Opioid Use

Ontario is facing an opioid crisis. A study of patients receiving long-term opioid therapy for non-cancer pain at the Pain Management Centre in Hamilton General Hospital found that 64.8% of the patients studied had presented with chronic low back pain. Opioid therapy however provides only modest, short-term pain relief for chronic back pain. 1, 2 The 2017 Canadian Guidelines for Opioids for Chronic Non-Cancer Pain recommends nonpharmacological therapies as a first line treatment for chronic pain, including spinal manipulative therapy for back pain, neck pain, knee osteoarthritis, fibromyalgia, severe headaches or migraines. For patients who are currently struggling with opioid dependency, a multidisciplinary approach is recommended to taper patients off opioids while utilizing nonpharmacological therapies to address the underlying pain. 3

Prevalence of MSK and Co-Morbid conditions

Low back pain is the leading cause of disability worldwide; contributing 10.7% of years lived with a disability, while neck pain is the fourth leading cause of disability. As a group, MSK conditions ranked second, contributing 21.3% of years lived with a disability. People with various chronic health conditions, including chronic obstructive pulmonary disease (COPD) and diabetes, also suffer from musculoskeletal pain. 4 MSK pain is twice as common in those with COPD, with 36% of patients experiencing back pain and 13% of patients experiencing neck pain. 5, 6 MSK pain is also approximately twice as common in those with diabetes, with 52% of patients experiencing shoulder/neck pain, 60% of patients experiencing low back pain, and 71% of patients experiencing arm/hand/knee/hip pain. 7

For more information about the benefits of chiropractic care for specific conditions, please visit our Benefits of Chiropractic page


1 Busse, J. W., Mahmood, H., Maqbool, B., Maqbool, A., Zahran, A., Alwosaibai, A., … & Sumpton, J. (2015). Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario. CMAJ open, 3(3), E324.2
2 Shaheed, C. A., Maher, C. G., Williams, K. A., Day, R., & McLachlan, A. J. (2016). Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA internal medicine, 176(7), 958-968.
3 Busse, J. (2017). The 2017 Canadian guideline for opioids for chronic non-cancer pain. Retrieved from
4 Vos, T., Flaxman, A., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M.… Murray, C. (2012). Years lived with disability (ylds) for 1160 sequelae of 289 diseases and injuries 1990—2010: A systematic analysis for the global burden of disease study 2010. The Lancet, 380(9859), 2163 – 2196
5 Roberts, M. H., Mapel, D. W., Hartry, A., Von Worley, A., & Thomson, H. (2013). Chronic pain and pain medication use in chronic obstructive pulmonary disease. A cross-sectional study. Annals of the American Thoracic Society, 10(4), 290-298.
6 HajGhanbari, B., Holsti, L., Road, J. D., & Reid, W. D. (2012). Pain in people with chronic obstructive pulmonary disease (COPD). Respiratory medicine, 106(7), 998-1005.
7 Molsted, S., Tribler, J., & Snorgaard, O. (2012). Musculoskeletal pain in patients with type 2 diabetes. Diabetes research and clinical practice, 96(2), 135-140.