Position Statements

Pain can be challenging to manage. Every year, more than 11 million Canadians suffer from pain directly related to back and other musculoskeletal (MSK) conditions. According to the World Health Organization (WHO), MSK conditions are the second largest contributor to disability worldwide.

Chronic pain is associated with the poorest quality of life as compared with other chronic diseases. Health care practitioners and Canada’s health system struggle with safe and effective pain management. And, there are significant gaps in accessing appropriate and effective pain management options within the current healthcare system in Canada. The BCCA supports a better approach to pain management. An approach that includes prompt access to and integration of chiropractic care across the country.

Too often, pharmacological and invasive treatments (including opioids) are the first-line of treatment used to manage acute and chronic non-cancer pain. Notably, low back pain is one of the primary causes for over-use of prescribed opioids. Greater access to non-pharmacological alternatives through prompt triage and referral would decrease invasive treatments and the pressure to prescribe opioids. Interprofessional collaboration that integrates chiropractors into innovative models of health care can lead to improved patient outcomes and satisfaction, and reduced reliance on opioids by healthcare professionals for pain management.

Systematic reviews and clinical practice guidelines do not recommend the initiation of opioid therapy for chronic non-cancer pain. Rather, evidence supports the use of self-management strategies and conservative care including chiropractic as first-line treatments to help manage pain and improve function.

The wait times for publicly-funded pain clinics in Canada can be up to or greater than one year, with the majority of Canadians having limited access to proper care. Yet, referrals to first-line treatment options for managing MSK conditions, such as community-based interprofessional primary care clinics, rarely include chiropractors. Incorporating chiropractors as part of the pain management team will improve health outcomes and overall quality of life, as well as reduce the burden on healthcare systems.

The chiropractic profession supports public health promotion and prevention efforts that are essential to the physical and mental health and well-being of Canadians. As one of Canada’s largest primary contact professions, chiropractors are leading providers of care that directly contribute to many important public health goals.

Chiropractors provide effective treatment when low back pain and other musculoskeletal (MSK) conditions are limiting physical activity and mobility. Chiropractors are trained to take an active role in addressing risk factors related to preventing and managing a number of chronic diseases. Further, they promote physical activity and educate patients on healthy eating.

The BCCA recognizes that good health requires more than good health care. The BCCA supports national public policies and initiatives that address the socio-economic determinants of health such as mental health programs, early childhood development, poverty reduction, accessible education, and safe affordable communities.

Musculoskeletal (MSK) injuries and disorders are a significant public health concern. MSK conditions, including low-back and neck pain, are significant health issues and a leading reason for disability. MSK conditions are also significant contributors to inactivity, which make it difficult to prevent and manage many chronic diseases. For Canadians with a lower socioeconomic status, the prevalence of MSK conditions is higher, disproportionately impacting the group’s health and well-being. This population may face additional barriers to accessing needed care and challenges in securing or holding employment.

Public health authorities play an essential role in educating the public and healthcare professionals on the impact of MSK conditions. Public health initiatives can also help to promote access to evidence-based approaches to prevention and treatment, including where socio-economic barriers exist.

The BCCA supports public health initiatives that recognize the burden of MSK conditions as a public health concern. Canada’s chiropractors are committed to improving the health of Canadians by promoting prevention, early intervention, and community-based programs that enhance the health of our population.

The BCCA supports the protection of the public interest through the legislated establishment of independent regulatory authorities that have the power to grant or remove a practitioner’s license to practice. Each regulatory authority is charged with protecting the public interest by ensuring the competence of practitioners, establishing standards for the conduct of the profession, administering the scope of practice of the profession, and investigating complaints that may arise regarding the professional conduct of practitioners. The Board of each regulatory authority is comprised of individuals representing both the profession and the public.

The CCA’s Code of Ethics complements and supports the regulations of the provincial regulatory authorities by setting out the duties of members of the Association to their patients, to the profession and to society. All members of the BCCA are expected to conduct themselves in a manner consistent with the regulations of their provincial licensing body, as well as the CCA’s Code of Ethics and current Clinical Practice Guidelines approved by CCA.

Chiropractic is a regulated health profession with particular expertise in the care of the spine and extremity articulations. The legislated scope of practice of the profession includes the controlled act of spinal manipulation, a therapy that is central to the delivery of care by chiropractors.

Spinal manipulation requires a high degree of skill. The clinical decision to utilize manipulation is determined based on a thorough patient assessment and diagnosis requiring the clinical acumen to determine an appropriate course of treatment.

To ensure that the chiropractic profession is competent to assess, diagnose and provide spinal manipulation, the Council on Chiropractic Education of Canada (CCEC) requires that accredited chiropractic degree programs provide a minimum of 4,200 hours of education encompassing an approved curriculum. The World Health Organization (WHO) has also established 4,200 hours of training for chiropractic education in countries where is there is legislation governing the profession.

As well, the WHO has established a minimum of 2,200 hours of additional training for any other regulated health care professional, whose scope of practice includes the controlled act of manipulation, and who wishes to become proficient in the assessment and diagnosis of neuromusculoskeletal conditions and the application of spinal manipulation to address those conditions.

Therefore, it is the position of the BCCA, that chiropractors be educated in compliance with CCEC standards, and that other health professionals whose scope of practice includes the controlled act of spinal manipulation obtain a minimum of 2,200 hours of additional training that meets CCEC and WHO standards in order to be sufficiently qualified to assess and diagnose neuromusculoskeletal conditions and provide spinal manipulation.

The BCCA cautions that public safety is at risk when spinal manipulation is performed by any health professional whose training and education do not meet CCEC and WHO standards.

*Please note that this position statement is currently being updated or under review. If you have any questions, please contact the CCA at [email protected].

• • Chiropractic care has been shown to be effective for a range of neuromusculoskeletal (MSK) conditions for which there is credible research evidence. Communication of the benefits of care should be based on the best available literature and/or reasonable clinical experience.
  • The communication of diagnosis following a comprehensive patient assessment is a fundamental element of clinical excellence.
  • The provision of a treatment plan with clear markers for evaluation of patient progress and improvement is essential to patient-centred care.
  • The provision of care should be preceded by a discussion of the benefits and risks of the proposed treatment. Patient consent should be documented in the patient’s file.
  • Ongoing treatment of a patient should be based on clinical findings and consideration of objective and subjective improvement. Re-evaluation of the need for care at regular intervals is essential. The absence of re-assessment renders long-term projections of care as conjecture.
  • Referral to or consultation with an appropriate health care provider is warranted when there is a lack of clinical improvement or diagnosis for which chiropractic care is not indicated.
  • Patient care should not be contingent on conditions such as, but not limited to, requiring pre-payment, tying delivery of treatment to participation in a clinic activity, or requiring other family members to attend the clinic for treatment.
  • Privacy is the right of all patients. Options for privacy must be made available to all patients and the privacy of patients must be respected and accommodated at all times.

*Please note that this position statement is currently being updated or under review. If you have any questions, please contact the CCA at [email protected].

The BCCA believes that patient-centred interprofessional collaboration is critical to improving the quality of health care in Canada. Interprofessional collaboration strengthens health systems and improves health outcomes. Patient satisfaction, quality of care, and the cost of care delivery can also be enhanced through a collaborative patient-centred approach.

Interprofessional collaboration happens when two or more health care professionals across different disciplines work together to achieve common patient goals. Team-based collaborative care facilitates access to a diverse range of disciplines to address the needs of patients and improve their health outcomes. Chiropractors, as musculoskeletal (MSK) experts, are uniquely positioned to help strengthen the health care team by managing patients with underlying MSK conditions. Chiropractors can provide primary methods of treatment or work collaboratively with other healthcare providers and provide patient referrals as needed.

Chiropractors offer expertise in various MSK conditions, including acute and chronic pain, which is a key driver of costs and health care utilization in Canada. To appropriately manage pain, for example, a multi-modal, interprofessional approach is recommended. For MSK conditions, this collaborative approach should include chiropractic as an important conservative care option prior to considering medication or invasive interventions.

The delivery of health care in Canada is constantly evolving, driven by patient demands, fiscal influences, primary care reform, stakeholder demographics, and the integration of various health practitioner groups into the formal health care system.

The chiropractic profession has also evolved and is defined by the following characteristics:

• • Legislated regulatory bodies in every jurisdiction with the statutory authority to define the scope of practice, impose standards of practice, and protect the public interest;
  • Established efficacy for a range of clinical indications; Standardized national examinations;
  • Inclusion in the limited group of regulated health professionals who deliver primary contact health care;
  • Established legislation wherein chiropractors are permitted to undertake the controlled act of adjustment/manipulation of the spine and extremity joints;
  • An established and growing base of substantive evidence for musculoskeletal (MSK) conditions.

The chiropractic profession adheres to a patient-centred, biopsychosocial approach to health care, encompassing examination, diagnosis and treatment, and utilizing conservative, safe approaches to health care, minimizing patients’ reliance on drugs and surgery when possible. Chiropractic care is included in insurance plans by both government and third-party payers.

While chiropractic care has been considered Complementary and Alternative Medicine (CAM), the chiropractic profession in Canada today is best described as a regulated, primary contact health profession with particular expertise in the care of the spine and extremity articulations.

*Please note that this position statement is currently being updated or under review. If you have any questions, please contact the CCA at [email protected].

The BCCA supports public policies for improving the delivery of health care services that are integrative, patient-centred and reflective of outcomes. The BCCA advocates that the Canada Health Act definition of “medically necessary” be revised to better reflect the needs of Canadians and the scientific evidence in order to:

• • Assure that patients receive the most appropriate care;
  • Assist in removing financial barriers which prevent patient access to the most efficacious, evidence-based treatment from the best-qualified health care providers, and;
  • Facilitate inter-disciplinary patient care where indicated.

It is the position of the BCCA that government health plans should include meaningful coverage for chiropractic care and that every Canadian should have full and equitable access to chiropractic care.

The BCCA supports health care system reform based on a multi-disciplinary, primary health care model that recognizes the effectiveness and cost-saving value of evidence-based, regulated health services, such as chiropractic, in addition to medicine.

The BCCA believes that the sustainability of the Canadian health care system can only be achieved through greater inter-professional co-operation and an integrated approach to patient care that emphasizes health promotion and preventive care.

*Please note that this position statement is currently being updated or under review. If you have any questions, please contact the CCA at [email protected].