All the Ways DCs Top MDs for Spinal Pain

A new systematic review compares the cost of caring for patients with spine-related pain, examining the difference in downstream costs between chiropractic care and medical management.¹

The authors conducted a Medline search, initially finding 2,256 citations from which they identified 44 applicable studies of high or acceptable quality. The 44 studies include 26 cohort studies, 17 cost studies and one randomized, controlled trial.

This is the first such study conducted since a similar paper was published in 2015.² This is important, as most of the papers published since then identified not only initial costs of care, but downstream costs as well, which can be even more expensive than the initial care.

Here are all the ways chiropractic management resulted in lower downstream utilization and cost compared to medical management:

• Diagnostic Imaging – 15 studies found chiropractic care resulted in less diagnostic imaging, particularly advanced imaging like MRI.
• Opioids – 11 studies found chiropractic care resulted in fewer opioid prescriptions.
• Surgery – Eight studies found patients underwent fewer surgeries with chiropractic management.
• Hospitalization – Seven studies found chiropractic care resulted in fewer hospitalizations.
• First Provider – Six studies associated lower downstream cost with a DC as the first provider.
• Injections – Five studies found decreased use of injections with chiropractic care.
• Specialist Visits – Five studies associated chiropractic care with fewer referrals to specialists.
• ER Visits – Two studies found chiropractic care resulted in fewer emergency department visits.

The authors concluded: “Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.”

Perhaps one of the greatest values of this paper is the list of references for each of the above variables. This arms DCs with the necessary citations to write their own articles, post on social media or have dialogues with other providers.

The study was funded in part by the Clinical Compass and the NCMIC Foundation. It is available without cost or subscription, with a pdf format downloadable for future reference. Every DC is encouraged to download and utilize this study.

References

1. Farabaugh R, Hawk C, Taylor D, et al. Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review. Chiropr Man Therap, 2024;32:Article 8.
2. Dagenais S, Brady O, Haldeman S, Manga P. A systematic review comparing the costs of chiropractic care to other interventions for spine pain in the United States. BMC Health Serv Res, 2015;15:474.