Manual Therapy to Manage MSK Pain and Reduce Pharmacological Dependencies


Evidence-based Resources to Help Manage MSK Pain and Reduce Pharmacological Dependencies

The Centre for Effective Practice (CEP) has developed several evidence-based tools that outline and support the use of manual therapy to treat non-cancer, chronic pain. One of these is the evidence-based Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain Clinical Tool, which OCA hired CEP to develop.

This clinical tool is designed to increase medical doctors (MD)s’ and nurse practitioners (NP)s’ confidence in collaborating with chiropractors to implement an evidence-based plan of care to manage MSK pain while tapering a patient’s opioid use to reduce pharmacological dependencies. This plan may include patient education, manual therapy and therapeutic exercise. The Centre for Addiction and Mental Health (CAMH) included this clinical tool in its Opioid De-implementation Pathway for physicians.

The College of Chiropractors of Ontario (CCO) endorsed a complementary Chiropractor Dialogue Map that helps these regulated health professionals speak with their patients about safely managing their opioid use for MSK pain and stay within the chiropractic scope of practice.

Team-based and Collaborative Care

“Patients do better when they have a team of care providers, including not only family doctors and specialists but also nurses, dietitians, physiotherapists and others. Where these teams exist, patients have faster and easier access to specific care they need so are healthier, have fewer hospital admissions and are more satisfied. System costs are also reduced.” 


OCA’s Opioid and Pain Reduction Collaborative

We oversaw the development of these resources as part of our Opioid and Pain Reduction Collaborative to help chiropractors, or other manual therapists, coordinate a plan of care with patients and their prescribing health care professionals toward the end goal of them successfully reducing their opioid use.

Given the rise of opioid use during the COVID-19 pandemic, Caroline Brereton, our CEO believes “this is a watershed moment for all of us to come together to change the outcomes for Ontarians who depend on opioids to relieve their MSK pain.”  To learn more about our initiative and how chiropractic care can help these patients, please read her blog post: Addressing the Opioid Crisis with Interprofessional Collaboration.



CEP Resources

The CEP-developed clinical resources in this section will help you collaboratively manage patients with MSK and other types of chronic non-cancer pain.

Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain Tool

Manual Therapy as an Evidence-Based Referral for Musculoskeletal Pain Tool

MSK pain conditions are the biggest cause of disability internationally. They are often treated with pain medication, including opioids, and surgery when applicable. However, there is little guidance to assist medical doctors (MD)s and nurse practitioners (NP)s in implementing non-pharmacological treatments, such as manual therapy with or as an alternative to pharmacological treatment.

To address this gap, OCA hired CEP to develop this clinical tool. MDs and NPs like you can use it as a guide when referring a patient for manual therapy, delivered by a chiropractor, physiotherapist or registered massage therapist, collaborating on a plan of care and evaluating outcomes.

View/Download Clinical Tool
Clinically Organized Relevant Exam (CORE) Back Tool

Clinically Organized Relevant Exam (CORE) Back Tool

CEP developed the Clinically Organized Relevant Exam (CORE) Back Tool to help primary care professionals better manage patients who suffer from low back pain. This initiative’s goal was to reduce the number of unnecessary diagnostic tests, improve wait times and enhance patient care.

This tool was developed using an evidence review, expanded references and integration of expert input. The Canadian Spine Society (CSS) and the Nurse Practitioners’ Association of Ontario (NPAO) have endorsed this tool. Several OCA members were on the Education Planning Committee involved in its 2016 updated version.

View/Download Clinical Tool
Management of Chronic Non-Cancer Pain Tool

Management of Chronic Non-Cancer Pain (CNCP) Tool

As part of a collaboration between the CEP, Ontario College of Family Physicians (OCFP) and the Nurse Practitioners’ Association of Ontario (NPAO), this tool was developed to help primary care professionals support patients with CNCP. It was funded by the Ministry of Health and Long-Term Care.

This tool is designed to assist primary care professionals in developing and implementing a management plan for adult patients living with CNCP. It applies to various chronic pain conditions, including osteoarthritis, low back pain, musculoskeletal pain, fibromyalgia and neuropathic pain.

View/Download Clinical Tool