Chiropractic pain management may be the best Noninvasive Nonpharmacological Treatment for Chronic Pain

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In February of 2017, the Annals of Internal Medicine offered their overview of what works for lower back pain and what doesn't  Their assessment was that a number of approaches including spinal manipulation were effective for back pain.  Chiropractors routinely use a number of the methods listed to relieve lower back pain in their holistic multifaceted approach to care.  The common element in what they recommended was movement, while they also suggested that nonpharmacological and noninvasive care should be used first. A recent paper by the Agency for Healthcare Research and Quality has looked at other conditions such as fibromyalgia, back pain, neck pain, osteoarthritis, and headaches and reviewed the best available evidence.  Again, a multifaceted approach seems to be the most effective way of handling these conditions according to the current evidence. It brings into question the idea that perhaps, the idea of primary care for the musculoskeletal system is likely the best approach available and chiropractors, being physician-level providers are best suited for the job based on their approach to care that includes manipulation, exercise, and muscle work as well as their holistic ground-up way of looking at the body which allows for a more informed approach to which treatments are right for which patients. Perhaps, large insurers can improve care by just getting out of the way and allow providers to do what they were trained to do.  Currently, many insurers have chiropractors pre-approve for care which does little to improve the quality of care while reducing efficiency shielding insurers from the true cost of care. Some insurers such as Aetna use NIA to pre deny care which merely shifts the costs to the doctor and patient while the doctor has to go through numerous appeals to get paid. Considering nonpharmacologic care has more evidence to support it, this should be the first option afforded patients who suffer from pain but the providers must also demonstrate efficacy in their treatment approaches.   Insurers according to the best available evidence should understand that most painful problems are due to movement and the provider that has the most comprehensive approach using a treatment that is movement-based is your local chiropractor. They should also begin to realize that these providers are of a higher value and should be compensated as such.   They should also realize that many methods such as injections and other approaches which offer far less evidence to support their usage should be utilized last. Check out the study below

Noninvasive Nonpharmacological Treatment for Chronic Pain

A Systematic Review Update SYSTEMATIC REVIEWApril 16, 2020 Purpose of Review To assess noninvasive nonpharmacological treatments for common chronic pain conditions. Key Messages Interventions that improved function and/or pain for ≥1 month:
  • Low back pain: Exercise, psychological therapy, spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR).
  • Neck pain: Exercise, low-level laser, mind-body practices, massage, acupuncture.
  • Knee osteoarthritis: Exercise, cognitive behavioral therapy (CBT).
  • Hip osteoarthritis: Exercise, manual therapies.
  • Fibromyalgia: Exercise, CBT, myofascial release massage, mindfulness practices, tai chi, qigong, acupuncture, MDR.
  • Tension headache: Spinal manipulation.
Some interventions did not improve function or pain. Serious harms were not observed with the interventions. Read more