Improving Quality of Life, Minimizing Pain in Veterans

Acute and chronic pain significantly detracts from a person’s quality of life.^1,2 Yet, the challenge with pain management is often helping patients find relief while maintaining their expected quality of life, such as participating in job, family, and social activities.

As we have witnessed with the opioid crisis in the United States, sometimes pain management treatment can be far worse than pain itself. Even for people who did not develop substance use disorders after they were prescribed opioids, side effects of such drugs include drowsiness, headache, constipation, dizziness, nausea, and others. The majority of patients taking one opioid were so affected by these side effects that it negatively impacted their quality of life.³

Surgery for treating chronic pain, specifically low back pain, has a poor track record of success,⁴ often requiring multiple procedures. In fact, multiple procedures are so common that a condition called “failed back surgery syndrome” was coined⁵ in the early 1990s to describe patients who never achieved pain relief despite several surgeries. After procedures, patients often take opioids or other painkillers to control the surgery-related pain, which then increases their risk of substance use disorder.

Growing evidence suggests, however, that natural, drug-free, noninvasive care can assist the nearly 60% of Americans who experience neuromusculoskeletal pain⁶ without the health risks and side effects of a pharmacologic intervention or surgery. Perhaps even more importantly, however, these holistic pain management methods can improve a patient’s quality of life, enabling them to fully participate in the activities that make their life worth living.

Latest Finding Verifies Trend

A study⁷ published in 2022 confirmed how a natural drug-free, pain management method of chiropractic care reduces low-back pain while helping people maintain or improve their quality of life.

The randomized clinical trial included 750 active-duty military personnel with low back pain. Approximately one-half of the military personnel received usual medical care, which typically included pain medication and, in some cases, referrals to a physical therapist and/or pain clinic. The other half of the study participants received usual medical care plus chiropractic care.

Participants filled out the Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 questionnaire, where they assessed pain intensity using a single 0 to 10 numeric rating item and responded to questions concerning health domains (physical function, fatigue, pain interference, depression, anxiety, satisfaction with social role, and sleep disturbance).

While the difference between the 2 groups was not enormous, researchers found the chiropractic care group had statistically significant differences on questionnaire responses indicating greater improvement. Notably, among the chiropractic care group, 58% of participants reported pain reduction after 12 weeks, compared to 42% of military personnel who received usual medical care alone.

Non–pain-related scores also improved more significantly for the chiropractic group. For example, 28% of participants reported decreased emotional distress, such as depression and anxiety combined, compared to only 18% of the usual medical care group. While 45% of the chiropractic care group reported an improvement in their ability to perform in social roles, such as work and family, only 33% of the usual medical care group reported an improvement. More of the chiropractic care group showed improved mental health summary scores, less fatigue, and greater overall physical health—all of which suggest that chiropractic care can impact health-related quality of life beyond pain and pain-related disability.

Echoing Previous Research

The results of this study echo those from research published⁸ in 2019 from the same authors. In Hays et al, more than 2000 patients with chronic pain in the lower back or neck receiving chiropractic care were asked to complete a different version of the PROMIS questionnaire after 3 months. Similar to the study of military members, 30% of the participants reported improved overall mental health, 21% reported improved social health, and 23% stated they were less fatigued.

Researchers did not conclude in either study why the chiropractic care group improved at higher rates for the mental health and other health-related quality of life outcomes. Other studies have concluded that the spinal manipulation procedure typically received during a chiropractic clinic visit, which is also globally most often performed by a doctor of chiropractic (DC), has far-reaching effects beyond reducing pain.

For example, symptoms of depression, such as high cortisol, high adrenaline, insomnia, agitation, and anxiety, can be attributed to over-activation of the sympathetic nervous system. After reviewing studies, researchers in 2020 determined that spinal manipulation, also called chiropractic manipulation, activates the parasympathetic system to counterbalance the activity of the sympathetic system and thus reduce depression symptoms.⁹ Stimulating the parasympathetic system is also considered an effective therapy for major depression as it releases neurotrophins essential for anti-depressive therapies, including brain-derived neurotrophic factor and nerve growth factor, according to researchers.

Specifically, this study and others¹⁰ have theorized that alignment of the spine through chiropractic manipulation improves the functioning of the vagus nerve, part of the parasympathetic nervous system. Dysfunction of the vagus nerve has been associated with major depressive disorder, digestive problems, and a variety of other conditions.¹¹ 

Holistic Care

Chiropractic care has also been shown to improve sleep, as evidenced in Hays et al, among military personnel, which can improve health-related quality of life. Chiropractic manipulation can relieve pain, which can certainly improve sleep quality, but DCs can also recommend proper sleep positions, bed surfaces, optimal sleep environments, and other daily habits associated with better sleep.¹² Meanwhile, DCs counsel patients on other health-related behaviors such as posture, nutrition, and exercise, all of which impact mental and physical health.

This holistic perspective on health, which includes pain relief, translates to a higher quality of life. Such ancillary benefits of natural, drug-free care need to be considered with any patient consultation concerning pain management. Often, a doctor needs to help patients see passed their pain in establishing their goals because focusing on eliminating pain alone is not the same as creating optimal health.

References:

1. Cedraschi, C, Ludwig, C, Allaz, AF, Herrmann FR, Luthy C. Pain and health-related quality of life (HRQoL): a national observational study in community-dwelling older adults. Eur Geriatr Med. 2018;9(6):881–889. doi:10.1007/s41999-018-0114-7
2. Hadi MA, McHugh GA, Closs SJ. Impact of chronic pain on patients' quality of life: a comparative mixed-methods study. J Patient Exp. 2019;6(2):133-141. doi:10.1177/2374373518786013
3. Anastassopoulos KP, Chow W, Ackerman SJ, Tapia C, Benson C, Kim MS. Oxycodone-related side effects: impact on degree of bother, adherence, pain relief, satisfaction, and quality of life. J Opioid Manag. 2011;7(3):203-15. doi:10.5055/jom.2010.0063
4. Arts MP, Kols NI, Onderwater SM, Peul WC. Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome: a case series of 100 patients. Acta Neurochir (Wien). 2012;154(7):1213-1217. doi:10.1007/s00701-012-1380-7
5. Follett KA, Dirks BA. Etiology and evaluation of the failed back surgery syndrome. Neurosurg Q. 1993;3(1):40.
6. Lucas JW, Connor EM, Bose J. Back, lower limb, and upper limb pain among US adults, 2019. NCHS Data Brief. 2021 Jul;(415):1-8.
7. Hays RD, Shannon ZK, Long CR, et al. Health-related quality of life among United States service members with low back pain receiving usual care plus chiropractic care plus usual care vs usual care alone: secondary outcomes of a pragmatic clinical trial.Pain Med. 2022; 23(9):1550-1559. doi:10.1093/pm/pnac009
8. Hays RD, Spritzer KL, Sherbourne CD, Ryan GW, Coulter ID. Group and individual-level change on health-related quality of life in chiropractic patients with chronic low back or neck pain. Spine (Phila Pa 1976). 2019;44(9):647-651. doi:10.1097/BRS.0000000000002902
9. Kiani AK, Maltese PE, Dautaj A, et al. Neurobiological basis of chiropractic manipulative treatment of the spine in the care of major depression. Acta Biomed. 2020;91(13-S):e2020006. Doi:10.23750/abm.v91i13-S.10536
10. Maltese PE, Michelini S, Baronio M, Bertelli M. Molecular foundations of chiropractic therapy. Acta Biomed. 2019; 90(10-S):93-102. Doi:10.23750/abm.v90i10-S.8768
11. Browning K, Verheijden S, Boeckxstaens GE. The vagus nerve in appetite regulation, mood, and intestinal inflammation. Gastroenterology. 2017;152(4):730-744. doi:10.1053/j.gastro.2016.10.046
12. Jacobson BH, Boolani A, Dunklee G, Shepardson A, Acharya H. Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Appl Ergon. 2010; 42(1):91-97. doi:10.1016/j.apergo.2010.05.004