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Opioids, Low Back Pain, Post-Surgical Pain
Objective: To demonstrate the use of chiropractic care and active rehabilitation to treat chronic postsurgical spinal pain while safely tapering a patient from long-term opioid therapy (LTOT).
Clinical Features: A 70-year-old male veteran sought care for chronic radiating low back pain as well as pain at the cervicothoracic junction (CTJ). He had undergone lumbar laminectomy in 2005 and cervical fusion from C3-C7 in 2014. He was previously treated with a limited trial of physical therapy consisting of only passive modalities including moist heat with electrical-stim/ultrasound but without any significant relief. In addition to the limited trial of physical therapy, treatment for his CLBP and CTJ pain include LTOT primarily consisting of hydrocodone since 2011.
Intervention and Outcome: Chiropractic care was performed 7 times over a period of 3-months, consisting of spinal manipulation and flexion-distraction supplemented with at-home stretching protocols, prone press-ups and foam rolling. This care was able to help safely manage the patients' pain while he was tapered from his long-term opioid therapy. During his care he was completely tapered from LTOT which began at 40mg of hydrocodone. He is currently seen in the chiropractic clinic every 4-6 weeks to help manage his chronic post-surgical spinal pain without opioids.
CONCLUSION: Chiropractic care with supplemental at-home active rehabilitation was able to successfully manage a postsurgical spinal pain patient while being safely tapered from long-term opioid therapy.
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