• McGregor M
• Nielsen A
• Chung C
• Fillery MD
• Wakeland W
• Mior S

• Affiliation / Canadian Memorial Chiropractic College (CMCC). Division of Graduate Education and Research
• Affiliation / Portland State University. Department of System Science
• Affiliation(G) / Canada / Ontario / Toronto
• Affiliation(G) / United States / Oregon / Portland
• Analgesics, Opioid
• Canada
• Chiropractic
• Chronic Pain
• Models, Theoretical
• Musculoskeletal Pain / therapy
• Opioid-Related Disorders / prevention and control
• Pain Management
• Systems Analysis

OBJECTIVE: The purpose of this investigation was to create a system dynamics (SD) model, including published data and required assumptions, as a tool for future research identifying the role of chiropractic care in the management of chronic, nonmalignant pain in a Canadian population.

METHODS: We present an illustrative case description of how we evaluated the feasibility of conducting a large-scale clinical trial to assess the impact of chiropractic care in mitigating excessive opioid use in Canada. We applied SD modeling using current evidence and key assumptions where such evidence was lacking. Modeling outcomes were highlighted to determine which potential factors were necessary to account for compelling study designs.

RESULTS: Results suggest that a future clinical study diverting patients with nonmalignant musculoskeletal pain early to the chiropractic stream of care could be most effective. System dynamics modeling also highlighted design challenges resulting from unresearched assumptions that needed to be proxied for model completion. Assumptions included changing rates in opioid-associated deaths and rates of success in treatment management of addicted patients.

CONCLUSION: In this case, SD modeling identified current research gaps and strong contenders for appropriate follow-up questions in a clinical research domain, namely the role of chiropractic care in the management of chronic, nonmalignant pain in a Canadian population.

Author keywords: Chronic Pain, Musculoskeletal Pain, Pain Management, Chiropractic, Opioid-Related Disorders

Author affiliations: MM, CC, SM, MDF: Division of Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada; AN, WW: Department of System Science, Portland State University, Portland, Oregon.

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