Managing chronic pain: Can chiropractic care help reduce opioid use?

# Background

Dr. Peter Emary, a chiropractor and clinician-researcher based at Langs CHC and McMaster University, is leading this randomized controlled trial (RCT) in Ontario CHCs. The goal is to measure and demonstrate the effectiveness of chiropractic care  for managing chronic spinal pain within an interprofessional primary care setting. If sufficient benefit is demonstrated, the findings will be used to advocate for making chiropractic care accessible to more people in Ontario. 

# Study Design

This trial is a “cluster RCT,” in which groups (or “clusters”), rather than individuals, are sorted into the different arms of a study. In this case, each cluster will consist of clients at one CHC who are receiving care for chronic spinal pain. The CHCs assigned to the control group will continue to provide the usual standard of care to their chronic spinal pain clients. Those assigned to the intervention group will provide usual care plus 12 weeks of chiropractic care. Outcomes for clients in both groups will be measured using EMR data and client feedback. 

This trial will unfold in two stages. The first stage, a pilot study, will take place in four CHCs – two in the intervention arm, and two in the control arm – and involve a total of 25 clients. It is intended to address four feasibility questions: 

1. Will patients want to join? 
2. Can they follow the care plans? 
3. Is the data-collection sufficient? 
4. Will patients be available for follow-up? 

Learnings from the pilot will help refine the protocol for the second stage, a definitive RCT involving many clients at a large number of CHCs.  

# Get Involved

The pilot is scheduled to begin in January 2025. Three CHCs have been recruited so far, and one to three additional CHCs are needed. Recruitment for the second phase will take place across Ontario in 2026. 

To ensure that participating in this trial does not place a financial burden on CHCs, research-related costs including participant recruitment, chiropractic services, and equipment will be covered, and participating CHCs will also be paid a minimum of $3,000.  Centres will only need to provide part-time access to a small examination room. However, the chiropractic services could be provided offsite at a community-based clinic if needed. Centres will also need to designate a lead physician/NP team to oversee trial activities related to client care during the study.

If you are interested in getting involved, now is the time to talk to your team. You can learn more about chiropractic care here. Dr. Emary will also be happy to answer your questions about this study and the intervention it is evaluating; you can email him here.