Chiropractic care for neck and back problems first? Here’s the evidence that has been ignored for years.
The evidence for visiting a chiropractor first has been building for years.
As it’s been said, who you see first for a problem will determine the safety, effectiveness, and cost. Chiropractors, who are physician-level providers specialize in the primary care holistic approach to the musculoskeletal system.
Their unique skills of combining exercise, myofascial work and manipulation have been shown to be very effective at improving solving physical problems without the use of drugs, surgeries or other invasive methods.
Follow the evidence…
- “The pathway that’s most aligned with all prevailing guidelines [is] when patients start with chiro / PT/acupuncture. … You receive the services you should, you avoid the services you shouldn’t, imaging is aligned, total episode cost is lowest.”
- “Average per-episode costs for care that begins with a DC / PT/acupuncturist is only $619, compared with $728 for primary care and $1,728 for specialist care. If you make the initial investment in chiropractic / PT acupuncture, significant total-episode savings occur.“
- “However, first contact with a DC / PT/acupuncturist only occurs in 30 percent of cases, compared to 70 percent for primary (30 percent) or specialist (40 percent) care.“
- “[T]he actuaries have done the work, it’s presented at the actuarial conference, the net of the increased conservative care will take out about 230 million in annual medical expenditures and reduce opiate prescribing for back pain by 25-26 percent.”
- Patients who saw chiropractors first were very unlikely to have a problem with opioids or other addictions or side effects of pain medication.
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The National Governors Association (NGA) Center for Best Practices; Expanding access to non-opioid paper. (Released August 2020. Report completed June 2018).
- Expanding the use of non-opioid therapies and multimodal approaches which can help prevent the adverse consequences of inappropriate opioid prescribing while advancing reforms to help patients manage chronic pain.
- Lack of coverage of these services among Medicaid and private payers – and with few provider networks offering these services – has limited patient access.
- Increasing access to effective non-opioid* forms of pain management are important strategies states can use to confront the opioid overdose epidemic.
- Only 12 of 41 responding states indicated they had implemented programs or policies to encourage or require the use of non-opioid pain management therapies.
- Collaborative care models have been shown to be more efficacious and cost-effective than usual care for common mental health disorders, but traditional fee-for-service payment approaches can be a barrier to widespread implementation.
National and state guidelines have recommended evidence-based non-drug treatment: full scope chiropractic care before medications. These guidelines provide good support for using chiropractic manipulative therapy (CMT), exercise therapy, acupuncture, massage and yoga, first for pain relief. However, these guidelines have been ignored.
- Ohio Guidelines for The Management of Acute Pain Outside of Emergency Rooms – Governor Kasich’s Opiate Action Team created these guidelines that recommend non-drug treatment first, including chiropractic manipulative therapy.
- Ohio Guidelines for Prescribing Opioids for the Treatment of Chronic, Non-Terminal Pain recommends that “providers should first consider non-pharmacologic and non-opioid therapies.” Specifics not given.
- American College of Physicians Back Treatment Guidelines – The ACP updated prior guidelines, recommending non-drug treatment first for back pain, including chiropractic manipulative therapy (CMT), osteopathic manipulative therapy (OMT), exercise therapy, acupuncture, massage and yoga.
- FDA Education Blueprint for Health Providers Involved in Pain Management: The Blueprint recommends “The [health care provider] should be knowledgeable about which therapies can be used to manage pain and how these should be implemented.” Chiropractic and acupuncture are specifically noted as non-pharmacologic therapies that can play an important role in managing pain.
- Updated Joint Commission Standards for Pain Assessment & Management at Hospitals requires patient education on and access to non-drug pain treatments (effective 1/1/18).
- The CDC released Guidelines for Prescribing Opioids for Chronic Pain in 2016. The Guidelines include 12 recommendations, the first being, “non-pharmacological therapy and non-opioid pharmacologic therapy are preferred for chronic pain.”
Research documents the benefit and cost-effectiveness of chiropractic treatment.
#1. Workers whose first health care visit for the injury was to a doctor of chiropractic had substantially better outcomes.
#2. Paid costs for episodes of care initiated with a chiropractor were almost 40% less than episodes initiated with an MD.
#3. Spinal, hip, and shoulder pain patients had similar pain relief, greater satisfaction, and lower cost if they started care with chiropractors, compared with medical doctors.
#4. For occupational low back pain, chiropractic patients had the shortest compensation duration, and the physiotherapy patients had the longest.
#5. Seeing a chiropractor first for new back or lower body pain was associated with lower odds of receiving an opiate prescription.
#6. About 43% of workers who first saw a surgeon had surgery within 3 years, compared to only 1.5% of those who first saw a chiropractor.
#7. Among older adults who initiated long-term care of chronic low back pain with opioids, the rate of adverse drug events was substantially higher than those who initially chose spinal manipulation.
#8. The choice of an initial health care provider matters when it comes to spine-related disorders. Favorable health and economic outcomes can be achieved by incorporating evidence-informed decision criteria and guidance about entry into conservative low back care such as the care provided by chiropractors.
#9. Having a chiropractor as the initial provider was associated with a reduced likelihood of early MRI.
#10. Early engagement of conservative therapists (e.g. chiropractors) may decrease initial opioid prescriptions in association with MD visits by providing the opportunity to incorporate evidence-based non-pharmacological interventions.
#11. People with neck pain who initially saw acupuncturists or chiropractors had the lowest odds of an opioid fill within 30 days and 1 year compared to physical therapists and medical doctors.
#12. Initial treatment patterns by the chiropractic group had the lowest prescription medication rates, the least costs per episode of LBP, and the least guideline-incongruent use of medications and imaging. *NOTE: this paper looked across treatment groups as an initial treatment pattern – the design was not specifically looking at the first provider per se.
#13. The total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205). There were no differences in delays in the diagnosis of serious illness. “…our study gives confidence that care beginning with more conservative providers (e.g., PT, Chiro, and Acu) may in fact significantly lower use of potentially unnecessary and costly imaging services and prescription opioids.” MY ADD: Patients who chose Chiropractic and Acupuncture first for a musculoskeletal injury were least likely to be hospitalized, least likely to have back surgery.
#14. Optum insurance findings: Chiropractic care is more cost-effective and can reduce opioid prescribing by 26%. Findings from Optum, the health services subsidiary of UnitedHealth Group: Data shows patients, 70% of the time, choose primary care providers (PCPs) and specialists to treat their lower back pain compared to 30% who choose conservative care. The data shows conservative care: Chiropractic/Physical Therapy/Acupuncture can save $230 million dollars in annual medical expenditures and can reduce opioid prescribing by 26%. The goal for Optum in the next two years: Increase the use of conservative care in two years: 2020: Raise the referrals to DCs from MDs from 2% to 10%: Raise the use of conservative care pathway, which is increasing patient access to DCs, from 31% to 50%.
#15. The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization founded in 1983. Its recent report on Chiropractic Care for Workers with Low Back Pain reveals a number of important factors relating to the use of chiropractic for LBP in physical medicine within worker’s comp in 28 states. The article compared to non-chiropractic care for pain management, chiropractic-only care, and E&M resulted in: 47% lower treatment costs per claim, 35% lower indemnity payments, 26% shorter disability periods, 79% less paid for non-pain-management medical services. Much lower use of opioid prescriptions, MRI, and pain management injections.
#16. BMJ Open recently published a study of over 200 thousand patients with new-onset lower back pain. The study determined that the patients who saw a chiropractic physician FIRST were 90% less likely to make use of opioids within the first thirty days and significantly less likely to use them in the long term compared to patients who saw a PCP first. The study suggested that the public should be incentivized to see doctors of chiropractic FIRST as a means to reduce opioid use. Medical research journal recently published a study of over 200 thousand patients with new-onset lower back pain, The patients who saw a Chiropractic physician FIRST were 90% less likely to make use of opioids within the first thirty days and significantly less likely to use them in the long term. That the patients who saw a chiropractic physician FIRST were 90% less likely to make use of opioids within the first thirty days and significantly less likely to use them in the long term compared to patients who saw a PCP first. The study suggested that the public should be incentivized to see doctors of chiropractic FIRST as a means to reduce opioid use. Medical research journal recently published a study of over 200 thousand patients with new-onset lower back pain, The patients who saw a Chiropractic physician FIRST were 90% less likely to make use of opioids within the first thirty days and significantly less likely to use them in the long term.
The choice couldn’t be simpler. Choose chiropractic first for musculoskeletal problems of the shoulder, legs, hips, and spine. Need an appointment now? Book online.