| Abstract/Notes |
Background:Acute and chronic musculoskeletal pain is widespread in the substance-use disorder population. The correlation between chronic pain and substance abuse is well documented. Musculoskeletal pain can motivate susceptible individuals to abuse drugs and alcohol in an effort to obtain pain relief. Pain can exacerbate substance abuse and serve as an obstacle in the rehabilitation process. Chiropractic care may provide an effective, non-pharmaceutical treatment for this patient population. However, persons who are uninsured, underinsured, indigent and in residential rehabilitation centers often have difficulty accessing this care. In 2004, Western States Chiropractic College was awarded a grant from the Collins Foundation to provide chiropractic care to residents in three substance abuse treatment programs. The grant extends the outreach of the West Burnside Chiropractic Clinic (WBCC), one of the school’s teaching clinics. Under the Collins grant, three treatment programs each host a weekly on-site clinic, staffed by a supervising chiropractor and 1-2 interns. This paper reports on the phase of the 3-year project. Objectives:The goals of this project were to help marginalized patients and the community by providing chiropractic treatment to improve rehabilitation outcomes for substance abuse disorders; document the outcomes of chiropractic care with a vulnerable population; provide student interns with clinical training in working with a vulnerable client population; and develop a model for similar treatment programs and community partnerships. Methods:The project and its evaluation were approved by the Institutional Review Board of Western States Chiropractic College and the review boards at each treatment center. Confidentiality, coordination of care, and ongoing communication were highlighted in formal agreements between the WBCC and the treatment programs. Outcome measures were designed for each of the objectives. Results:In a three-month period, 70 residents (39 women and 31 men) received chiropractic care from 5 interns. The majority reported themselves as Caucasian (73%), aged 18 - 56 years. Complaints included back (55%), neck (20%) or shoulder (17%) pain; many reported multiple foci. Chronic conditions were reported by 24 residents, including hepatitis, diabetes, asthma, and hypertension. Interns performed an admission assessment on each resident, devised a treatment plan and provided the appropriate care. The admitting intern provided subsequent care, with most residents returned for more than 2 clinic visits. In addition to spinal manipulation and soft tissue manipulation, care included self-care instruction regarding exercises, stretches, proper lifting, and posture. All involved with this project have reported satisfaction with the outcomes. The vast majority of residents have reported decreased pain levels following treatment, although the weekly treatments have not significantly reduced their subsequent pain ratings. In addition to valuing ‘real-world’ experience with diverse, complex clients, intern’s comments conveyed an increased ease working with diverse clients and surprise with residents’ motivation to incorporate self-care suggestions into daily activities. Discussion:Chiropractic’s emphasis on patient responsibility for a healthy lifestyle supports substance-abuse treatment programs’ efforts to teach self-care and problem-solving skills. Community-based partnerships are increasingly vital. Alcohol and drug treatment are in a state of crisis due to drastic cuts to longstanding social and health services. Cooperation between chiropractic institutions and safety-net facilities strengthens the quality and availability of treatment options to a diverse population of substance-use disorder patients. In addition to fostering chiropractic knowledge and clinical decision-making skills, chiropractic professional education should impart attitudes that foster integrity and a concern for humankind. Care models are needed to prepare interns to address the needs of marginalized populations. Such training enhances the overall quality of health care provided by chiropractic physicians. This abstract is reproduced with the permission of the publisher. |
