Chiropractors Reduce Costs by 40% if the 1st Option for Spine

 

DC’s Would Save the Healthcare System 1.86 Trillion Dollars Over 10 Years

 

By: Matt Erickson, DC, FSBT

Mark Studin DC, FASBE(C), DAAPM, DAAMLP

 

A report on the scientific literature

 

Citation: Erickson M., Studin M (2019) Chiropractors Reduce Costs by 40% if the 1st Option for Spine, American Chiropractor 41(8) 38, 40-43

 

INTRODUCTION

 

Currently, our country is facing a health care crisis not only with respect to the opioid epidemic, but also due the fact our health care costs in the US have skyrocketed out of control. According to Centers for Medicare and Medicaid Services (CMS), National Health Expense (NHE) fact sheet (2017), “NHE grew 3.9% to $3.5 trillion in 2017, or $10,739 per person, and accounted for 17.9% of Gross Domestic Product (GDP).” It was also predicted by CMS (2017) thatUnder current law, national health spending is projected to grow at an average rate of 5.5 percent per year for 2018-27 and to reach nearly $6.0 trillion by 2027”(https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html).

 

 

In a study from data primarily from 2013-2016, Papanicolas, Woskie and Jha (2018) reported, “The United States spends more per capita on health care than any other nation, substantially outpacing even other very high-income countries. However, despite its higher spending, the United States performs poorly in areas such as health care coverage and health outcomes” (p. 1025).

 

Papanicolas et al., (2018), also stated, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries” (p. 1038). Papanicolas et al., (2018), reported, “Ten high-income countries were selected for comparison” (p. 1025). The ten countries included, “the United Kingdom (consisting of England, Scotland, Wales, and Northern Ireland), Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands, and Switzerland” (p. 1025).

 

 

Singh, Andersson and Watkins-Castillo (2019, para. 1) reported “Lumbar/low back pain and cervical/neck pain are among the most common medical conditions requiring medical care and affecting an individual’s ability to work and manage the daily activities of life. Back pain is the most common physical condition for which patients visit their doctor. In any given year, between 12% and 14% of the United States adult population age 18 and older visit their physician with complaints of back pain. The number of physician visits has increased steadily over the years. In 2013, more than 57.1 million patients visited a physician with a complaint of back pain, compared to 50.6 million in 2010. Also, an unknown number of patients visit a chiropractor or physical therapist for these complaints. Singh et. al (2019, para. 4) further reported, “The estimated annual direct medical cost for all persons with a back-related condition in 2014 dollars was an average of $315 billion per year across the years 2012-2014(https://www.boneandjointburden.org/fourth-edition/iia0/low-back-and-neck-pain).

 

According to Cynthia Cox of the Kaiser Family Foundation (2017) reporting on data from 2013, The top five disease-based spending categories (ill-defined conditions, circulatory, musculoskeletal, respiratory, and endocrine) account for half of all medical services spending by disease category. Ill-defined conditions each represent about 13% of overall health spending by disease while circulatory, musculoskeletal, respiratory, and endocrine conditions represent 12%, 10%, 8%, and 7% respectively.” That is to say, musculoskeletal disease represents 10% of the health care expenditures” (https://www.healthsystemtracker.org/chart-collection/much-u-s-spend-treat-different-diseases/#item-top-five-disease-categories-account-roughly-half-medical-service-spending).

 

The above graphic is from the 2017 Peterson-Kaiser report, “How much does the U.S. spend to treat different disease?”

 

 

As neck and back pain in one of the most prevalent issues that present to primary care physician (PCP) offices, considering the current opioid crisis and the associated health care expenditure, particularly related to neck and back pain, this raises the question if Doctors of Chiropractic-who are licensed to manage spinal disorders and comprehensive training in spine care, can not only provide similar or better outcomes and greater or equivalent satisfaction among patients, but provide care in a more cost effective manner, as well as help to unburden the already overloaded primary care practices considering the trending shortage of PCPs in our health care delivery system?

 

THE EVIDENCE

 

In an article by Houweling, Braga, Hausheer, Vogelsang, Peterson and Humphreys (2015), the authors reported on first-contact care with a medical vs. a chiropractic provider after a consultation with a Swiss telemedicine provider. The study looked to compare outcomes, patients satisfisfaction and health care costs in spinal, hip and shoulder pain patients.

 

Houweling et al., (2019), reported that “Pain of musculoskeletal origin represents a major health problem worldwide. In a Swiss survey conducted in 2007, back pain was a commonly reported health problem, with 43% of the population experiencing this complaint over the course of a year. Of these, 33% reported that their symptoms led to reduced productivity at work. The burden of musculoskeletal conditions on the Swiss health care system is equally staggering, with health care expenditure resulting from this condition being estimated at 14 billion Swiss Francs (CHF) per year (US $14 billion) or 3.2% of the gross domestic product” (p. 478-479).

 

 

The study by Houweling et al., (2019), also showed that spinal, hip, and shoulder pain patients had modestly higher pain relief and satisfaction with care at lower overall cost if they initiated care with DCs, when compared with those who initiated care with MDs” (p. 480). Houweling et al., further added, “Although the differences in pain relief scores between groups were statistically significant, they were likely not of clinical significance.” (p. 480). Houweling et al., explained the reason for this was, “the extent of the differences in pain relief observed might be too small for patients to notice a clinically meaningful difference” (p. 480).

 

With respect to patient satisfaction Houweling et al., (2019), reported, “The findings of this study pertaining to patient satisfaction were in line with previous research comparing chiropractic care to medical care for back pain, which found that chiropractic patients are typically more satisfied with the services received than medical patients” (p. 481). Houweling et al., added, “The Mean total spinal, hip, and shoulder pain-related health care costs per patient during the 4-month study period were approximately 40% lower in patients initially consulting DCs compared with those initially consulting MDs. The reason for this difference was a lower use of health care services other than first-contact care in patients initially consulting DCs compared with those initially consulting MDs” (p. 481).

 

Thus, Houweling et al., (2019) concluded, “The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions” (p. 481). The authors also noted, “In addition to potentially reducing health care costs, direct access to chiropractic care may ease the workload on MDs, particularly in areas with poor medical coverage and hence enabling them to focus on complex cases. The minority of patients with complex health problems initially consulting a chiropractic provider would be referred to, or comanaged with, a medical provider to provide optimal care” (p. 481).

 

CONCLUSION

 

In conclusion, health care cost has skyrocketed out of control with the prediction the US expenditures will reach 6 trillion by 2027. Considering neck and back pain expenditures in between 2012-2014 averaged $315 billion annually and total health care costs in 2017 were $3.5 trillion, this means approximately 10% of health care expenditures annually are for neck and back pain which is supported by the Peterson-Kaiser Health Tracker System report. Moreover, considering the estimated health costs are predicted to be $6 trillion by 2027, if the expenditure for neck and back pain remained on par at 10% that means the cost of neck and back pain in would increase to around $600 billion over that time frame.

 

Considering in the Houweling et al., that by using doctors of chiropractic as a first-line provider for spine, hip and shoulder pain, it demonstrated a 40% reduction in costs, that means in 2027, if DCs were first-line providers, it is estimated this could save the health care delivery system $240 BILLION DOLLARS in one year alone (just for neck and back pain). If one considers the prediction of 5.5% annual expenditure increase, that means the estimated total expenditure for neck and back pain between 2018-2027 would be $4.65 trillion dollars. If having DCs as a first-line provider were to save 40% in costs, that would translate into saving $1.86 TRILLION DOLLARS. If that was applied to the predicted 2027 neck and back pain expenditure, that number would represent a 32% savings in that year. Given our skyrocketing health care costs, that would represent a significant savings!

 

Further, if we consider from the study, there was a modestly higher pain relief and ever greater patient satisfaction reported, when you factor in the predicted PCP shortage, having the ability for DCs to serve as a first-line provider, not only can it help unburden the already overloaded PCPs, but doing so would have a significant financial impact in lowering health care expenditures. All things considered, it is time our decision makers take a serious look at improving access to Doctors of Chiropractic so they may serve as first-line providers for the management of all spine and even hip and shoulder related disorders.

 

REFERENCES

 

  1. “National Health Expenditure Fact Sheet” (2019, April 26). Centers for Medicare and Medicaid. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html.
  2. Irene Papanicolas, Liana R. Woskie, Ashish K. Jha. (2018). Health Care Spending in the United States and Other High-Income Countries, Journal of the American Medical Association, 319(10), 1024-1039.
  3. Kern Singh, MD, Gunnar Andersson, MD, PhD and Sylvia I. Watkins-Castillo, PhD. (2019) United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), forthcoming. Rosemont, IL. Retrieved from https://www.boneandjointburden.org/fourth-edition/iia0/low-back-and-neck-pain.
  4. Cox Cynthia. (2017, May 22). How much does the U.S. spend to treat different disease? Peterson-Kaiser Health Tracker System. Retrieved from https://www.healthsystemtracker.org/chart-collection/much-u-s-spend-treat-different-diseases/#item-top-five-disease-categories-account-roughly-half-medical-service-spending.
  5. Houweling, Braga, Hausheer, Vogelsang, Peterson and Humphreys. (2015). First-Contact Care with a Medical vs. Chiropractic Provider After Consultation with a Swell Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients. Journal of Manipulative and Physiological Therapeutics, 38(7), 477-483.

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Published in Neck Problems

Chiropractic Improves Neck Pain in a Military Veteran Population & Lowers the Need for Opiates

 

By Mark Studin

William Owens

 

A Report on the Scientific Literature

 

According to the American Academy of Pain Medicine, neck pain accounts for 15% of commonly reported pain conditions. Sinnott, Dally, Trafton, Goulet and Wagner (2017) reported:

 

Neck and back pain problems are pervasive and associated with chronic pain, disability and high healthcare utilization. Among adults 60% to 80% will experience back pain and 20% to 70% will experience neck pain that interferes with their daily activities during their lifetime. At any given time, 15% to 20% of adults will report having back pain and 10% to 20% will report neck pain symptoms. The vast majority of back and neck pain complaints are characterized in the literature as non-specific and self-limiting.” (pg. 1) 

 

The last sentence above describes why back and neck pain has contributed significantly to the opioid crisis and why our population, after decades still suffers from back and neck problems that have perpetuated. Mechanical lesions of the spine are not “self-limiting” and are not “non-specific.” They are well-defined and based upon Wolff’s Law (known since the 1800’s) don’t go away. Allopathy (Medicine) has purely focused on the pain and has vastly ignored the underlying cause of the neuro-bio-mechanical cause of the pain. 

 

Corcoran, Dunn, Green, Formolo and Beehler (2018) reported that musculoskeletal problems as the leading cause of morbidity for female veterans and females are more prone to experience neck pain than men. In addition, there has been a 400% increase in opioid overdoes deaths in females since 1999 compared to 265% for men and as a result, the Veterans Health Administration has utilized chiropractic as a non-pharmacological treatment option for musculoskeletal pain. Neck pain has also comprised of 24.3% of musculoskeletal complaints referred to chiropractors. 

 

Corcoran et. Al. also reported with chiropractic care, based upon a numeric rating scale (NRS) and the Neck Bournemouth Questionnaire (NBQ) scores, the NRS improved by 45% and the NBQ improved by 38%, with approximately 65% exceeding the minimum clinically important difference of 30%. A previous study of male veterans revealed a 42.9% for NSC and a 33.1 improvement for NBQ; statistics similar to female veterans. 

 

Although this is a very positive outcome that has helped many veterans, the percentages do not reflect what the authors have found in their clinical practices. These authors of this article (Studin and Owens) reported that for decades, cervical pain has been eradicated in 90 and 95% of the cases treated in our practices. The question begs itself, why is the population of veterans showing statistics less than half? 

 

Corcoran, et. Al. (2018) reported how the chiropractic treatment was delivered in their study:

 

The type of manual therapy varied among patients and among visits, but typically included spinal manipulative therapy (SMT), spinal mobilization, flexion – distraction therapy, and or myofascial release. SMT was operatively defined as a manipulative procedure involving the application of a high - velocity, low – ample to thrust the cervical spine. Spinal mobilization was defined as a form of manually assisted passive motion involving repetitive joint oscillations typically at the end of joint playing without application of a high- velocity, low – ample to thrust. Flexion – distraction therapy is a gentle form of a loaded spinal manipulation involving traction components along with manual pressure applied to the neck in a prone position. Myofascial release was defined as manual pressure applied to various muscles on the static state or all undergoing passive lengthening.

 

The above paragraph explains why the possible disparity in outcomes as Corcoran et. Al  do not reflect the ratios of who received high-velocity low-amplitude chiropractic spinal adjustment vs. the other therapies. When considering the other modalities; mobilization, flexion distraction therapy and myofascial release we must equate that to the outcomes physical therapist realize when treating spine as those are their primary reported treatment modalities. The following paragraphs indicate why spine care delivered by physical therapist is inferior to a chiropractic spinal adjustment, which equates to only a portion of the referenced chiropractic treatment modalities cited in the Corcoran Et. Al. The following citations conclude why these modalities provide inferior results compared to the high-velocity, low-amplitude chiropractic spinal adjustment that was exclusively used by the authors and rendered significantly higher positive outcome.


Studin and Owens (2017) reported the following:

Groeneweg et al. (2017) also stated:

This pragmatic RCT [randomized control trial] in 181 patients with non-specific neck pain (>2 weeks and <1 year) found no statistically significant overall differences in primary and secondary outcomes between the MTU (manual Therapy University) group and PT group. The results at 7 weeks and 1 year showed no statistically and clinically significant differences. The assumption was that MTU was more effective based on the theoretical principles of mobilization of the chain of skeletal and movement-related joint functions of the spine, pelvis and extremities, and preferred movement pattern in the execution of a task or action by an individual, but that was not confirmed compared with standard care (PT). (pg. 8)

Mafi, McCarthy and Davis (2013) reported on medical and physical therapy back pain treatment from 1999 through 2010 representing 440,000,000 visits and revealed an increase of opiates from 19% to 29% for low back pain with the continued referral to physical therapy remaining constant. In addition, the costs for managing low back pain patients (not correcting anything, just managing it) has reached $106,000,000,000 ($86,000,000,000 in health care costs and $20,000,000,000 in lost productivity).

Cifuentes et al. (2011) started by stating:

Given that chiropractors are proponents of health maintenance care...patients with work-related LBP [low back pain] who are treated by chiropractors would have a lower risk of recurrent disability because that specific approach would be used. (p. 396). The authors concluded by stating: “After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type” (Cifuentes et al., 2011, p. 404).

Mafi, McCarthy and Davis (2013) stated:

Moreover, spending for these conditions has increased more rapidly than overall health expenditures from 1997 to 2005...In this context, we used nationally representative data on outpatient visits to physicians to evaluate trends in use of diagnostic imaging, physical therapy, referrals to other physicians, and use of medications during the 12-year period from January 1, 1999, through December 26, 2010. We hypothesized that with the additional guidelines released during this period, use of recommended treatments would increase and use of non-recommended treatments would decrease. (p. 1574)

(http://www.uschirodirectory.com/index.php?option=com_k2&view=item&id=822:the-mechanism-of-the-chiropractic-spinal-adjustment-manipulation-chiropractic-vs-physical-therapy-for-spine-part-5-of-a-5-part-series&Itemid=320)

The above paragraph has accurately described the problem with allopathic “politics” and “care-paths who have continued to report medical “dogma” and have ignored the scientific literature results of chiropractic vs. physical therapy.

Mafi, McCarthy and Davis (2013) concluded:

Despite self-reported overwhelming evidence where there were 440,000,000 visits and $106,000,000,000 in failed expenditures, they hypothesized that increased utilization for recommended treatment would increase. The recommended treatment, as outlined in the opening two comments of this article, doesn’t work and physical therapy is a constant verifying a “perpetually failed pathway” for mechanical spine pain. (p. 1574)


(http://www.uschirodirectory.com/index.php?option=com_k2&view=item&id=822:the-mechanism-of-the-chiropractic-spinal-adjustment-manipulation-chiropractic-vs-physical-therapy-for-spine-part-5-of-a-5-part-series&Itemid=320)

Despite the disparity in statistics, the literature is clear chiropractic renders successful out comes for both male and females, and the spine is not discriminatory for veterans versus non-veterans and offers a successful solution in lieu of the utilization of opiates for musculoskeletal spinal issues. In addition, the labels “non-specific” and “self – limiting” are inaccurate and have been placed by providers with no training in the biomechanics of spine care. Chiropractors has been trained in spinal biomechanics for over 100 years and currently there are advanced courses in spinal biomechanical engineering, of which many chiropractors have concluded. 

References:

  1. AAPM facts and figures on pain, the American Academy of pain medicine (2018), retrieved from: http://www.painmed.org/patientcenter/facts_on_pain.aspx#common
  2. Sinnott P., Dally S., Trafton J., Goulet J. and Wagner T. (2017) Trends in diagnosis of painful neck and back conditions, 2002 to 2011, Medicine, 96 (20), pgs. 1-6
  3. Corcoran K., Dunn A., Green B., Formolo L., and Beehler G. (2018) Changes in Female Veterans’ Neck Pain Following Chiropractic Care at a Hospital for Veterans, Complimentary Therapies in Clinical Practice 30, pgs. 91-95
  4. Studin M., Owens W., (2017) The Mechanism of the Chiropractic Spinal Adjustment/Manipulation: Chiropractic vs. Physical Therapy for Spine, Part 5 of 5, Retrieved from: http://www.uschirodirectory.com/index.php?option=com_k2&view=item&id=822:the-mechanism-of-the-chiropractic-spinal-adjustment-manipulation-chiropractic-vs-physical-therapy-for-spine-part-5-of-a-5-part-series&Itemid=320

 

 

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Published in Neck Problems

Chiropractic Reduces Opioid Use by 55% in Low Back Pain

 

By Mark Studin

William J. Owens

 

A report on the scientific literature  

 

In the United States, of the adults who were prescribed opioids, 59% reported back pain.1 According to Statistia, the percentage of adults in the United States in 2015 with low back pain was 29.1% (https://www.statista.com/statistics/684597/adults-prone-to-selected-symptoms-us/)  and in 2017 that number was 49% for all back-pain sufferers reporting symptoms (https://www.statista.com/statistics/188852/adults-in-the-us-with-low-back-pain-since-1997/).

 

Peterson ET. AL. (2012) reported:

 

[The] Prevalence of low back pain is stated to be between 15% and 30%, the 1-year period prevalence between 15% and 45%, and a life-time prevalence of 50% to 80%” (pg. 525). 

 

While acute pain is a normal (author’s note: pain is never normal) short-lived unpleasant sensation triggered in the nervous system to alert you to possible injury with a reflexive desire to avoid additional injury, chronic pain is different. Chronic pain persists and fundamentally changes the patient’s interaction with their environment. In chronic pain it is well documented that aberrant signals keep firing in the nervous system for weeks, months, even years. (http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm)

Baliki Et. AL. (2008) stated

 

Pain is considered chronic when it lasts longer than 6 months after the healing of the original injury. Chronic pain patients suffer from more than pain, they experience depression, anxiety, sleep disturbances and decision-making abnormalities that also significantly diminish their quality of life (pg. 1398).

 

 

Chronic pain patients also have shown to have changes in brain function in sufferers with Alzheimer’ disease, depression, schizophrenia and attention deficit hyperactivity disorder giving further insight into disease states. In addition, chronic pain has a cause and effect on the morphology of the spinal cord and the brain resulting in a process termed “linear shrinkage”, which has been suggested to cause ancillary negative neurological sequella.  

 

Apkarian Et. Al. (2004) reported that “Ten percent of adults suffer from severe chronic pain. Back problems constitute 25% of all disabling occupational injuries and are the fifth most common reason for visits to the clinic; in 85% of such conditions, no definitive diagnosis can be made.” (pg. 10410) 

 

Whedon, Toler, Goel and Kazal (2018) reported the following:

 

One in 5 patients with noncancer pain or pain related diagnosis is prescribed opioids in office-based setting… primary care clinicians account for 50% of opioid prescriptions (Pg. 1). 1 day of opioid exposure carries a 6% chance of being on opioids 1year later, increasing to 13.5% by 8 days and 29.9% by 31 days. Among drug overdoses in the United States in 2014, 28,647, 61% involved an opioid. Opioids were involved in 75% of pharmaceutical deaths in 2010 and in 2015 over 22,000 deaths involved in prescription opioids were recorded-an increase of 19,000 deaths over the previous year (pg. 2).

 

 

Perhaps a portion of this phenomena is related to the training of medical primary care providers regarding musculoskeletal conditions. Studin and Owens reported (2016):

 

Day Et. Al. (2007) reported that only 26% of fourth year Harvard medical students had a cognitive mastery of physical medicine (pg. 452). Schmale (2005) reported “Incoming interns at the University of Pennsylvania took an exam of musculoskeletal aptitude and competence, which was validated by a survey of more than 100 orthopaedic program chairpersons across the country. Eighty-two percent of students tested failed to show basic competency. Perhaps the poor knowledge base resulted from inadequate and disproportionately low numbers of hours devoted to musculoskeletal medicine education during the undergraduate medical school years. Less than 1⁄2 of 122 US medical schools require a preclinical course in musculoskeletal medicine, less than 1⁄4 require a clinical course, and nearly 1⁄2 have no required preclinical or clinical course. In Canadian medical schools, just more than 2% of curricular time is spent on musculoskeletal medicine, despite the fact that approximately 20% of primary care practice is devoted to the care of patients with musculoskeletal problems. Various authors have described shortcomings in medical student training in fracture care, arthritis and rheumatology, and basic physical examination of the musculoskeletal system (pg. 251).  

 

With continued evidence of lack of musculoskeletal medicine and a subsequent deficiency of training in spine care, particularly of biomechanical orientation, the question becomes which profession has the educational basis, training and clinical competence to manage these cases?  Let’s take a closer look at chiropractic education as a comparison. Fundamental to the training of Doctor of Chiropractic according to the American Chiropractic Association is 4,820 hours (compared to 3,398 for physical therapy and 4,670 to medicine) and receive a thorough knowledge of anatomy and physiology. As a result, all accredited Doctor of Chiropractic degree programs focus a significant amount of time in their curricula on these basic science courses. So important to practice are these courses that the Council on Chiropractic Education, the federally recognized accrediting agency for chiropractic education requires a curriculum which enables students to be “proficient in neuromusculoskeletal evaluation, treatment and management.” In addition to multiple courses in anatomy and physiology, the typical curriculum in chiropractic education includes physical diagnosis, spinal analysis, biomechanics, orthopedics and neurology. As a result, students are afforded the opportunity to practice utilizing this basic science information for many hours prior to beginning clinical services in their internship.

 

http://uschiropracticdirectory.com/index.php?option=com_k2&view=item&id=758:chiropractic-vs-medicine-who-is-more-cost-effective-renders-better-outcomes-for-spine&Itemid=320

 

Whedon, Toler, Goel and Kazal (2018) continued:

 

Recently published clinical guidelines from the American College of Physicians recommended nonpharmacological treatment is the first – line approach to treating back pain, with consideration of opioids only is the last treatment option or if other options present substantial harm to the patient. Recent systematic review and meta-analysis found that for treatment of acute low back pain, spinal manipulation provides a clinical benefit equivalent to that of an NSAID’s, with no evidence of serious harm. Spinal manipulation is also shown to be an effective treatment option for chronic low back pain (pg. 2).

 

A retrospective claims study of 165,569 adults found that utilization of chiropractic services delivered by Doctor of Chiropractic was associated with reduced use of opioids. More recently, it was reported that the supply chiropractors as well as spending on spinal manipulative therapy is inversely correlated with opioid prescriptions in younger Medicare beneficiaries. This finding suggests that increased availability and utilization of services delivered by Doctor of Chiropractic could lead to reductions in opioid prescriptions. It has been reported that services delivered by Doctor of Chiropractic may improve health behaviors and reduced use of prescription drugs… Pain management services provided by Doctor of Chiropractic may allow patients use lower less frequent doses of opioids, leading to lower costs and reduce risk of adverse effects loops getting together (pg. 2).

 

Although chiropractic has been clinically reporting for over 100 years positive outcomes for a vast array of conditions inclusive of low back pain the American Medical Association (AMA) has been a significant opponent historically. Although the AMA’s position has been well chronicled through lawsuits such as Wilk v. American Medical Association, 895 F.2d 352 (7th Cir. 1990)

(https://openjurist.org/895/f2d/352/wilk-dc-dc-dc-dc-v-american-medical-association-a-wilk-dc-w-dc-b-dc-b-dc), in 2017 it appears they have reversed their position. In the August 2017 Journal of the American Medical Association’s “Clinical Guideline Synopsis for Treatment of Low Back Pain” under the heading MAJOR RECOMMENDATIONS, spinal manipulation is recommended as a first – line therapy, with a strong recommendation. As the AMA did not list Chiropractic specifically and based upon clinical guidelines of other highly regarded medical institutions such as the Cleveland Clinic and the Mayo Clinic, physical therapy is probably high on their list as first-line of referral for spinal manipulation (This is a  topic for another article and nomenclature utilized by chiropractic). When considering the treatment of mechanical spine issues comparatively between chiropractic and physical therapy the outcomes are overwhelmingly in chiropractic’s favor as reported by Studin and Owens (2017)

 

Mafi, McCarthy and Davis (2013) reported on medical and physical therapy back pain treatment from 1999 through 2010 representing 440,000,000 visits and revealed an increase of opiates from 19% to 29% for low back pain with the continued referral to physical therapy remaining constant. In addition, the costs for managing low back pain patients (not correcting anything, just managing it) has reached $106,000,000,000 ($86,000,000,000 in health care costs and $20,000,000,000 in lost productivity). 

 

Mafi, McCarthy and Davis (2013) stated:

Moreover, spending for these conditions has increased more rapidly than overall health expenditures from 1997 to 2005...In this context, we used nationally representative data on outpatient visits to physicians to evaluate trends in use of diagnostic imaging, physical therapy, referrals to other physicians, and use of medications during the 12-year period from January 1, 1999, through December 26, 2010. We hypothesized that with the additional guidelines released during this period, use of recommended treatments would increase and use of non-recommended treatments would decrease. (p. 1574)

 

The above paragraph has accurately described the problem with allopathic “politics” and “care-paths.” Despite self-reported overwhelming evidence of chiropractic vs. physical therapy outcomes for spine, where there were 440,000,000 visits and $106,000,000,000 in failed expenditures, they hypothesized that increased utilization for recommended treatment would increase. The recommended treatment, as outlined in the opening two comments of this article, doesn’t work and physical therapy is a constant verifying a “perpetually failed pathway” for mechanical spine pain.

 

http://uschiropracticdirectory.com/index.php?option.com_k2&view=item&id=822:the-mechanism-of-the-chiropractic-spinal-adjustment-manipulation-chiropractic-vs-physical-therapy-for-spine-part-5-of-a-5-part-series&Itemid=320

 

Whedon, Toler, Goel and Kazal (2018) reported the concluded:

In 2013, average annual charges per person for filling opioid prescriptions were 74% lower among recipients compared with non-recipients (author’s note: recipients are referring to those patients receiving chiropractic care). For clinical services provided at office visits for low back pain, average annual charges per person in 2013 were 78% lower among recipients compared with non-recipients. The authors have similar between – Cohort differences in charges in 2014: annual charges per person were 70% lower with opioid prescriptions and 71% lower for clinical services among recipients compared with nonrecipients. The Adjusted likelihood find prescription for the opiate analgesic in 2014 was 55% lower among recipients compared with nonrecipients.

 

…the Adjusted likelihood of filling a prescription opioid analgesic was 55% lower for recipients of services provided by Doctor of Chiropractic compared with non-recipients (pg. 4)

 

The above reports evidenced based outcomes verifying chiropractic must be considered as the first-line of referrals, or Primary Spine Care Providers for mechanical spine diagnosis (no fracture, tumor or infection). The evidence also reveals that chiropractic outcomes exceed those of physical therapy and medicine for mechanical spine diagnosis. Unfortunately, it has taken 10,000’s of opioid related deaths to bring chiropractic to the forefront and start to eradicate the medical dogma against chiropractic and consider chiropractic as the 1st referral option for spine.

 

 References:

 

  1. Hudson, Teresa J., Edlund, Mark J., Steffick, Diane E., Tripathi, Shanti P., Sullivan, Mark D. (2008) Epidemiology of Regular Prescribed Opioid Use: Results from a National, Population-Based Survey Journal of Pain and Symptom Management, 2008, Vol.36(3), pp.280-288
  2. Percentage of adults in the U.S. with low back pain from 1997 to 2015 (2018) retrieved from:https://www.statista.com/statistics/188852/adults-in-the-us-with-low-back-pain-since-1997/
  3. Percentage of adults in the U.S. who were prone to select symptoms as of 2017 (2018), Retrieved from: https://www.statista.com/statistics/684597/adults-prone-to-selected-symptoms-us/
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  9. Studin M., Owens. W., (2016), Chiropractic vs. Medicine: Who is Most Cost Effective and Renders Better Outcomes for Spine? Retrieved from: http://uschiropracticdirectory.com/index.php?option=com_k2&view=item&id=758:chiropractic-vs-medicine-who-is-more-cost-effective-renders-better-outcomes-for-spine&Itemid=320
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