The American Public Health Association has announced a public health policy statement for musculoskeletal pain, a statement that's long overdue for this 140-year-old organization that has historically focused on infectious disease. However, musculoskeletal pain affects millions across the U.S. every day, and low back pain alone is the single largest cause of years lived in disability, causing 83 million such years in 2010.
Chiropractors have a huge opportunity now to step forward and take a role in public health and the prevention and management of musculoskeletal pain. It's looking at an old problem in a new way: Rather than focusing on managing pain at the practice level, it's about asking if you can make a difference in how health systems can prevent or minimize chronic pain for a population.
As a chiropractor, there are two specific ways you can help: 1) Participate in research on risk factors for pain in populations and how those risk factors can be reduced or modified; and 2) Look beyond your individual patients and consider care at the population level—which will help individuals from those populations avoid pain in the first place.
Now that the APHA officially champions "advocacy for public health legislation that supports the prevention and management of musculoskeletal disorders" (APHA policy 20114) and has been influenced to rethink musculoskeletal pain as a public health concern, how can chiropractors also learn from this? If the relationship with the APHA is a two-way street, how can the chiropractic profession improve in response to the way this large public health organization adapted to rethink musculoskeletal pain? The key is in the policy quote above, specifically: "prevention and management."
Many chiropractors might rightly think: Aren't we already deeply involved in the management of low back pain and other causes of musculoskeletal pain? What could we learn about management from the APHA? And some might think chiropractors are already involved in prevention of low back pain and other musculoskeletal pain, perhaps envisioning spinal manipulation for chronic low back pain, or assigned home care or supervised exercises for individual patients.
However, to really prevent musculoskeletal pain, and to really think like public health agencies and practitioners, the chiropractic profession needs to widen its own gaze to consider the prevention of musculoskeletal pain at the population level. That is, the chiropractic profession needs to think: How can we reduce the overall burden and severity of musculoskeletal pain? Just as dentists think, How can health systems help prevent cavities in the first place? or public health nurses think, How can the health system help prevent diabetes in adolescents?, chiropractors need to actively consider how health systems can either stop musculoskeletal pain from happening at all, help fewer people get it, or help minimize its severity when it appears. Asking those questions about a reduction of the burden and severity of musculoskeletal pain in populations allows the public health perspective to influence the chiropractic perspective.
This article excerpt, by Jonathan Todd Egan, DC, MPH, PhD (cand.), originally appeared here: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=57379