. Her instructions were to keep taking the morphine until her pain decreased.
We will restrain ourselves from commenting on what this might mean for a 21-year old female with her life in front of her, and no visible pathway out of pain.
The attending chiropractor undertook thorough testing and evaluation included concussion exam, neurological exam, orthopedic exam and chiropractic exam as is responsible in a case like this.
We will also restrain ourselves from commenting on the profound findings of the chiropractic examination apart from to say that joint dysfunction was found at: “Occiput, C1, C5, T1-2, T4, T7, T9, T12, L4-5, L Sacrum, R SI. Significant muscles which were all contributing to the joint dysfunction included the suboccipitals, levator scapulae, sternoclavicular muscles, scalenes, diaphragm, erectors spinae, quadradus lumborum, gluteaus max/med, piriformus, iliopsoas. [2]”
After a thorough course of care, which cannot be covered properly in a blog article as it included TBI rehabilitation, vestibular work and chiropractic adjustments (see reference below for the full details, 2), vast improvements were noted. The study noted that “She reported improvement after every chiropractic treatment; she decreased her dosage from taking morphine for a year after the incident to no painkillers in four weeks of chiropractic care, safely with GP overview. She went from 2 weeks of morphine, then to codeine only once daily for 2 weeks. Once that was complete, she was not on any pain medication and did not require tramadol since it is not suitable for TBI patients. [2]”
It was also noted that while she did experience some withdrawal symptoms, this was managed partially by chiropractic. Her hip flexion also improved from 50 to 95 degrees and she was feeling “a lot more like her usual self, improving both mental and physical aspects, after ceasing her use of the opioid medication.”
What this means for chiropractic
Obviously, this is an incredibly complex case, and we can’t generalise because it is only one case. However, it does present the opportunity to change the conversation around chronic pain, whether or not it is for life, and what role chiropractic might play in managing complex cases like this.
While more research is required, one thing we know for sure: we are really glad that young woman walked into a chiropractic clinic. Who knows what life may have held if she didn’t.
REFERENCES:
Enos, G,. (2020), “Overdose resurgence amid pandemic fuels debate over treatment access measures.” Alcoholism and Drug Abuse Weekly
https://doi.org/10.1002/adaw.32750
Patel, H., (2022). “Resolution of Opioid Medication Use from Chiropractic Management of Nonunion Hip Fracture, Post Surgical Pelvic Fusion and Severe TBI: A case report.” Journal Contemporary Chiropractic.
