News / Publications

May 8, 2017

A new Canadian guideline published today (May 8, 2017) in the Canadia Medical Association Journal (CMAJ) strongly recommends doctors to consider non-pharmacologic therapy, including chiropractic, in preference to opioid therapy for chronic non-cancer pain.

The guideline (http://www.cmaj.ca/content/189/18/E...) is the product of an extensive review of evidence involving stakeholders from medical, non-medical, regulatory, and patient stakeholders.

The lead author, Dr Jason Busse DC, PhD is a graduate of Canadian Memorial Chiropractic College and is an Associate Professor in the Department of Anaesthesia at McMaster University. Other authors of the guideline include those from the fields of physiotherapy, dentistry, public health and medicine.

Chronic non-cancer pain (CNCP) is defined as pain lasting more than 3 months that is not associated with malignancy. It is estimated that up to 20% of adult Canadians suffer with CNCP and, the guideline says, is the leading cause of health resource utilization and disability among working age adults.

Behind the USA, Canada has the second-highest level of opioid prescribing in the world. It is an enormous issue, with a doubling of admissions to publicly-funded opioid-related treatment programs between 2004 and 2012. In 2015, over 2000 Canadians died of opioid overdose, with final figures expected to be higher in 2016. Many of these deaths were associated with Fentanyl, the same opioid cited as being the cause of death of the musician Prince in 2016. Other commonly used opioid drugs are Percocet, OxyContin, Dilaudid and morphine.

The new guidelines significantly revise those published in 2010 with a clear message that opioids should not be the first-line therapy in CNCP and should only be used as a last, carefully dose-controlled resort after all other options have been exhausted.

Another key recommendation is that MDs do not simply keep raising the dose level of opioids if recommended levels are not providing effective relief, and to avoid opioids altogether where there is a history of substance abuse or mental health issues.

None of this is relevant to those already addicted to opioids. The guideline addresses this issue by advocating a tapering down of doses over time, utilizing multidisciplinary care options, such as chiropractic.

A keynote speaker at the joint WFC/ACC/ACA Conference, DC2017, Dr Brian Goldman, has spoken out strongly against MDs prescribing opioids, but says that the guideline must be supported by national programs to encourage compliance with the guideline’s recommendations (http://www.cbc.ca/radio/whitecoat/b...).

With many users of opioids doing so due to chronic back pain or other musculoskeletal disorders, the recommendation to primary care physicians to optimize their use of non-opioid medications and non-pharmacological therapy has the potential to increase utilization of chiropractic.

Secretary-General of the World Federation of Chiropractic, Richard Brown, commented: “The dangers of opioid therapy for chronic non-cancer pain are well documented, not just in Canada, but throughout the world. This new guideline sets out very clearly the recommendation to avoid prescribing opioids and to consider safer alternatives. The evidence for manual therapy in the treatment of back pain is strong and we are now seeing growing calls for its use as a first-line option.”

“Chiropractors as spine care experts are well-placed to deliver an effective and evidence-informed alternative as part of the solution to the opioid crisis. Chiropractors working in collaborative teams with other health professionals, such as in the US Veterans Administration, is resulting in very positive outcomes and we anticipate significant growth in the involvement of chiropractors in helping to tackle the opioid crisis. The WFC welcomes these recommendations and congratulates Dr Busse and his team on the publication of this important guideline.”

The WFC Public Health Committee has identified opioid overuse as one of its key priority areas. Its Chair, Dr Chris Cassirer D.Sc, MPH is clear on how chiropractors can make a difference. He remarked: “As nations continue to struggle with the growing epidemic of opioid addiction, it is imperative that we underscore the importance of this new Canadian guideline. Recommending chiropractic care as a primary intervention for patients suffering from neck and spine related conditions recognizes the growing body of scientific evidence that chiropractic is no longer an ‘alternative’, and instead it is a clinically effective first line of intervention for all doctors to recommend.”

Later this month, the WFC will be in Geneva at the World Health Assembly and will meet with representatives of the World Health Organization to discuss how chiropractic is contributing to global public health initiatives. As the only chiropractic non-governmental organization in official relations with WHO, the WFC is committed to supporting key strategies in a range of health areas, including the provision of non-pharmacologic health care around the world.

May 5, 2017

By World Federation of Chiropractic

Richard Deyo is a bit of a big cheese in the back pain world. A medical practitioner, he’s a Professor of Evidence-Based Medicine in the Department of Family Medicine at Oregon Health and Sciences University. He’s the Deputy Editor of Spine. He’s also on the editorial board of the Back Review Group of the Cochrane Collaboration. So it’s fair to say that so far as back pain goes, when he speaks, we should listen.

In the April 11 issue of the Journal of the American Medical Association (JAMA), Deyo’s editorial (1) focuses on the role of spinal manipulation in the treatment of back pain. Like this week’s article by Dr Aaron Carroll published in the New York Times (For Back Backs It May Be Time To Rethink Prejudices About Chiropractors, May 1, 2017), Deyo stresses the need to balance popular criticism often leveled at those using spinal manipulation with a few home truths when it comes to so-called conventional approaches to acute and chronic back pain.

Deyo hints that although spinal manipulation’s profile is rising as an evidence-based treatment intervention, its link to chiropractic has stunted its growth. Why? Because, he says, outdated views about health promoted by some chiropractors, rejecting immunization and other scientific advances, have led to suspicion and a reluctance of medical doctors to refer to them.

Despite this, Deyo reflects on the popularity of chiropractic in the US, citing one study involving 4000 respondents that showed chiropractic had more ‘highly satisfied’ consumers than physical therapy and primary care physicians. While reflecting on a recent systematic review that showed spinal manipulation to lead to modest improvements in pain and dysfunction, Deyo highlights the challenges of finding studies comparable in subjects, study design and interventions; thus, he say, it’s difficult to really be certain about the real magnitude of benefit.

Deyo concedes that there remains much we don’t know about the precise mechanisms of back pain, or how spinal manipulation actually works. Importantly, however, he says that this is no reason not to use it as a first-line intervention. Addressing the “but it’ll get better on its own” brigade, Deyo is quick to point out, as do many chiropractors, that the body has a tremendous ability to heal itself, but stresses that this is no reason not to manage pain associated with back pain using spinal manipulation.

Deyo refers widely in his editorial to a new systematic review and meta-analysis published by Neil Paige and his colleagues in the same April 11 issue of JAMA (2). The multidisciplinary authorship of this paper, including chiropractors Paul Dougherty and Richard Branson, sets out the benefits of spinal manipulation as well as transient harms. As Deyo points out, not a single study examined in the systematic review suggested that spinal manipulation was less effective than conventional care.

Key to Deyo’s editorial is the admission that we don’t have all of the answers when it comes to back pain. What’s the precise cause? Why some people do better than others? How do we best predict responses? How exactly does manipulation work?

When it comes to the popularity of chiropractic, contextual factors are often cited in explaining successful outcomes, and Deyo touches on these in his editorial. The hands-on nature of care. The ongoing doctor-patient relationship, with continuity of care over successive visits. The expectation of positive change, often with practitioner encouragement, reassurance, and positivity. Patients who feel empowered by their experience. As Deyo suggests, is it really so important that we don’t quite know the precise mechanisms of action when care is considered in the round and patients are so satisfied with their treatment?

Deyo goes on to address those who claim that spinal manipulation is dangerous. Besides pointing out that none of the RCTs or large observational studies reviewed by Paige et al identified any serious complications, he highlights the prevalence of renal and gastrointestinal adverse events from non-steroidal anti-inflammatory drugs and the risk of addition to opioids, both of which, he says, should be factored into cost comparisons when studying the relative effectiveness of spinal manipulation and conventional pharmacological approaches.

In conclusion, Deyo cautions against chiropractors who make exaggerated claims over the likely benefits of their care, especially in relation to non-musculoskeletal diseases, but stresses that spinal manipulation is a legitimate treatment option for low back pain, which the evidence shows is at least as effective as conventional drug approaches. In an era of evidence-based care, he observes that this is one area where the informed views and preferences of patients should count as much as the preferences of clinicians.

What Richard Deyo’s excellent editorial makes clear is that with a growing body of evidence suggesting comparative effectiveness, cost-effectiveness and safety of spinal manipulation, chiropractors are faced with opportunities like never before to position themselves as spinal health care experts in the healthcare system. At the same time, issues that perpetuate suspicion and mistrust must be tackled forcefully. Our future is, quite literally, in our hands.

References:
Deyo R. The role of spinal manipulation in the treatment of low back pain. JAMA (2017) April 11; 317(14):1418-1419.
Paige NM, Miake-Lye IM, Booth MS, et. al. Association of spinal manipulative therapy with clinical benefit and harm for acute low back pain. JAMA (2017) April 11; 317(14):1451-1460

April 7, 2017

TORONTO, CANADA, April 7, 2017. The World Federation of Chiropractic (WFC) has named world renowned epidemiologist Professor Pierre Côté DC, PhD as the first Chair of its new Disability and Rehabilitation Committee.

Dr Côté is the Canada Research Chair in Disability Prevention and Rehabilitation. He graduated as a chiropractor from the Canadian Memorial Chiropractic College in 1989. In 1996 he obtained a Master of Surgery degree from the University of Saskatchewan where he studied the Epidemiology of Neck and Back Pain in the General Population. He completed his PhD in Epidemiology and a minor in Research Bioethics at the University of Toronto in 2002. In 2003, he was awarded a five-year New Investigator Award from the Canadian Institutes of Health Research.

Prior to joining UOIT, where he is an Associate Professor, Dr Côté was a scientist in the Division of Health Care and Outcomes Research at the Toronto Western Research Institute and an Associate Professor of Epidemiology at the Dalla Lana School of Public Health at the University of Toronto, where he continues to hold an appointment. He was a member of the Scientific Secretariat of the 2000-2010 Bone and Joint Task Force on Neck Pain and its Associated Disorders and also held a 2010 appointment as Chair of the Catastrophic Impairment Expert Panel.

Dr Côté is currently the Chair of the Minor Injury Guideline Project funded by the Ontario Ministry of Finance. He is the Director of the UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation. He is a member of EuroSpine, the European spine society, and is a past member of the WFC Research Council.

The Disability and Rehabilitation Committee (DRC) has been established by the WFC in response to the growing global need for experts in disability prevention and rehabilitation. Priority areas of work are the positioning chiropractic as a global partner for the promotion of evidence-based disability prevention, publication of evidence-informed position papers and advancing and facilitating the involvement of chiropractors as members of rehabilitation teams and as agents for the implementation of local, national and international public health policies on disability and rehabilitation.

WFC President Dr Espen Johannessen said: “We are delighted that Dr Côté has accepted this important new position within the WFC. As a non-governmental organization in official relations with WHO, it is important that we strongly encourage doctors of chiropractic to be agents of change in their practices and communities. Disability prevention and rehabilitation are critical components in supporting population health.”

The WFC was a signatory to WHO’s Rehabilitation 2030 Call to Action at a high level international meeting in Geneva in February. Attended by ministers of health, numerous government representatives and other health leaders, the meeting highlighted the global need for rehabilitation services.

The WFC will shortly issue a call for applications for membership of the committee, which will seek to attract members from both within and outside the chiropractic profession.

April 2017

Following ratification of their appointments by WFC Council, the following individuals have been confirmed as members of the WFC Public Health Committee:

	CHAIR: CHRISTOPHER CASSIRER Sc.D., MPH. (USA) Dr Cassirer is the President and CEO of Northwestern Health Sciences University. He has a Masters in Public Health from Yale School of Medicine and a Doctor of Science from the Johns Hopkins Bloomberg School of Public Health. Dr Cassirer brings huge experience in strategy and leadership to the Public Health Committee.
	WFC COUNCIL LIAISON: MICHELE MAIERS DC, MPH, PhD. (USA) Dr Maiers is the Executive Director of Research and Innovation at Northwestern Health Sciences University. With a Masters in Public Health from the University of Minnesota and a PhD from the University of Southern Denmark, Dr Maiers has significant experience in the public health arena.
	MUSTAFA AGAOGLU DC (TURKEY) Dr Agaoglu is an assistant coordinator at on the chiropractic program at Bahçeşehir University of Istanbul. A past president of the Turkish Chiropractic Association, Dr Agaoglu's familiarity of diversity and middle-eastern culture is a valuable asset on the committee.
	KENDRAH DA SILVA M.Dip.Tech Chiropractic (SOUTH AFRICA) Dr Da Silva has broad experience in ICD10 coding and has coordinated a WHO FIC (Family of International Classifications) meeting in South Africa. A past President of the Chiropractic Association of South Africa (CASA), Dr da Silva remains a member of the CASA Executive.
	REIDAR LYSTAD BChiroSc, MChir , MPH, PhD, (AUSTRALIA/NORWAY) Dr Lystad is a postdoctoral research fellow at the Australian Institute of Health Innovation at Macquarie University. Previously an Intern at the George Institute for Global Health, Dr Lystad also completed a PhD in sports epidemiology and injury prevention.
	SARKAW MOHAMMAD BSc. (Chiro), PhD (c) (NEW ZEALAND) With a background in emergency medicine, Dr Mohammed qualified in New Zealand with degrees in chiropractic and para-medicine. Further postgraduate studies include a Diploma in Travel Medicine, Diploma in Psychological Rehabilitation (Refugee and Migrant Health) and Masters in Health Science (Rehabilitation).
	JESSICA WONG BSc, DC, FCCS (CANADA) With an undergraduate degree in Medical Radiation Sciences, Dr Wong is a 2010 graduate of Canadian Memorial Chiropractic College. She is on the faculty of Canadian Memorial Chiropractic College and completes her Masters in Public Health (Epidemiology) in 2017.

August 31, 2016

Northwestern President appointed to lead WFC committee

TORONTO, Canada—The World Federation of Chiropractic has named Dr. Chris Cassirer, President and CEO of Northwestern Health Sciences University, as Chair of its Public Health Committee, which oversees efforts to promote health and wellness worldwide.
 
Cassirer, 52, has been President and CEO of Northwestern since 2014. He holds a Doctor of Science Degree from Johns Hopkins University, a Master of Public Health Degree from Yale University and a Bachelor of Arts Degree in psychology from Rutgers University.
 
“I am honored to work with my colleagues at the Federation and to help advance chiropractic care globally,” Cassirer said. “At Northwestern, we educate our students to become leaders in an evolving health-care world, where chiropractic is recognized as playing a vital role in providing safe, economical, clinically effective, non-invasive patient care. I’m eager to begin working with the Federation and its global partners to offer a shared message of hope and healing around the world.”
 
Cassirer becomes the first non-chiropractor to receive such an appointment by the Federation, a non-profit organization advocates for the chiropractic profession worldwide and is a non-governmental organization in official relations with the World Health Organization.
 
WFC President Dr. Espen Johannessen said: “We are delighted to have someone of Dr. Cassirer’s caliber as the new Chair of the Public Health Committee. His experience and enthusiasm for the chiropractic profession will ensure that the profile of public health, as it relates to doctors of chiropractic, will be significantly elevated.”
 
Secretary-General Dr Richard Brown said Cassirer’s experience in public health and as an educator will help chiropractic increasingly be seen as an important part of an integrated approach to health care worldwide.
 
“With the agreed identity of chiropractors as spine-care experts in the health care system, the Federation is keen to intensify its participation in public health and wellness initiatives,” Brown said. “Dr. Cassirer’s stellar track record in public health means that the Federation can take a central role in delivering initiatives that will support chiropractors and the patients they serve.”
 
Founded in 1988, the WFC represents the chiropractic profession internationally. Its voting members are the national chiropractic associations of nearly 90 countries in 7 world regions. The WFC advocates for the highest standards of professional conduct, education and research. In advancing the chiropractic profession, its work centers on support, empowerment, promotion and unity of the chiropractic profession. Its head office is in Toronto, Canada.