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Chiropractic Care and Gut Health Support Integration

Chiropractic Care and Gut Health Support Integration

Chiropractic Care and Gut Health Support at El Paso Back Clinic®

Chiropractic Care and Gut Health Support Integration

Digestive symptoms can be frustrating because they often feel unpredictable. You may eat “right,” take probiotics, and still deal with reflux, bloating, constipation, or IBS-like flare-ups. One reason is that digestion is not just about food—it is also about how well your nervous system regulates the gut, how your body handles stress, and how your posture and spinal mechanics affect breathing and pressure patterns through the abdomen. This is where an integrative chiropractic approach can be a helpful part of a broader plan.

At El Paso Back Clinic®, the care model described in their wellness content blends chiropractic, functional medicine, and nutrition-based strategies to support whole-body recovery—not just symptoms. The goal is practical: help the body move better, regulate stress more effectively, and create conditions that support improved gut function.

This article explains the key ways chiropractic care may support gut health—especially when digestive symptoms overlap with posture strain, chronic pain, and stress physiology—and how an integrative clinic may pair adjustments with nutrition and lifestyle guidance.

Important: Chiropractic care can be supportive, but it does not replace medical evaluation. If you have severe or persistent symptoms, unexplained weight loss, blood in stool, fever, vomiting, or trouble swallowing, seek medical care promptly.


The Gut–Brain–Spine Connection (Why Digestion Is Not “Just the Stomach”)

Your digestive system is closely linked with your nervous system. The “gut–brain axis” is the two-way communication between your brain and your GI tract through nerves, hormones, immune signals, and the gut microbiome. When your nervous system is stressed, digestion can shift too—motility changes, sensitivity increases, and symptoms can feel worse.

Many people notice patterns like these:

  • Stressful week → more reflux or belly tightness

  • Poor sleep → constipation or loose stools

  • Long hours sitting → bloating or slower digestion

  • Neck/back pain flare → gut flare

Integrative chiropractic sources often describe that spinal tension and restricted movement can add “noise” to the nervous system. They propose that improving spinal mechanics may help the body shift into a better-regulated state that supports digestion.


Key Way #1: Reducing Physical Stress Load That Can Keep the Body in “Alarm Mode”

A stressed body does not digest as smoothly. Physical stress includes more than emotions—it also includes:

  • Chronic neck and back pain

  • Poor posture and muscle guarding

  • Shallow breathing patterns

  • Limited daily movement

  • Long sitting or repetitive work strain

Many chiropractic gut-health articles describe adjustments as a way to reduce musculoskeletal tension and improve joint motion, which may help calm the body’s overall stress response.

At El Paso Back Clinic®, the broader philosophy discussed in their blog is holistic and recovery-focused—helping patients restore function after injury and addressing lifestyle factors that affect healing.

What this can mean in real life:

  • Less back tightness → easier walking after meals

  • Less ribcage stiffness → deeper breathing (better “rest-and-digest” support)

  • Less pain → better sleep (which supports digestion and appetite regulation)


Key Way #2: Supporting Nervous System Regulation (Including the Gut–Brain Axis)

Many clinics explain the digestive benefits of chiropractic care by noting that the spine influences nervous system signaling to the body, including the digestive tract.

Even if you describe it in simple terms, the concept is straightforward:

  • The brain and gut constantly communicate.

  • When the nervous system is overloaded, digestion can become less predictable.

  • If care reduces pain and tension and improves movement patterns, the nervous system may become less reactive.

Several chiropractic resources you provided describe chiropractic adjustments as supporting the nervous system’s “control” of digestion and helping to normalize digestive movement.

At El Paso Back Clinic®, gut-focused posts use similar language—describing the nervous system as a key driver of gut function and positioning chiropractic care as part of a “reset” strategy paired with nutrition and detox-style lifestyle support.


Key Way #3: Thoracic (Mid-Back) Function, Rib Motion, and Reflux-Like Symptoms

Reflux and heartburn are not only about stomach acid. They can also worsen when:

  • Posture is collapsed (rounded shoulders, forward head)

  • The rib cage doesn’t expand well

  • Breathing becomes shallow and upper-chest dominant

  • Abdominal pressure patterns increase (especially after meals)

Some chiropractic sources discuss thoracic spine and upper abdominal mechanics in relation to digestion and reflux. They suggest that improving spinal mobility and reducing tension patterns may help some individuals experience smoother digestion.

Supportive strategies often paired with care include:

  • Posture coaching for desk work and driving

  • Gentle thoracic mobility work

  • Meal timing (avoiding late heavy meals when reflux is an issue)

  • Breathing drills that encourage diaphragmatic expansion

El Paso Back Clinic® also emphasizes combining chiropractic with nutrition and wellness planning, which fits well with reflux management strategies (food triggers, timing, and stress load).


Key Way #4: Lumbar (Low Back) and Pelvic Mechanics That Can Affect “Sluggish” Motility

Constipation and slow motility usually involve several factors at once:

  • Hydration and fiber intake

  • Daily movement and walking

  • Stress and nervous system tone

  • Pelvic floor coordination

  • Medication side effects

  • Pain and guarding patterns

Some chiropractic resources propose that addressing lower back and pelvic mechanics supports more normal digestive movement by reducing tension and supporting nervous system regulation.

There is also published clinical literature on chiropractic care and gastrointestinal symptoms, including reports and studies in which some patients reported improvement. The evidence varies in quality, and results are not guaranteed, but it supports why this topic continues to be explored.

If constipation is persistent, do not guess—get evaluated. Chronic constipation can sometimes point to thyroid issues, medication effects, pelvic floor dysfunction, or other medical problems that need specific care.


Key Way #5: Breathing Mechanics, the Diaphragm, and Abdominal Pressure

Breathing is not just for oxygen—it also affects the “pressure system” of the trunk, including the abdomen and pelvic floor.

When someone is stuck in shallow breathing, they may experience:

  • Higher neck and chest tension

  • Reduced diaphragm motion

  • More bracing through the belly

  • Less core stability during movement

  • A stress pattern that can aggravate gut symptoms

Integrative chiropractic articles often connect spinal tension, stress regulation, and digestion—suggesting that improving mobility and reducing pain may help people return to healthier breathing patterns that support “rest-and-digest” physiology.

At El Paso Back Clinic®, the integrative style described in gut-focused and nutrition-focused posts supports this whole-body logic: address mechanics, address stress, and support healing habits.


Key Way #6: Integrative Chiropractic + Nutrition Support (Where Results Often Improve)

One of the strongest points across your resources is that chiropractic care is often most effective for gut goals when paired with nutrition guidance and daily habits.

El Paso Back Clinic® specifically highlights nutrition and functional medicine-style planning as part of their wellness approach, including digestive health support through diet, stress management, and personalized routines.

Examples of gut-supportive nutrition habits that many clinics focus on:

  • More whole, fiber-rich foods (vegetables, beans, berries, oats—if tolerated)

  • Adequate protein for tissue repair and stable energy

  • Hydration consistency (not just “some water”—daily enough to support motility)

  • Fermented foods or probiotics when appropriate (and tolerated)

  • Identifying trigger foods (spicy foods, alcohol, carbonated drinks, ultra-processed foods)

Lifestyle add-ons that often matter just as much as food:

  • A short walk after meals

  • Regular sleep schedule

  • Stress downshifts (breathing drills, stretching, sunlight, journaling)

  • Less late-night eating if reflux is an issue

This is also consistent with the “nutrition + digestion + whole-body wellness” emphasis described in El Paso Back Clinic® content.


Key Way #7: The Gut–Liver Connection (Detox Is a Process, Not a Trend)

El Paso Back Clinic® also publishes content on the gut–liver connection, emphasizing that digestion and detoxification are linked through bile flow, gut barrier function, and metabolic processing.

A grounded way to think about it:

  • Your liver processes and packages substances for elimination.

  • Your gut helps move waste out of the body.

  • If motility is slow or the gut barrier is irritated, you may feel worse.

Their clinic content frames chiropractic and integrative care as supportive tools within a broader plan that includes nutrition and lifestyle strategies.


What Chiropractic Can (and Can’t) Claim for Gut Issues

To keep this honest and helpful:

Chiropractic care may help support

  • Stress-related digestive flare-ups

  • Tension patterns that affect breathing and abdominal pressure

  • Motility support for some people when paired with movement and nutrition

  • Overall regulation by improving pain, posture, and mobility

Chiropractic care does not replace

  • Workups for GERD, ulcers, gallbladder disease, IBD, celiac disease, infections, or anemia

  • Imaging/labs when symptoms are severe or persistent

  • Medication decisions (always coordinate with a prescribing clinician)

Some clinic resources discuss improvements in reflux, constipation, and IBS symptoms, but responses vary by person and by the underlying cause of the symptoms.


A Practical “El Paso Back Clinic® Style” Support Plan (Simple and Actionable)

If you want the best chance of success, use a layered plan instead of a single tactic.

Step 1: Track your patterns for 14 days

Write down:

  • What you eat and when

  • Stress level (1–10)

  • Sleep (hours + quality)

  • Symptoms (reflux, bloating, constipation, pain)

  • Movement (walked after meals or not)

Step 2: Address mechanics + regulation

Supportive options commonly used in integrative chiropractic settings include:

  • Spinal adjustments (as appropriate)

  • Mobility work (thoracic spine, hips)

  • Soft tissue work for tension patterns

  • Breathing drills to downshift stress response

Step 3: Make digestion easier with “boring basics”

  • Hydration daily

  • Protein + fiber consistency

  • Walk 10 minutes after meals (if tolerated)

  • Reduce late-night heavy meals if reflux is present

Step 4: Reassess honestly

  • Better? Keep what works and build gradually.

  • Not better? Escalate evaluation and get medical guidance. Don’t keep guessing.


Incorporating Dr. Alexander Jimenez’s Clinical Observations (Integrative Lens)

El Paso Back Clinic® content describes Dr. Alex Jimenez as providing integrative, whole-body wellness insights—often linking musculoskeletal function, gut health, nutrition, and recovery planning.

His dual-scope background (DC + APRN/FNP) is presented across related clinic and professional profiles as supporting a broader clinical perspective—especially when symptoms involve multiple systems at once.

In the gut-health articles on El Paso Back Clinic®, the clinical message is consistent:

  • Digestion is connected to nervous system regulation,

  • Chiropractic care can reduce stress load and support function,

  • Nutrition and lifestyle strategies help make the improvements “stick.”


Conclusion

Gut health is not only a food issue—it is also a regulation issue. When your body is tense, inflamed, sleep-deprived, or stuck in poor movement patterns, digestion often becomes more reactive. Chiropractic care may support gut health by improving spinal mechanics, reducing physical stress load, and helping the nervous system shift toward a calmer “rest-and-digest” state—especially when paired with nutrition and lifestyle strategies.

At El Paso Back Clinic®, the care approach described in their wellness content emphasizes integrative recovery: chiropractic support, nutrition planning, and whole-body habits aimed at restoring function and resilience.


References

Poor Posture, Breathing, and Digestion Health Tips

Poor Posture, Breathing, and Digestion Health Tips

Poor Posture, Breathing, and Digestion

Poor Posture, Breathing, and Digestion Health Tips

A Practical Guide for El Paso Back Clinic Readers

Poor posture is more than a back or neck problem. It can also affect how well you breathe and how well your digestive system works. When a person slouches, hunches forward, or carries the head too far in front of the shoulders, the rib cage and abdomen lose space. That change can make it harder for the diaphragm to move well, which may lead to shallow breathing and lower oxygen intake. It can also place extra pressure on the stomach and intestines, which may contribute to reflux, bloating, and constipation (UCLA Health, 2024; Harvard Health Publishing, 2023).

This article is written for the El Paso Back Clinic audience and follows the clinic’s integrative approach: look at posture, spinal alignment, breathing mechanics, mobility, and daily habits together. The clinic and Dr. Alexander Jimenez frequently discuss posture and breathing as a functional pattern, not just a pain issue, on their educational pages. In other words, how you hold your body can shape how your lungs, core, and digestive system work throughout the day (Jimenez, n.d.; El Paso Back Clinic, n.d.).


Why Posture Matters for Breathing

Your diaphragm is the main muscle used for breathing. It sits below the lungs and helps pull air in when it moves downward. For that to happen easily, your rib cage and abdomen need enough room to expand.

When posture collapses (slouching, rounded shoulders, forward head posture), several things can happen:

  • The chest may cave inward

  • The upper back may round more

  • The ribs may not expand as well

  • The diaphragm may not move as freely

  • The body may rely more on neck and shoulder muscles to breathe

UCLA Health explains that poor posture can cause the chest to cave in, affecting breathing mechanics (UCLA Health, 2024). Harvard also lists breathing difficulties among the less obvious problems linked to poor posture (Harvard Health Publishing, 2023).

A research article on head-neck posture and respiratory function also found that posture changes can alter normal breathing mechanics, including diaphragm function. This matters because many people spend hours sitting at a desk, driving, or looking down at phones, which can reinforce forward head posture and rounded shoulders (Zafar et al., 2018).

Common signs that posture may be affecting your breathing

You may not always say, “I can’t breathe.” Instead, people often describe it like this:

  • “I can’t take a full deep breath”

  • “My chest feels tight when I sit”

  • “My neck and shoulders always feel tense”

  • “I sigh a lot”

  • “I feel winded faster than I should”

Sources on physical therapy and posture education also note a connection between poor posture and reduced diaphragm mobility, poor chest expansion, and shallow breathing (Capital Area PT, 2025; Total Health Chiropractic, 2022).


How Poor Posture Can Affect Digestion

Most people think digestion is only about food choices, enzymes, or stomach acid. Those are important, but body position matters too.

When you slouch, your abdomen compresses. That pressure can affect the stomach and intestines. UCLA Health notes that poor posture can slow digestion and increase abdominal pressure, which may trigger heartburn and acid reflux (UCLA Health, 2024).

BreatheWorks and other posture-focused digestive resources describe similar patterns: slouched alignment can increase abdominal pressure, affect swallowing and breathing coordination, and make reflux or bloating worse for some people (BreatheWorks, 2023a, 2023b).

Digestive symptoms that may be worse with slouching

Some common examples include:

  • Heartburn after meals

  • Acid reflux (GERD) symptoms when sitting or bending

  • Bloating or pressure in the upper abdomen

  • Feeling overly full

  • Constipation (especially with long periods of sitting)

Chiropractic and posture education sources (including Nolensville Chiropractic and BreatheWorks) often describe poor posture as a “compression” problem that can interfere with comfortable digestion and gut motility (Nolensville Chiropractic, 2025; BreatheWorks, 2023a).


The Breathing–Digestion Connection

Breathing and digestion are closely linked, and posture affects both simultaneously.

Here’s why:

The diaphragm supports both breathing and abdominal pressure control

The diaphragm is not just a breathing muscle. It also helps regulate pressure in the trunk. If it cannot move well, breathing becomes less efficient, and pressure control in the abdomen may change.

Poor posture can encourage shallow chest breathing

When breathing shifts more into the upper chest and neck, the body often feels more tense. In many people, this goes along with stress and “fight-or-flight” patterns, which can make digestion feel worse.

Slouching compresses the digestive area

A flexed, collapsed posture can reduce the space available to the stomach and intestines. That can be especially noticeable after eating.

BreatheWorks specifically describes how breathing coordination, alignment, and digestive comfort are connected, especially in people with reflux and bloating symptoms (BreatheWorks, 2023a, 2023b). El Paso Back Clinic and Dr. Jimenez’s educational content also emphasize this whole-body view, especially in patients with both musculoskeletal complaints and gut-related symptoms (Jimenez, n.d.; El Paso Back Clinic, n.d.).


Posture Patterns That Commonly Cause Problems

At El Paso Back Clinic, many patients dealing with neck, upper back, or shoulder pain also show posture patterns that can affect breathing and digestion. Dr. Jimenez’s educational content often highlights the same patterns in functional assessments (Jimenez, n.d.).

Forward head posture

This happens when the head moves in front of the shoulders. It increases neck strain and often leads to upper-chest breathing.

Rounded shoulders

Rounded shoulders can limit chest expansion and change rib cage motion.

Excessive upper-back rounding (kyphotic posture)

This can reduce thoracic mobility (mid-back motion), which is important for full breathing.

Slumped sitting posture

A tucked pelvis, a collapsed lower back, and a caved chest can increase abdominal pressure, making both breathing and digestion less efficient.


Why Integrative Chiropractic Care Can Help

A strong posture plan usually needs more than a quick reminder to “sit up straight.” Many people need a combination of mobility work, spinal/rib movement restoration, soft-tissue care, breathing retraining, and strength work to build lasting change.

That is why the El Paso Back Clinic approach is helpful for many people. The clinic’s posture and rehabilitation content describes a broader plan that can include:

  • Spinal adjustments

  • Mobility and stretching

  • Movement retraining

  • Soft-tissue care

  • Posture-focused exercises

  • Health coaching (El Paso Back Clinic, n.d.)

How this may improve breathing

When spinal and rib mobility improve, the chest can move more naturally during breathing. That can support deeper, more efficient breaths and reduce overuse of neck muscles.

How this may improve digestion

When posture improves, abdominal compression may decrease. Better alignment can also make it easier to breathe diaphragmatically, which may support calmer, more comfortable digestion in some patients.

Dr. Jimenez’s educational pages also describe the importance of posture, breathing mechanics, rib mobility, and functional movement in patients with reflux, bloating, and related complaints (Jimenez, n.d.).


Practical Steps to Improve Posture, Breathing, and Digestion

The good news is that small daily changes can make a real difference.

Reset your sitting posture

Try this simple “stacking” setup:

  • Feet flat on the floor

  • Hips level (not rolled backward)

  • The rib cage is stacked over the pelvis

  • Shoulders relaxed (not rounded forward)

  • Chin level (not poking forward)

Even a few posture resets per day can help reduce the long stretches of slouching that many people fall into while working or driving (UCLA Health, 2024).

Use posture breaks every 30–60 minutes

Long sitting is a major factor in the worsening of posture over time. A short break helps.

Quick break routine (2 minutes)

  • Stand up

  • Roll your shoulders back gently

  • Take 5 slow breaths

  • Walk for 1 minute

  • Reset your sitting position

This kind of movement break can reduce stiffness and help restore better breathing mechanics. General health and posture guidance consistently supports frequent movement to reduce the effects of prolonged sitting (Harvard Health Publishing, 2023; UCLA Health, 2024).

Practice diaphragmatic breathing

Diaphragmatic breathing can help train the body away from shallow chest breathing.

Simple drill (1–2 minutes)

  • Sit upright or lie on your back

  • Place one hand on your chest and one on your belly/ribs

  • Breathe in through your nose

  • Try to expand the lower ribs and belly gently

  • Exhale slowly and fully

  • Keep shoulders relaxed

Posture-focused breathing resources often recommend this type of drill to improve breathing efficiency and reduce tension (Capital Area PT, 2025; Total Health Chiropractic, 2022).

Improve meal posture

How you sit while eating matters, especially if you have reflux.

Better meal posture tips

  • Sit upright when eating

  • Avoid eating while slouched on a couch

  • Chew slowly

  • Stay upright after meals

  • Take a light walk after eating if possible

BreatheWorks and UCLA Health both discuss how posture can affect reflux and digestive comfort, especially in people who slouch during or after meals (BreatheWorks, 2023b; UCLA Health, 2024).


When to Get Medical Care Right Away

Posture can affect breathing and digestion, but some symptoms require medical evaluation and should not be blamed solely on posture.

Seek prompt medical care if you have:

  • Chest pain

  • Severe shortness of breath

  • Trouble swallowing

  • Vomiting blood

  • Black/tarry stools

  • Severe abdominal pain

  • Unexplained weight loss

  • Ongoing reflux that is not improving

These can be signs of a more serious condition and need a full medical workup (UCLA Health, 2024; Harvard Health Publishing, 2023).


Clinical Perspective from Dr. Alexander Jimenez, DC, APRN, FNP-BC

For the El Paso Back Clinic audience, the key message is simple: posture problems are often functional problems. In Dr. Jimenez’s educational content, posture is not treated as an isolated issue. It is part of a bigger clinical picture that includes spinal mechanics, rib motion, breathing patterns, stress load, and daily movement habits (Jimenez, n.d.).

That is why many patients feel better when care is more comprehensive. Instead of only focusing on pain, an integrative plan may help by:

  • Improving spinal and rib mobility

  • Restoring more natural breathing mechanics

  • Reducing neck and shoulder overuse

  • Addressing posture during work and meals

  • Supporting better movement and daily function

The El Paso Back Clinic posture and rehabilitation pages also describe a personalized approach using adjustments, exercise, stretching, and movement retraining, which fits well with this type of whole-body care model (El Paso Back Clinic, n.d.).


Final Takeaway

Poor posture can affect much more than the spine. Slouching and forward head posture can limit diaphragm movement, reduce chest expansion, and lead to shallow breathing. At the same time, abdominal compression can make digestion less comfortable and may worsen reflux, bloating, and constipation in some people.

The good news is that posture can improve. With the right plan—especially one that includes posture correction, breathing retraining, and integrative chiropractic care—many people can breathe better, move better, and feel more comfortable after meals.

For readers of El Paso Back Clinic, this is an important reminder: posture is not just about standing tall. It is about giving your body the space and mechanics it needs to function well.


References

Primary Care Doctor vs. a Gastroenterologist for Digestive Issues

Primary Care Doctor vs. a Gastroenterologist for Digestive Issues

When to See a Primary Care Doctor vs. a Gastroenterologist for Stomach Problems

Primary Care Doctor vs. a Gastroenterologist for Digestive Issues

A senior man working in the office and having stomach pain

Stomach issues can range from minor annoyances to serious health concerns that affect daily life. Many people wonder whether to see their primary care doctor or a specialist when experiencing digestive discomfort. A primary care physician (PCP), also known as a general practitioner or family doctor, manages overall health and addresses common problems. In contrast, a gastroenterologist (GI doctor) has additional training to diagnose and treat complex digestive system conditions, including the esophagus, stomach, intestines, liver, and more. Understanding when to choose one over the other can help you get the right care faster and avoid unnecessary worry.

This article explores the key differences, the symptoms that guide your decision, and alternative options such as integrative care from nurse practitioners and chiropractors. We’ll also draw on clinical insights from experts, including Dr. Alexander Jimenez, to provide a well-rounded view.

Starting with Mild or New Digestive Issues: See Your Primary Care Doctor

For many stomach problems, your first stop should be a PCP. These doctors are trained to manage a wide array of health issues, including basic digestive complaints. They can perform initial exams, order simple tests, and prescribe treatments for everyday problems. If the issue proves more complex, they can refer you to a specialist.

Primary care doctors often treat short-lived or mild symptoms effectively. For example, if you have a brief episode of stomach flu, they can recommend hydration and rest. They also address common conditions such as occasional heartburn or mild constipation with over-the-counter remedies or lifestyle changes. This approach saves time and money, as PCP visits are usually easier to schedule and less specialized.

Here are some common scenarios where a PCP is the best choice:

  • Short-term stomach flu: If you have sudden nausea, vomiting, or diarrhea that lasts a few days, a PCP can check for dehydration and suggest fluids or anti-nausea meds.
  • Mild or occasional heartburn: Burning in your chest after meals, especially if it occurs rarely, can often be managed with dietary adjustments, such as avoiding spicy foods.
  • Light constipation: If you’re having trouble with bowel movements but it’s not chronic, a PCP might recommend more fiber or exercise.
  • Simple stomach aches: General discomfort from gas, indigestion, or overeating usually resolves with basic care from your regular doctor.

According to health experts, primary care providers can evaluate or begin treatment for mild or acute symptoms, such as occasional digestive upsets. They focus on your overall health, considering how stomach issues may be linked to other factors such as stress or medications. If symptoms don’t improve, they guide you to the next step.

PCPs play a key role in improving gut health through preventive measures. They can discuss diet, screen for basic issues, and monitor ongoing mild problems. In some cases, if symptoms persist, they may order tests such as blood work before referring you. This holistic oversight ensures nothing is overlooked early on.

When Symptoms Are Serious or Ongoing: Time for a Gastroenterologist

If your digestive problems are persistent, severe, or accompanied by warning signs, it’s best to see a gastroenterologist. These specialists complete additional years of training beyond medical school, specializing in the digestive tract. They use advanced tools, such as endoscopies and colonoscopies, to identify and treat conditions that a PCP may not address on their own.

Gastroenterologists are experts in conditions affecting the esophagus, stomach, small and large intestines, liver, pancreas, and gallbladder. They can manage chronic diseases and perform procedures to remove polyps or biopsy tissues. If you’re over 45, they often recommend routine screenings to catch problems early.

Key signs that point to needing a GI doctor include:

  • Trouble swallowing: If food feels stuck or causes pain, this may indicate esophageal issues such as GERD or strictures.
  • Constant abdominal pain: Ongoing discomfort that doesn’t respond to basic treatments may indicate ulcers, gallstones, or inflammation.
  • Blood in stool or rectal bleeding: Red or black stools can be a red flag for hemorrhoids, polyps, or even cancer.
  • Unexplained weight loss: Losing pounds without trying, especially with appetite changes, needs specialist evaluation.
  • Chronic diarrhea: Loose stools lasting more than four weeks may indicate IBS, IBD, or infection.
  • Recurrent heartburn: If it occurs frequently and over-the-counter medications don’t help, it may be GERD requiring advanced care.
  • Age 45 or older for screening: Even without symptoms, a colonoscopy is advised to prevent colorectal cancer.

Experts note that symptoms like rectal bleeding, frequent heartburn, or changes in bowel habits warrant a visit to a gastroenterologist for specialized care. For instance, ongoing diarrhea or constipation might stem from disorders like irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO), which GIs can diagnose with targeted tests.

Gastroenterologists also handle liver-related problems, such as fatty liver disease or hepatitis, and pancreatic issues like pancreatitis. Their training enables them to identify subtle signs that could lead to serious conditions if left unaddressed. If you have a family history of digestive diseases, seeing a GI early can be crucial for prevention.

Not Sure Where to Start? Begin with Your PCP for Guidance

If you’re unsure about your symptoms, it’s always safe to start with a primary care doctor. They act as your health coordinator, assessing the issue and deciding if a referral is needed. This step prevents jumping straight to a specialist when a simple fix might suffice.

PCPs can run initial tests, like stool samples or X-rays, to rule out common causes. If results show something unusual, they’ll refer you to a GI doctor. This system ensures efficient care and avoids overwhelming specialists with minor cases.

For example, mild heartburn might be managed by a PCP with lifestyle advice, but if it’s chronic, they’ll send you for further evaluation. Starting here also builds a complete health record, helping any specialist understand your full picture.

Exploring Integrative Options: Nurse Practitioners and Chiropractors for Holistic Care

Beyond traditional doctors, integrative approaches offer another path for managing stomach problems. Nurse practitioners (NPs), especially in functional or integrative medicine, provide patient-centered care with more time for in-depth discussions. They focus on root causes such as diet, stress, sleep, and nutrient deficiencies, often ordering advanced tests such as microbiome mapping or food sensitivity panels.

Functional medicine differs from conventional medicine in that it places greater emphasis on history and uses lab tests to address imbalances in the gut microbiome or leaky gut. NPs create personalized plans emphasizing whole foods, reduced sugar, and lifestyle changes to reduce inflammation and support digestion.

Integrative chiropractors take a whole-body view, linking spinal health to digestion through the gut-brain connection. Misalignments, or subluxations, can disrupt nerves that control the digestive system, leading to symptoms such as bloating or constipation. Adjustments restore nerve function, improve posture, and enhance blood flow to organs.

Key ways chiropractors help:

  • Gut-brain connection: Aligning the spine supports the autonomic nervous system, balancing stress responses that affect digestion.
  • Manual therapies: Techniques such as visceral manipulation gently realign organs to ease pain and improve movement.
  • Lifestyle guidance: Advice on anti-inflammatory diets, supplements, and exercises to boost gut health.

Studies show that chiropractic care can alleviate symptoms such as indigestion and abdominal pain by improving gastrointestinal function. At centers like Highland Wellness, precise adjustments promote nutrient absorption and reduce digestive disorders holistically.

Insights from Dr. Alexander Jimenez on Integrative Digestive Care

Dr. Alexander Jimenez, DC, APRN, FNP-BC, IFMCP, CFMP, brings over 30 years of experience in integrative chiropractic and functional medicine. He emphasizes addressing the root causes of digestive issues through detailed assessments of genetics, lifestyle, and environmental factors. His approach combines chiropractic adjustments with nutrition and detox protocols to treat chronic conditions like inflammation and autoimmunity, which often affect the gut.

Dr. Jimenez highlights the gut-brain connection, noting that spinal misalignments can affect digestion through nerve signals to the immune and endocrine systems. He uses non-invasive methods, such as spinal decompression and exercises, to restore balance and reduce symptoms. For instance, patients with back pain and digestive complaints benefit from movement-based recovery that links spine and gut health.

In his functional medicine practice, Dr. Jimenez promotes personalized nutrition to prevent chronic diseases and support gut microbiota. He integrates therapies such as acupuncture and stress management, referring patients to specialists as needed for collaborative care. His work underscores that holistic methods can complement traditional care, focusing on long-term wellness rather than just symptoms.

Balancing Traditional and Integrative Approaches for Better Outcomes

Combining PCPs, GIs, and integrative providers offers the best results for many. A PCP might start with basics, a GI handles diagnostics, and an NP or chiropractor adds lifestyle support. This team approach addresses both immediate symptoms and underlying causes.

For chronic issues like IBS, functional medicine’s focus on diet and stress can reduce flare-ups alongside GI treatments. Chiropractic care may alleviate pain associated with nerve issues, improving overall comfort.

Preventive care is key: regular check-ups with a PCP, GI screenings, and holistic habits help prevent escalation. Listen to your body—if symptoms change, seek help promptly.

In summary, for mild or new stomach problems, see a PCP. For chronic or severe ones, consult a gastroenterologist. Integrative options provide added support. Always prioritize your health by starting with professional advice.


References

Hancock Health. (2021). GI or GP? That is the question.

Advocate Health. (n.d.). When to see a gastroenterologist.

Houston Methodist. (2022). 7 signs it’s time to see a gastroenterologist.

Rush University Medical Center. (n.d.). 5 reasons to see a gastroenterologist.

Verywell Health. (2023). What is a gastroenterologist?

TruHealers. (n.d.). Chiropractor for gut health: Enhancing digestion and well-being through chiropractic care.

PARC of Ontario. (n.d.). How chiropractic care improves digestive health.

Rupa Health. (n.d.). Functional medicine vs. conventional medicine: Key differences.

Jimenez, A. (n.d.). Dr. Alex Jimenez – El Paso’s Chiropractor.

Jimenez, A. (n.d.). Dr. Alexander Jimenez DC, APRN, FNP-BC – LinkedIn.

A Clinical Approach and Its Implications on Opioid Use Disorder

A Clinical Approach and Its Implications on Opioid Use Disorder

Discover the importance of a clinical approach to opioid use disorder in developing effective intervention strategies.

Overcoming Barriers in Managing Opioid Use Disorder: Strategies for Effective Care

Many people today have a serious health problem called opioid use disorder (OUD). It is part of a bigger group of problems called substance use disorders (SUD). Treating OUD can be hard because everyone has different problems, such as other health issues or pain. Plans should be made for each patient by doctors and other health care workers. They also have to keep up with the latest laws, ethics, and ways to keep patient information safe. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is an example of a general rule that applies to all patients. However, there are extra rules for people who are getting help with drug or alcohol problems.

This guide talks about how to deal with problems that come up when managing OUD. We talk about patient-centered care, how to talk to patients, stigma, team-based approaches, and the law. Health care providers can help patients get better faster by using these methods. Keywords like “managing opioid use disorder,” “overcoming stigma in OUD,” and “patient-centered care for SUD” bring out important points that make it easier to find and understand.

Learning Objectives

  • Explain treatment planning methods that use patient-focused choices and proven ways to talk.
  • Name the three kinds of stigma and how they affect people with mental health issues, SUD, and especially OUD.
  • Talk about legal, ethical, and privacy concerns in caring for people with OUD.

Effective Treatment Planning with Patient-Centered Decisions

People with complex issues, like mental health problems, SUD, and pain, need special care. Each person shows up differently, so health systems are now focusing on care that puts the patient first.

Patient-centered care means building teams with doctors, patients, and families. They work together to plan, give, and check health care. This way ensures the patient’s needs are met, and their wishes, likes, and family situations are respected. It focuses on shared choices about treatments while seeing the patient as a whole person in their daily life (Dwamena et al., 2012; Bokhour et al., 2018).

Studies show key steps for a good patient-centered plan:

  • Take a full patient history and a check-up, reviewing old and new treatments.
  • Find all available drug and non-drug options.
  • Check the patient’s current health, recent changes, and patterns.
  • Look at risks for misusing or abusing opioids.

If starting opioids or if the patient is already on them, think about opioid stewardship. This means checking harms, benefits, risks, side effects, pain control, daily function, drug tests, stop plans, and ways to spot OUD. These programs, sometimes called analgesia stewardship, help manage opioids safely (Harle et al., 2019; Coffin et al., 2022). Guides exist to set them up (American Hospital Association, n.d.; Shrestha et al., 2023).

Integrative chiropractic care can play a big role here. It uses spinal adjustments and targeted exercises to get proper spinal alignment. This helps reduce pain without relying only on drugs, making it a good fit for OUD patients with pain. For example, adjustments fix spine issues that cause pain, and exercises strengthen muscles to keep alignment right.

A Nurse Practitioner (NP) adds full management and ergonomic advice. They look at work setups to prevent pain, such as how to sit or lift. NPs coordinate care by reviewing options such as therapy, meds, and lifestyle changes, ensuring everything works together.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, with over 30 years in chiropractic and as a family nurse practitioner, observes that blending these methods cuts opioid use. At his El Paso clinic, he uses functional medicine to address root causes through nutrition and non-invasive treatments. He notes that poor posture from modern life worsens pain, leading to OUD risks. His teams help patients with self-massage and VR for recovery, reducing drug needs (Jimenez, n.d.a; Jimenez, n.d.b).

Evidence-Based Ways to Communicate

Good talking skills are key to building a patient-centered plan (Schaefer & Block, 2009). There are proven methods for starting conversations and getting patients involved.

One method is BATHE:

  • Background: Ask, “How have things been since your last visit?”
  • Affect: Ask, “How does this make you feel?”
  • Trouble: Ask, “What bothers you most?”
  • Handling: Ask, “How are you coping?”
  • Empathy: Say, “That sounds hard.”

This uses open questions to let patients lead and feel supported (Stuart & Lieberman, 2018; Thomas et al., 2019).

Another is GREAT:

  • Greetings/Goals: Start with hello and set aims.
  • Rapport: Build trust.
  • Evaluation/Expectation/Examination/Explanation: Check and explain.
  • Ask/Answer/Acknowledge: Listen and respond.
  • Tacit agreement/Thanks: Agree and thank.

This guide talks well (Brindley et al., 2014).

Motivational interviewing is also useful. It’s a team-style talk to boost a patient’s desire to change. Build a bond, focus on the issue, spark a desire for change, and plan steps (Frost et al., 2018).

These methods emphasize listening, clear communication, and a structured approach to planning. For OUD patients with pain or mental issues, mix techniques for the best results.

Dr. Jimenez shares that in his practice, these talks help patients see non-drug options, such as chiropractic adjustments. He finds that empathy reduces stigma and fear, encouraging openness about OUD (Jimenez, n.d.a).

Understanding Stigma in Mental Health and Substance Use Disorders

Stigma blocks good talk for many with mental health or SUD. It’s attitudes, beliefs, actions, and systems that lead to unfair views and bad treatment (Cheetham et al., 2022).

Studies show stigmas like linking mental illness to violence (Perry, 2011). Media on shootings with mentally ill people strengthens this (McGinty et al., 2014; McGinty et al., 2016; Schomerus et al., 2022). For SUD, people think they’re more dangerous than those with schizophrenia or depression (Schomerus et al., 2011). Society blames people with SUDs more and avoids them (McGinty et al., 2015; Corrigan et al., 2012).

Views come from knowledge, contact with affected people, and the media. Public ideas are tied to norms on causes, blame, and danger. Race, ethnicity, and culture shape attitudes too (Giacco et al., 2014).

Health workers have biases. A survey of VA mental health providers showed awareness of race issues but avoidance of talks, using codes like “urban,” and thinking training stops racism (McMaster et al., 2021).

There are three stigma types:

  • Structural Stigma: The ways Society and institutions keep prejudice. In health, it’s worse care, less access to behavioral health. Less funding for mental vs. physical issues (National Academies of Sciences, Engineering, and Medicine, 2016).
  • Public Stigma: General or group attitudes, like police or church norms. Laws reinforce it, like broad mental illness rules implying all are unfit (Corrigan & Shapiro, 2010).
  • Self-Stigma: When people internalize stigmas, it leads to low self-worth and shame. “Why try” affects independent living (Corrigan et al., 2009; Clement et al., 2015).

Dr. Jimenez observes that stigma makes OUD patients hide symptoms, delaying care. In his integrative work, he addresses this through education on holistic options, showing that recovery is possible without judgment (Jimenez, n.d.b).

Overcoming Stigma and Addressing Social Factors

To fight stigma, use education, behavior changes, and better care. Laws like the ADA and MHPAEA help ensure equal coverage and prevent discrimination (U.S. Congress, 2009; U.S. Congress, 2008; U.S. Department of Health and Human Services, n.d.; Busch & Barry, 2008; Haffajee et al., 2019).

These address social determinants of health (SDOH), such as coverage, access, quality, education, and stability (Centers for Disease Control and Prevention, n.d.).

Community programs help too:

  • West Virginia’s Jobs and Hope: Training, jobs, education, transport, skills, record clearing for SUD people (Jobs and Hope, n.d.).
  • Belden’s Pathway: Rehab for failed drug tests, leading to jobs (Belden, n.d.).

Education boosts provider confidence in OUD meds, reducing barriers (Adzrago et al., 2022; Hooker et al., 2023; Campbell et al., 2021).

Overcoming stigma is key to success in mental health and SUD.

Interprofessional Team Work

Teams improve outcomes for patients with chronic pain and mental health or SUD (Joypaul et al., 2019; Gauthier et al., 2019).

Teams include doctors, nurses, NPs, pharmacists, PAs, social workers, PTs, therapists, SUD experts, and case managers.

Each helps uniquely:

  • Pharmacists watch meds, spot interactions.
  • Case managers link specialists, find resources, and support families (Sortedahl et al., 2018).
  • Teams set goals, max non-opioid treatments (Liossi et al., 2019).

Integrative chiropractic care includes adjustments and exercises for alignment, easing pain naturally.

NPs give full care, ergonomic tips to avoid pain triggers, and coordinate options.

Dr. Jimenez’s clinic shows this. As a DC and FNP-BC, he leads teams with therapists, nutritionists, and coaches. He observes interprofessional work cuts opioid use by addressing the roots with functional medicine, VR, and nutrition. For OUD, he blends chiropractic care for pain, NP coordination for plans, and stigma-fighting through team support (Jimenez, n.d.a; Jimenez, n.d.b).

Legal and Ethical Issues in SUD Care

Providers must know laws and ethics for mental/SUD patients, like discrimination, aid, and privacy (Center for Substance Abuse Treatment, 2000).

Key Federal laws:

  • Americans with Disabilities Act (ADA) of 1990.
  • Rehabilitation Act of 1973.
  • Workforce Investment Act of 1998.
  • Drug-Free Workplace Act of 1988.

ADA and Rehabilitation ban discrimination in government and in business services like hotels, shops, and hospitals. Protect those with impairments limiting life activities (U.S. Department of Health and Human Services, n.d.).

Provisions:

  • Protect “qualified” people who meet the requirements.
  • Reasonable accommodations for jobs.
  • No hire/retain if there is a direct threat.
  • No denial of benefits, access, or jobs in funded places.

For SUD: Alcohol users are protected if qualified, no threat. Ex-drug users in rehab are the same. Current illegal drug users are protected for health/rehab, not others. Programs can deny if used during.

Workforce Act centralizes job programs; no refusal to SUD people (U.S. Congress, 1998).

Drug-Free Act requires drug-free policies for federal funds/contracts: statements, awareness, actions on violations (U.S. Code, n.d.).

States have their own laws; check the local laws.

Public Aid laws:

  • Contract with America Act (1996): No SSI/DI if SUD key factor (U.S. Congress, 1996).
  • Adoption Act (1997): 15-month foster reunification limit (U.S. Congress, 1997).
  • Personal Responsibility Act (1996): Work after 2 years of aid, drug screens (U.S. Department of Health and Human Services, 1996).

These push work, sobriety.

Dr. Jimenez notes that legal awareness helps his practice by ensuring holistic plans comply and by reducing OUD risks through a non-drug focus (Jimenez, n.d.a).

Keeping Patient Info Private

Privacy is vital. Laws include:

  • HIPAA (1996): Protects PHI, sets use/disclosure rules (U.S. Department of Health and Human Services, n.d.).
  • 42 CFR Part 2: Extra for SUD records. No disclosure of name or status without consent. Fines for breaks. Applies to federal-aided programs (Substance Abuse and Mental Health Services Administration, n.d.).

Consent needs: program name, receiver, patient name, purpose, info type, revoke note, expire date, signature, and date.

This fights discrimination fears, encouraging treatment (Center for Substance Abuse Treatment, 2000).

Wrapping Up

As we navigate the ongoing challenges of opioid use disorder (OUD), it’s clear that effective management requires a multifaceted approach that prioritizes patient well-being over quick fixes. From embracing patient-

It is clear that treating opioid use disorder (OUD) well requires a multi-faceted approach that puts the patient’s health and safety above quick fixes. Healthcare professionals play a pivotal role in transforming lives by implementing patient-centered decision-making and evidence-based communication, and by eradicating the three types of stigma—structural, public, and self—that hinder recovery. Interprofessional teams help people get the full treatment they need, and privacy laws like HIPAA and 42 CFR Part 2 make sure that people with disabilities can get help without being discriminated against.

Chiropractic therapy focuses on spinal adjustments and specific exercises to support proper alignment. It is a non-invasive way to ease pain and reduce dependence on opioids. Nurse Practitioners (NPs) make this better by providing comprehensive care, offering ergonomic advice to prevent injuries, and coordinating multiple treatment options, such as lifestyle changes and therapy. Dr. Alexander Jimenez, DC, APRN, FNP-BC, emphasizes in his clinical practice that these integrative approaches not only address physical symptoms but also empower patients through education and tailored strategies, leading to enduring recovery and diminished opioid consumption (Jimenez, n.d.a; Jimenez, n.d.b).

As we look ahead, new advancements in OUD therapy by 2025 show a trend toward making it easier to get and more tailored to each person. For instance:

  • Drugs like methadone, buprenorphine, and naltrexone that the FDA has approved are still the best way to treat OUD. They help with cravings and withdrawal symptoms and help people stay stable over time.
  • Precision medicine goes beyond one-size-fits-all methods by tailoring treatments to each person’s social, psychological, and genetic factors. This should lead to better results.
  • The World Health Organization’s 2025 updates put more emphasis on psychosocial support, with a focus on preventing overdoses in the community and making it easier for people to get care.
  • Declining Trends: The first yearly drop in opioid-related deaths since 2018 happened in 2023. This is a good sign because it shows that ongoing work in treatment, education, and lawmaking is having an effect.

We might be able to make OUD a treatable illness instead of a life sentence by combining these new ideas with collaborative care and reducing stigma. Policymakers, communities, and healthcare professionals must continue to advocate for equitable access to ensure that all individuals receive the evidence-based treatment they need. Overcoming problems in OUD management is about more than just getting better; it’s also about getting your dignity, hope, and a good quality of life back.

References

Clinical Approach Benefits for Pain Management in Opioid Therapy

Clinical Approach Benefits for Pain Management in Opioid Therapy

Discover how a clinical approach to opioid therapy can transform pain management strategies for patients in a healthcare setting.

Key Points on Safe Pain Management with Opioids

  • Pain Affects Many People: Research suggests that about 100 million adults in the U.S. deal with pain, and this number might grow due to aging, more health issues like diabetes, and better survival from injuries. It’s important to address pain early to prevent it from becoming long-term (Institute of Medicine, 2011).
  • Non-Opioid Options First: Evidence leans toward starting with treatments like exercise, therapy, or over-the-counter meds before opioids, as they can be just as effective for common pains like backaches or headaches, with fewer risks (National Academies of Sciences, Engineering, and Medicine, 2019).
  • Team-Based Care Works Best: Studies show teams of doctors, nurses, and therapists can improve pain relief and daily life, though results vary. This approach seems likely to help more than solo care, especially for ongoing pain (Gauthier et al., 2019).
  • Opioids When Needed, But Carefully: Guidelines recommend low doses, short times, and regular check-ins to balance relief with risks like addiction. It’s complex, so talk openly with your doctor (Centers for Disease Control and Prevention, 2022).
  • Alternatives Like Chiropractic and NP Support: Integrative methods, such as chiropractic adjustments for spine alignment and ergonomic tips from nurse practitioners, can reduce reliance on meds. Clinical observations from experts like Dr. Alexander Jimenez highlight non-invasive approaches to managing pain effectively.

Understanding Pain Types

Pain can be short-term (acute), medium-term (subacute), or long-lasting (chronic). Acute pain often lasts less than three months and comes from injuries. If not treated well, it might turn chronic, affecting daily activities. Always respect someone’s pain experience—it’s personal and influenced by life factors (Raja et al., 2020).

Assessing Pain Simply

Doctors use tools like questions about when pain started, what makes it worse, and how it feels. Scales help rate it, from numbers (0-10) to faces showing discomfort. For kids or elders, special tools watch for signs like faster heartbeats (Wong-Baker FACES Foundation, 2022).

Treatment Basics

Start with non-drug options like rest, ice, or physical therapy. For chronic pain, meds like acetaminophen or therapies like yoga help. Opioids are for severe cases but come with risks—use them wisely (Agency for Healthcare Research and Quality, n.d.).

Role of Experts

According to clinical observations by Dr. Alexander Jimenez, DC, APRN, FNP-BC, who runs a multidisciplinary practice in El Paso, Texas (https://dralexjimenez.com/), combining chiropractic care with exercises targets root causes, such as misaligned spines, reducing opioid needs. As a nurse practitioner, he coordinates care and offers ergonomic advice to prevent pain from daily habits (LinkedIn Profile).


Comprehensive Guide to Safe and Effective Pain Management Using Opioid Therapy

Millions of people struggle with pain, which affects everything from hobbies to employment. Finding safe strategies to deal with pain is crucial, whether it’s a recent injury or persistent discomfort. This comprehensive handbook examines how to measure pain, available treatments, and responsible opioid use recommendations. We’ll discuss team-based treatment, non-opioid alternatives, and perspectives from professionals like Dr. Alexander Jimenez, who prioritizes holistic approaches. To help you locate trustworthy information online, keywords like “pain management strategies,” “opioid therapy guidelines,” and “non-opioid pain relief” are interwoven.

Introduction to Pain in America

The Institute of Medicine estimates that around 100 million American adults face acute or chronic pain daily. This number is expected to climb due to an aging population, rising rates of conditions like diabetes, heart disease, arthritis, and cancer, plus better survival from serious injuries and more surgeries that can lead to post-op pain (Institute of Medicine, 2011).

As people learn more about pain relief options and gain better access through laws like the Affordable Care Act (ACA), more folks—especially older ones—seek help. Passed in 2010, the ACA requires insurers to cover essential pain management benefits, including prescription drugs, chronic disease care, mental health support, and emergency services (111th Congress, 2009-2010). To use these effectively, healthcare providers need a solid grasp of pain assessment, classification, and treatment.

What Is Pain?

The International Association for the Study of Pain defines it as an unpleasant feeling associated with real or potential tissue damage. It’s subjective, shaped by biology, emotions, and social life. People learn about pain through experiences—some seek help right away, others try home remedies first. Respect their stories (Raja et al., 2020).

Pain falls into three main types, though definitions overlap:

  • Acute Pain: Lasts less than 3 months, or 1 day to 12 weeks; often limits daily activities for a month or less.
  • Subacute Pain: Sometimes seen as part of acute, or separate; lasts 1-3 months, or 6-12 weeks.
  • Chronic Pain: Persists over 3 months, or limits activities for more than 12 weeks (Banerjee & Argáez, 2019).

Poorly managed short-term pain can become chronic, so early action is important (Marin et al., 2017).

Assessing Pain Thoroughly

Pain is complex, influenced by body, mind, and environment. A full check includes history, physical exam, pain details, other health issues, and mental states like anxiety.

Basic pain evaluation covers:

  • When it started (date/time).
  • What caused it (injury?).
  • How does it feel (sharp, dull?)?
  • How bad it is.
  • Where is it?
  • How long does it last?
  • What worsens it (moving?).
  • What helps it?
  • Related signs (swelling?).
  • Impact on daily life.

Mnemonics help remember these. Here’s a table comparing common ones:

Mnemonic Breakdown
COLDERRA Characteristics, Onset, Location, Duration, Exacerbation, Radiation, Relief, Associated signs
OLDCART Onset, Location, Duration, Characterization, Aggravating factors, Radiation, Treatment
PQRST Provoked, Quality, Region/Radiation, Severity, Timing

 

Pain scales provide information but aren’t diagnoses because they’re subjective. Single-dimensional ones focus on intensity:

  • Verbal: Mild, moderate, severe.
  • Numeric: 0 (none) to 10 (worst).
  • Visual: Like Wong-Baker FACES®, using faces for kids, adults, or those with barriers (Wong-Baker FACES Foundation, 2022). An emoji version works for surgery patients (Li et al., 2023).

Multi-dimensional scales check intensity plus life impact. The McGill Pain Questionnaire uses words like “dull” to rate sensory, emotional, and overall effects; shorter versions exist (Melzack, 1975; Main, 2016). For nerve pain, PainDETECT helps (König et al., 2021). Brief Pain Inventory scores severity and interference with mood/life (Poquet & Lin, 2016).

For babies, watch heart rate, oxygen, and breathing. Tools like CRIES rate crying, oxygen need, vitals, expression, sleep (Castagno et al., 2022). FLACC for ages 2 months-7 years checks face, legs, activity, cry, consolability (Crellin et al., 2015). Older kids use Varni-Thompson or draw pain maps (Sawyer et al., 2004; Jacob et al., 2014).

Elders face barriers like hearing loss or dementia. PAINAD assesses breathing, sounds, face, body, and consolability on a 0-10 scale (Malara et al., 2016).

The Joint Commission sets standards across various settings, which affect tool choice (The Joint Commission, n.d.).

Building Treatment Plans

Plans depend on pain type, cause, severity, and patient traits. For acute: meds, distraction, psych therapies, rest, heat/ice, massage, activity, meditation, stimulation, blocks, injections (National Academies of Sciences, Engineering, and Medicine, 2019).

Re-check ongoing acute pain to avoid chronic shift. Goals: control pain, prevent long-term opioids. Barriers: access to docs/pharmacies, costs, follow-ups.

For chronic: meds, anesthesia, surgery, psych, rehab, CAM. Non-opioids include:

  • Oral Meds:
    • Acetaminophen.
    • NSAIDs (celecoxib, etc.).
    • Antidepressants (SNRIs like duloxetine; TCAs like amitriptyline).
    • Anticonvulsants (gabapentin, etc.).
    • Muscle relaxers (cyclobenzaprine).
    • Memantine.
  • Topical: Diclofenac, capsaicin, lidocaine.
  • Cannabis: Medical (inhaled/oral/topical); phytocannabinoids (THC/CBD); synthetics (dronabinol) (Agency for Healthcare Research and Quality, n.d.).

Opioid use has risen, raising concerns (National Academies of Sciences, Engineering, and Medicine, 2019).

Key plan elements:

  • Quick recognition/treatment.
  • Address barriers.
  • Involve patients/families.
  • Reassess/adjust.
  • Coordinate transitions.
  • Monitor processes/outcomes.
  • Assess outpatient failure risk.
  • Check opioid misuse (Wells et al., 2008; Society of Hospital Medicine, n.d.).

Team Approach to Pain

Studies support the use of interprofessional teams for better results (Gauthier et al., 2019). Teams include docs, nurses, NPs, pharmacists, PAs, social workers, PTs, behavioral therapists, and abuse experts.

A 2017 report showed that teams improved pain/function from baseline, though not always compared with controls (Banerjee & Argáez, 2017). A meta-analysis found that teams were better at reducing pain after 1 month and sustained benefits at 12 months (Liossi et al., 2019).

Integrative chiropractic care fits here. It involves spinal adjustments—gentle manipulations to correct misalignments—and targeted exercises, such as core strengthening, to maintain alignment and reduce pressure on nerves/muscles. Dr. Alexander Jimenez observes that this helps sciatica/back pain without opioids, using tools like decompression (dralexjimenez.com).

Nurse Practitioners (NPs) provide comprehensive management, including ergonomic advice (e.g., better sitting postures) to prevent strain. They coordinate by reviewing options, referring to specialists, and overseeing plans, as seen in Dr. Jimenez’s practice, where his FNP-BC role includes telemedicine for holistic care (LinkedIn, n.d.).



Managing Opioids Safely

CDC’s 2022 guidelines cover starting opioids, dosing, duration, and risks (Centers for Disease Control and Prevention, 2022).

1. Starting Opioids:

Maximize non-opioids first—they match opioids for many acute pains (back, neck, etc.). Discuss benefits/risks (Recommendation 1, Category B, Type 3).

Evaluate/confirm diagnosis. Non-drug examples:

  • Back: Exercise, PT.
  • Low back: Psych, manipulation, laser, massage, yoga, acupuncture.
  • Knee OA: Exercise, weight loss.
  • Hip OA: Exercise, manuals.
  • Neck: Yoga, massage, acupuncture.
  • Fibromyalgia: Exercise, CBT, massage, tai chi.
  • Tension headache: Manipulation.

Review labels, use the lowest dose/shortest time. Set goals, exit strategy. For ongoing, optimize non-opioids (Recommendation 2, A, 2).

2. Choosing/Dosing Opioids:

Immediate-release (hydromorphone, etc.) over ER/LA (methadone, etc.). Studies show no edge for ER/LA; avoid for acute/intermittent (Recommendation 3, A, 4).

No rigid thresholds—guideposts. Risks rise with dose; avoid high if benefits dim (Recommendation 4, A, 3).

Taper slowly to avoid withdrawal (anxiety, etc.). Collaborate on plans; use Teams. If there is disagreement, empathize and avoid abandonment (Recommendation 5, B, 4).

3. Duration/Follow-Up:

For acute, prescribe just enough—often 3 days or less. Evaluate every 2 weeks. Taper if used for days. Avoid unintended long-term (Recommendation 6, A, 4).

Follow-up 1-4 weeks after start/escalation; closer for high-risk (Recommendation 7, A, 4).

4. Risks/Harms:

Screen for SUD/OUD. Offer naloxone for overdose risk (Recommendation 8, A, 4).

Check PDMPs for scripts/combos (Recommendation 9, B, 4).

Toxicology tests are performed annually to assess interactions (Recommendation 10, B, 4).

Caution with benzodiazepines (Recommendation 11, B, 3).

For OUD, use DSM-5 (2+ criteria/year); offer meds like buprenorphine (Recommendation 12, A, 1) (Hasin et al., 2013; American Psychiatric Association, 2013).

OUD signs: Larger amounts, failed cuts, time spent, cravings, role failures, social issues, activity loss, hazardous use, continued despite problems, tolerance, withdrawal.

Treatment: Meds, counseling, groups. Coordinate with specialists.

Conclusion

Finally, relying only on opioids is not necessary for efficient pain management. We can improve the lives of millions of people by giving priority to non-opioid alternatives like acetaminophen, physical therapy, or mindfulness and by taking opioids only when necessary under strict supervision. Teams of professionals, such as physicians, nurses, pharmacists, and specialists like chiropractors, collaborate to develop individualized strategies that lower dangers like addiction. By emphasizing spinal adjustments and targeted exercises, integrative chiropractic therapy may help restore normal alignment and reduce pain naturally, often eliminating the need for medication. Complete management, ergonomic guidance to prevent problems, and treatment coordination for optimal outcomes are all ways nurse practitioners provide value.

According to experts like Dr. Alexander Jimenez, these approaches target underlying issues using non-invasive treatments and functional medicine, promoting long-term well-being. Future developments in pain management seem promising, including FDA-approved non-opioid medications and distraction technologies such as virtual reality. In the end, everyone is empowered to address pain head-on, enhancing everyday activities and general health, when patients are included in decision-making and kept informed. Early evaluation and balanced treatment are crucial; discuss your options with your healthcare professional to determine what is best for you.


References

Clinical Approach Insights to Identify Substance Use Disorder

Clinical Approach Insights to Identify Substance Use Disorder

Discover the clinical approach for substance use disorder, a vital method in addressing challenges related to addiction treatment.

Integrative Management of Substance Use Disorder (SUD) and Musculoskeletal Health: A Collaborative Model for Chiropractors and Nurse Practitioners

Substance use disorder (SUD) is a chronic, treatable medical condition that affects the brain, behavior, and the entire body, including the musculoskeletal system. For many patients, SUD overlaps with chronic pain, injury, emotional distress, and functional limitations. An integrative care model that combines evidence‑based SUD screening and treatment with chiropractic care and nurse practitioner (NP)–led primary care can reduce risk, improve function, and support long‑term recovery (American Medical Association [AMA], n.d.; National Institute on Drug Abuse [NIDA], n.d.; National Institute of Mental Health [NIMH], 2025).

This article explains what SUD is, how it is identified and categorized, how clinicians can manage it using practical workflows, and how integrative chiropractic and NP care can address overlapping risk profiles and musculoskeletal consequences.


What Is Substance Use Disorder (SUD)?

SUD is a medical condition in which the use of alcohol, medications, or other substances leads to significant impairment or distress in daily life. It is not a moral failing or a lack of willpower; it is a chronic, brain‑ and body‑based disease that is treatable (NIDA, n.d.; NIMH, 2025).

SUD exists on a spectrum from mild to severe. People with SUD may:

  • Use more of the substance than they planned

  • Try and fail to cut down or stop

  • Spend a lot of time obtaining, using, or recovering from the substance

  • Continue to use even though it harms health, work, relationships, or safety (American Psychiatric Association, 2022; NIMH, 2025)

Person‑first, non‑stigmatizing language

Stigma can keep people from seeking care. Using respectful, person‑first language reduces shame and supports engagement. NIDA and the AMA recommend (NIDA, n.d.; AMA, n.d.):

  • Say “person with a substance use disorder,” not “addict” or “drug abuser.”

  • Say “substance use” or “misuse,” not “abuse.”

  • Focus on SUD as a chronic, treatable condition.


Categories and Diagnostic Features of SUD

DSM‑5‑TR framework: Mild, moderate, severe

Diagnostic criteria for SUD come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM‑5‑TR) (American Psychiatric Association, 2022; NIAAA, 2025). A diagnosis is based on the number of symptoms present over 12 months.

Typical criteria include (paraphrased):

  • Using more or for longer than intended

  • Unsuccessful efforts to cut down

  • Spending a lot of time obtaining, using, or recovering

  • Cravings or strong urges

  • Role failures at work, school, or home

  • Social or interpersonal problems caused or worsened by use

  • Giving up important activities

  • Using in physically hazardous situations

  • Continued use despite physical or psychological problems

  • Tolerance

  • Withdrawal

Severity is determined by symptom count (American Psychiatric Association, 2022; NIAAA, 2025):

  • Mild: 2–3 symptoms

  • Moderate: 4–5 symptoms

  • Severe: 6 or more symptoms

Substance‑specific categories

Clinically, SUD is further categorized by substance type (NIDA, n.d.; NIMH, 2025):

  • Alcohol use disorder (AUD)

  • Opioid use disorder (e.g., heroin, oxycodone, hydrocodone)

  • Stimulant use disorder (e.g., cocaine, methamphetamine)

  • Sedative, hypnotic, or anxiolytic use disorder (e.g., benzodiazepines)

  • Cannabis, tobacco, hallucinogen, or inhalant use disorders

Each category has similar behavioral criteria but unique medical risks, withdrawal profiles, and treatment options (NIDA, n.d.; NIAAA, 2025).

Risk and severity categories for clinical workflows

For practical care, validated screening tools classify risk that guide next steps (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Low/no risk: Negative screen or very low scores

  • Moderate risk: At‑risk use with potential consequences (e.g., falls, crashes, future disease)

  • Substantial/severe risk: High scores suggest likely SUD and active harm

For example, adult risk zones using tools like AUDIT and DAST (AMA, n.d.):

  • Low risk/abstain: AUDIT 0–7; DAST 0–2

  • Moderate risk: AUDIT 8–15; DAST 3–5

  • Substantial/severe risk: AUDIT ≥16; DAST ≥6

These categories help teams decide when to give brief interventions, when to intensify care, and when to refer to specialty treatment.


Epidemiology and Public Health Impact

National surveys show that millions of people in the United States live with SUD, yet only a fraction receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). The 2022 National Survey on Drug Use and Health reported high rates of both substance use and serious mental illness, often co‑occurring (SAMHSA, 2023).

Key points from recent federal data (SAMHSA, 2023; NIMH, 2025):

  • SUD commonly co‑occurs with depression, anxiety, and other mental disorders.

  • Co‑occurring conditions worsen medical outcomes and increase healthcare use.

  • Early identification and integrated treatment can improve function, reduce complications, and lower long‑term costs.


Identifying Patients With SUD: Screening and Assessment

Early, routine identification is critical. Primary care teams, NPs, and chiropractic clinics that integrate behavioral health can all play a role (AMA, n.d.; NIDA, n.d.; NIAAA, 2025).

Building a safe, trauma‑informed environment

Before asking about substance use, the team should (AMA, n.d.; NIDA, n.d.):

  • Explain that “we screen everyone” as part of whole‑person care.

  • Emphasize confidentiality within legal limits.

  • Use a calm, nonjudgmental tone and body language.

  • Offer patients the option not to answer any question.

  • Acknowledge that stress, trauma, pain, and life pressures often contribute to substance use.

This aligns with trauma‑informed care principles promoted by SAMHSA and helps patients feel safe enough to share (AMA, n.d.).

Validated screening tools

Evidence‑based tools are preferred over informal questioning. Common options include (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

For adults:

  • AUDIT or AUDIT‑C (Alcohol Use Disorders Identification Test) – screens for unhealthy alcohol use and risk of AUD.

  • DAST‑10 (Drug Abuse Screening Test) – screens for non‑alcohol drug use problems.

  • TAPS Tool (Tobacco, Alcohol, Prescription medication, and other Substances) – combined screen and brief assessment.

For adolescents:

  • CRAFFT 2.1+N – widely used for youth; captures risk behaviors and problems.

  • S2BI (Screening to Brief Intervention) and BSTAD – brief tools validated for ages 12–17 (NIDA, n.d.; AMA, n.d.).

For alcohol‑specific quick screens:

  • AUDIT‑C (3 questions) or full AUDIT

  • NIAAA Single Alcohol Screening Question (SASQ):
    “How many times in the past year have you had 4 (for women) or 5 (for men) or more drinks in a day?” (NIAAA, 2025)

Results guide risk categorization and next steps.

Role of the care team

In integrated practices, roles can be divided (AMA, n.d.):

  • Medical assistants or nurses

    • Administer pre‑screens and full questionnaires.

    • Flag positive or concerning responses.

  • Nurse practitioners / primary care clinicians

    • Review screening results.

    • Deliver brief interventions using motivational interviewing.

    • Conduct or oversee further assessment.

    • Prescribe and manage pharmacotherapy for SUD when indicated.

    • Coordinate referrals and follow‑up.

  • Behavioral health clinicians (on‑site or virtual)

    • Perform biopsychosocial in-depth evaluations.

    • Provide psychotherapy and relapse‑prevention skills.

    • Support motivational enhancement and family engagement.

  • Chiropractors and physical‑medicine providers

    • Screen for substance misuse related to pain, function, and injury patterns.

    • Observe red flags (frequent lost prescriptions, inconsistent pain reports, sedation, falls).

    • Communicate concerns to the NP or primary medical provider.

Dr. Alexander Jimenez, DC, APRN, FNP‑BC, exemplifies this dual role. As both a chiropractor and a family practice NP, he combines neuromusculoskeletal assessment with medical screening and functional medicine evaluation to identify root causes of chronic pain and unhealthy substance use patterns (Jimenez, n.d.).

Clinical clues that may suggest SUD

Beyond formal tools, clinicians should stay alert for patterns such as (AMA, n.d.; NIMH, 2025):

  • Frequent injuries, falls, or motor vehicle accidents

  • Repeated missed appointments or poor adherence to treatment

  • Drowsiness, agitation, slurred speech, or odor of alcohol

  • Unexplained weight loss, infections, or liver abnormalities

  • Social and financial instability, job loss, or legal problems

In chiropractic and musculoskeletal settings, repeated injuries, delayed healing, inconsistent exam findings, or “pain behaviors” that do not match imaging or biomechanics may prompt gentle, supportive screening and medical referral.


Understanding Long Lasting Injuries- Video


Comprehensive Assessment and Risk Stratification

Once a screen is positive, the next level is a more detailed assessment. This should examine substance type, frequency, amount, impact, withdrawal, mental health, physical comorbidities, and function (AMA, n.d.; NIMH, 2025).

Structured assessment tools

Clinicians may use (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Full AUDIT for alcohol

  • DAST‑10 for general drugs

  • CRAFFT or GAIN for adolescents

  • Checklists based directly on DSM‑5‑TR criteria to rate symptom count and severity (NIAAA, 2025).

These tools allow classification into mild, moderate, or severe SUD and support shared decision‑making regarding level of care.

Co‑occurring mental health conditions

SUD frequently co‑occurs with (NIMH, 2025):

  • Major depressive disorder

  • Anxiety disorders

  • Posttraumatic stress disorder (PTSD)

  • Bipolar disorder

  • Attention‑deficit/hyperactivity disorder

Co‑occurring disorders can:

  • Increased risk for self‑medication with substances

  • Worsen treatment outcomes if not recognized

  • Require integrated treatment plans (NIMH, 2025)

NPs, behavioral health clinicians, and chiropractors with integrative training should maintain a low threshold for mental health screening and referral.


Managing Patients With SUD: A Practical Clinical Process

Effective SUD care is chronic‑disease care: ongoing, team‑based, and tailored to readiness to change (AMA, n.d.; SAMHSA, 2023).

Core elements of management

Key components include (AMA, n.d.; NIDA, n.d.; NIMH, 2025):

  • Routine screening and re‑screening

  • Brief interventions and motivational interviewing

  • Harm‑reduction strategies

  • Medications for certain SUDs (when appropriate)

  • Evidence‑based behavioral therapies

  • Peer and family support

  • Long‑term follow‑up and relapse‑prevention planning

Brief intervention and motivational interviewing

For patients with low to moderate risk, brief intervention can be delivered in 5–15 minutes and often by NPs or primary care clinicians (AMA, n.d.; NIAAA, 2025). Using motivational interviewing, clinicians:

  • Ask open‑ended questions (“What do you enjoy about drinking? What concerns you about it?”)

  • Reflect and summarize the patient’s own statements

  • Ask permission before giving advice

  • Help patients set realistic, patient‑chosen goals (cutting down, abstaining, or seeking treatment)

This approach respects autonomy and builds internal motivation for change.

Determining level of care

The American Society of Addiction Medicine (ASAM) describes a continuum of care (AMA, n.d.; SAMHSA, 2023):

  • Prevention/early intervention

    • Brief interventions in primary care

    • Self‑management support and education

  • Outpatient services

    • Office‑based counseling and medications for AUD or opioid use disorder (OUD)

    • Integrated behavioral health visits

  • Intensive outpatient / partial hospitalization

    • Several therapy sessions per week, day or evening programs

  • Residential/inpatient services

    • 24‑hour structured care for severe or complex cases

  • Medically managed intensive inpatient services

    • Medically supervised detoxification and stabilization

NPs and primary care teams decide the appropriate level based on risk severity, co‑occurring medical and psychiatric conditions, social supports, and patient preference (AMA, n.d.; NIMH, 2025).

Medications for SUD

For some patients, medications support recovery by reducing cravings, blocking rewarding effects, or stabilizing brain function (SAMHSA, 2020; AMA, n.d.; NIAAA, 2025). Examples include:

  • Alcohol use disorder

    • Acamprosate – supports abstinence after detox

    • Disulfiram – creates an unpleasant reaction to alcohol, discouraging use

    • Naltrexone blocks the rewarding effects of alcohol

  • Opioid use disorder

    • Buprenorphine – a partial opioid agonist that reduces cravings and overdose risk; often prescribed in primary care with appropriate DEA registration

    • Methadone – full agonist, dispensed in specialized opioid treatment programs

    • Naltrexone (extended‑release) – opioid antagonist that prevents relapse after detox

  • Overdose prevention

    • Naloxone – rapid opioid‑overdose reversal, recommended for anyone at risk (AMA, n.d.).

NPs managing patients with SUD work within state scope‑of‑practice rules and in collaboration with addiction specialists where needed.

Behavioral therapies and peer support

Evidence‑based therapies include (AMA, n.d.; NIDA, n.d.):

  • Cognitive behavioral therapy (CBT)

  • Dialectical behavior therapy (DBT)

  • Motivational enhancement therapy

  • The Matrix Model (especially for stimulants)

  • Family‑based therapy for adolescents

Peer support groups (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery) can reinforce coping skills, hope, and accountability.

Long‑term follow‑up

SUD is chronic; relapse risk can persist for years. Best practice includes (AMA, n.d.; NIMH, 2025):

  • Follow‑up within 2 weeks after treatment initiation

  • Monthly to quarterly visits as patients stabilize

  • Peer support and care management between visits

  • Rapid re‑engagement after any relapse or lapse

NASW, NIDA, and NIMH stress that relapse should be treated as a signal to adjust care—not as failure (NIDA, n.d.; NIMH, 2025).


How SUD Affects the Body and the Musculoskeletal System

SUD impacts nearly every organ system. Many effects directly or indirectly worsen neuromusculoskeletal health and pain.

General systemic effects

Common systemic consequences include (NIDA, n.d.; NIMH, 2025; SAMHSA, 2023):

  • Cardiovascular disease and hypertension

  • Liver disease and pancreatitis (especially with alcohol)

  • Respiratory disease (especially with tobacco and some drugs)

  • Endocrine and hormonal disruption

  • Immune dysfunction and higher infection risk

  • Sleep disturbances and fatigue

  • Worsening of mood, anxiety, and cognitive function

These changes affect healing capacity, resilience, and the way patients perceive pain.

Musculoskeletal and pain‑related effects

Substance use and SUD can influence the musculoskeletal system through several pathways:

  • Increased injury risk

    • Impaired judgment, coordination, and reaction time increase the risk of falls, motor vehicle accidents, and sports injuries.

    • Heavy alcohol use is associated with fractures, soft tissue injuries, and delayed healing (AMA, n.d.; SAMHSA, 2023).

  • Bone, joint, and muscle changes

    • Alcohol and some drugs can impair bone density and quality, increasing osteoporosis and fracture risk.

    • Nutritional deficiencies associated with SUDs weaken connective tissue and muscle function.

    • Sedentary behavior and deconditioning are common in people with long‑standing SUD.

  • Chronic pain and central sensitization

    • Chronic alcohol or opioid use can alter pain pathways in the central nervous system, raising pain sensitivity.

    • Opioid‑induced hyperalgesia can make pain seem worse even at stable or increasing doses.

  • Functional and ergonomic stress

    • Disrupted sleep, poor posture, and prolonged sitting or immobility (for example, in recovery environments or during unemployment) can lead to spinal stress, neck and low back pain, and muscle imbalance.

Clinically, Dr. Jimenez and similar integrative providers often see patients with combined profiles: chronic low back or neck pain, sedentary work, ergonomic strain, poor sleep, high stress, and escalating reliance on medications, including opioids or sedatives. Addressing both the mechanical and behavioral contributors can change the trajectory of pain and SUD risk (Jimenez, n.d.).


Integrative Chiropractic Care in the Context of SUD

Philosophy of integrative chiropractic care

Integrative chiropractic care focuses on restoring alignment, mobility, and neuromuscular control while considering lifestyle, nutrition, sleep, and emotional stress. In the model used by Dr. Jimenez, chiropractic adjustments are combined with functional medicine strategies, targeted exercise, and collaborative medical care (Jimenez, n.d.).

For patients with or at risk of SUD, this approach offers:

  • Non‑pharmacologic pain management

  • Improved movement, posture, and ergonomics

  • Education that empowers patients to self‑manage pain

  • Reduced reliance on habit‑forming medications

Spinal adjustments and targeted exercises

Spinal and extremity adjustments aim to:

  • Restore joint mobility

  • Reduce mechanical irritation of nerves and soft tissues

  • Improve segmental alignment and overall posture

Targeted exercises are prescribed to:

  • Strengthen deep stabilizing muscles (core, gluteal, cervical stabilizers)

  • Correct muscle imbalances and faulty patterns

  • Increase flexibility and joint range of motion

  • Enhance proprioception, balance, and movement control

Examples of targeted exercise strategies often used in integrative chiropractic and rehab clinics include (Jimenez, n.d.):

  • Lumbar stabilization and core‑strengthening sequences

  • Hip mobility and glute activation drills for low back and sciatica‑like pain

  • Cervical and scapular stabilization for neck and shoulder pain

  • Postural retraining, including ergonomic break routines for prolonged sitting

By reducing biomechanical stress and enhancing functional capacity, these interventions may decrease pain intensity, frequency, and flare‑ups, which in turn can lower the drive to self‑medicate with substances.

Reducing overlapping risk profiles

Many risk factors for SUD and for chronic musculoskeletal pain overlap, including (NIMH, 2025; NIDA, n.d.; Jimenez, n.d.):

  • Chronic stress and trauma

  • Poor sleep and circadian disruption

  • Sedentary lifestyle and obesity

  • Repetitive strain and poor ergonomics

  • Social isolation and low self‑efficacy

Integrative chiropractic care can help shift these shared risk profiles by:

  • Encouraging regular physical activity and graded movement

  • Coaching ergonomic and postural strategies at work and home

  • Teaching breathing, stretching, and relaxation routines that reduce muscle tension and sympathetic overdrive

  • Collaborating with NPs and behavioral health clinicians to align interventions with mental health and SUD treatment plans

In Dr. Jimenez’s practice, this often includes structured flexibility, mobility, and agility programs that are adapted to age and functional status, with close monitoring to avoid over‑reliance on medications, including opioids and sedatives (Jimenez, n.d.).


The Nurse Practitioner’s Role in Comprehensive SUD and Musculoskeletal Care

NPs are well-positioned to coordinate SUD care and integrate it with musculoskeletal and chiropractic treatment.

Comprehensive medical management

NP responsibilities typically include (AMA, n.d.; NIMH, 2025; NIAAA, 2025):

  • Conducting and interpreting SUD screening and risk stratification

  • Performing physical exams and ordering labs or imaging

  • Diagnosing SUD and co‑occurring conditions

  • Prescribing non‑addictive pain strategies and medications where indicated

  • Managing or co‑managing medications for AUD or OUD (per training and regulations)

  • Monitoring for drug–drug and drug–disease interactions

  • Coordinating with behavioral health and community resources

In integrative settings like Dr. Jimenez’s clinic, the NP role is blended with functional medicine principles, looking at nutrition, metabolic health, hormonal balance, and inflammation that influence both pain and SUD risk (Jimenez, n.d.).

Ergonomic and lifestyle counseling

NPs also provide individualized counseling on:

  • Workplace ergonomics (desk height, chair support, screen position)

  • Safe lifting strategies and body mechanics

  • Activity pacing and graded return to work or sport

  • Sleep hygiene and circadian rhythm support

  • Nutrition strategies that support musculoskeletal healing and brain health

These interventions lower the mechanical load on the spine and joints, reduce fatigue, and increase a patient’s sense of control—all of which help reduce triggers for substance use and relapse.

Care coordination and team communication

NPs often serve as the central coordinator who (AMA, n.d.; NIMH, 2025):

  • Ensures all team members (chiropractor, physical therapist, behavioral health, addiction medicine, primary care, or specialty providers) share a coherent plan

  • Tracks progress on pain, function, substance use, mood, and quality of life

  • Adjusts the plan as conditions change

  • Supports families and caregivers in understanding both SUD and musculoskeletal needs

In a model like Dr. Jimenez’s, this may involve regular case conferences, shared EHR notes, and integrated treatment plans that align spinal rehabilitation with SUD recovery goals (Jimenez, n.d.).


Practical Clinical Pathway: From First Contact to Long‑Term Recovery

For clinics that combine chiropractic and NP services, a practical, stepwise pathway for patients with possible SUD and musculoskeletal complaints can look like this (AMA, n.d.; NIDA, n.d.; NIAAA, 2025; NIMH, 2025; Jimenez, n.d.):

Step 1: Initial visit and global screening

  • Intake includes questions on pain, function, injuries, sleep, mood, and substance use.

  • Staff administer brief tools (for example, AUDIT‑C and DAST‑10 for adults, CRAFFT for adolescents).

  • The chiropractor documents neuromusculoskeletal findings; the NP reviews medical and behavioral health risks.

Step 2: Identification of SUD risk

  • Negative or low‑risk screens → brief positive health message and reinforcement of low‑risk behavior.

  • Moderate risk → NP provides brief intervention, motivational interviewing, and a follow‑up plan.

  • Substantial or severe risk → NP initiates comprehensive assessment, safety planning, and possible referral to specialized services.

Step 3: Integrated treatment planning

The team crafts a unified plan that may include:

  • Spinal adjustments and targeted exercises to correct alignment and biomechanics

  • Gradual increase in physical activity with pain‑sensitive pacing

  • Non‑pharmacologic pain strategies (manual therapy, exercise therapy, education)

  • Behavioral health referral for CBT, trauma‑informed treatment, or other modalities

  • Consideration of medications for AUD or OUD, if indicated

  • Harm‑reduction measures (for example, naloxone prescription for those at overdose risk)

Step 4: Ergonomics and lifestyle

  • NP and chiropractor jointly review workplace and home ergonomics, posture, and activity patterns.

  • Patients learn micro‑break routines, stretching, and strengthening sequences for high‑risk tasks (for example, lifting or prolonged sitting).

  • Nutrition, stress‑management, and sleep interventions are introduced or refined.

Step 5: Monitoring and long‑term follow‑up

  • Regular follow‑up visits evaluate:

    • Pain levels and functional capacity

    • Substance use patterns and cravings

    • Mood, sleep, and quality of life

    • Adherence to exercise and ergonomic plans

  • The team updates the treatment plan to respond to progress, setbacks, or new diagnoses.

  • Patients are coached to view flare-ups or lapses as opportunities to learn and adjust, not as failures.

This kind of coordinated, integrative approach can reduce repeated injuries, unnecessary imaging or surgeries, and long‑term dependence on medications, including opioids.


Clinical Insights from an Integrative Practice Model

Although each practice is unique, Dr. Alexander Jimenez’s clinic illustrates several principles that can guide others (Jimenez, n.d.):

  • Whole‑person assessment: History taking includes injuries, lifestyle, trauma, nutrition, environment, and psychosocial stressors.

  • Functional movement focus: Care plans emphasize flexibility, mobility, agility, and strength to restore capacity rather than just relieve symptoms.

  • Non‑invasive first: Chiropractic adjustments, functional exercise, and lifestyle interventions are prioritized before invasive procedures or long‑term controlled substances.

  • Integrated roles: As both DC and FNP‑BC, Dr. Jimenez unifies neuromusculoskeletal, primary care, and functional medicine perspectives in a single, coordinated plan.

  • Patient empowerment: Education, coaching, and accessible care options help patients take a proactive role in maintaining spinal health and reducing SUD risk.

This model aligns with national guidance on behavioral health integration and SUD management in medical settings while adding the musculoskeletal and ergonomic expertise of chiropractic care (AMA, n.d.; NIDA, n.d.; NIMH, 2025).


Key Takeaways

  • SUD is a chronic, treatable medical condition that often co‑occurs with mental disorders and chronic pain.

  • Validated screening tools and non‑stigmatizing, trauma‑informed communication are core to early identification.

  • Risk and severity categories (mild, moderate, severe) guide brief intervention, level of care, and referral decisions.

  • SUD significantly affects the body, including bone health, soft tissue integrity, injury risk, and chronic pain pathways.

  • Integrative chiropractic care—with spinal adjustments, targeted exercises, and ergonomic guidance—can reduce pain, improve function, and lower overlapping risk factors for SUD.

  • Nurse practitioners provide comprehensive SUD management, coordinate care, and deliver ergonomic and lifestyle counseling that complements chiropractic treatment.

  • A collaborative, long‑term, patient‑centered model—such as the one exemplified by Dr. Alexander Jimenez—offers a promising pathway to healthier spines, healthier brains, and healthier lives.


Conclusion

Substance use disorder is a complex medical condition that requires compassion, evidence‑based screening, and coordinated care across multiple disciplines. For healthcare professionals—whether chiropractors, nurse practitioners, primary care physicians, or behavioral health specialists—the opportunity to identify and support patients with SUD begins with understanding what it is, how to recognize it, and how to respond with respect and proven interventions.

The integration of chiropractic care and nurse practitioner-led primary care offers a distinctive advantage for patients struggling with both chronic pain and substance use. When a patient presents with a work injury, auto accident, or years of poor ergonomics, they may not volunteer that they are also wrestling with alcohol dependence, prescription opioid misuse, or stimulant use. Yet these challenges often coexist. The musculoskeletal system bears the weight of increased fracture risk, muscle wasting, poor healing, and heightened pain sensitivity. The mind and nervous system are equally affected, with sleep disruption, mood changes, and reduced resilience to stress all fueling the cycle of pain and substance use.

Clinics and practices that integrate screening, brief intervention, and coordinated treatment have a powerful tool to interrupt this cycle. Spinal adjustments restore mechanical function. Targeted exercises rebuild strength and proprioception. Ergonomic guidance prevents re‑injury. Nurse practitioners coordinate medications, monitor for drug interactions, and counsel on lifestyle factors that support both spine health and recovery from SUD. Behavioral health clinicians provide therapy, peer support, and relapse prevention. Together, this team addresses root causes, not just symptoms.

The clinical model exemplified by providers like Dr. Alexander Jimenez demonstrates that a single clinician with dual expertise—chiropractic and family practice nurse practitioner credentials—can seamlessly weave these threads into a coherent, patient‑centered plan. Patients benefit from continuity, alignment of goals, and a provider who understands both the biomechanics of a herniated disc and the neurobiology of addiction. Larger practices can achieve similar results through deliberate team communication, shared decision‑making, and a commitment to non‑stigmatizing, trauma‑informed care.

The evidence is clear: early identification saves lives and improves outcomes. Validated screening tools are quick and accurate. Motivational interviewing and brief interventions work. Medications for alcohol and opioid use disorders are safe and effective when used thoughtfully. Non‑pharmacologic approaches—exercise, manual therapy, stress management, social support—are powerful and underutilized. And when musculoskeletal and behavioral health care are woven together, patients heal faster, return to function sooner, and are far less likely to relapse into substance misuse.

For healthcare teams willing to expand their lens beyond isolated complaints—beyond “just” back pain or “just” anxiety—the reward is profound: patients who reclaim their health, their relationships, and their sense of purpose. This is the promise of integrative, collaborative, evidence‑based care for substance use disorder and musculoskeletal health.


References

Functional Wellness and Healing from Autoimmune Conditions

Functional Wellness and Healing from Autoimmune Conditions

Learn about the role of functional wellness in addressing autoimmune conditions and supporting overall health.

Understanding Autoimmune Conditions: How Functional Wellness Can Transform Your Health

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