Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher
A recent study examined how the use of chiropractic spinal manipulative therapy (SMT) impacts the use of “escalated spine care” for low back pain (LBP) patients. Escalated spine care was defined as “imaging studies, injection procedures, emergency department visits, surgery, and opioid medication use.” For this study, chiropractic SMT care was categorized based on utilization for a single “episode” of LBP: low – one visit, moderate – two to 12 visits, and high – 13+ visits.
The investigators examined health insurance claims from 2012-2018; a total of 83,025 claims representing 11,114 unique back pain episodes. They computed the relative risk of each form of escalated spine care for each of the three SMT groups compared to patients who did not receive any chiropractic SMT, yielding the following findings:
Low SMT Group
- 47% less likely to receive imaging
- 70% less likely to get injections
- 92% less likely to end up in an ER
- 51% less likely to undergo surgery
- 67% less likely to take opioids
Moderate SMT Group
- 27% less likely to receive imaging
- 74% less likely to get injections
- 79% less likely to end up in an ER
- 60% less likely to undergo surgery
- 63% less likely to take opioids
The high SMT group saw an increase in the likelihood of imaging (RR 1.37) and a reduction in the risk of injections (RR .46) and emergency department visits (RR .27). Surgery and opioid use were about even compared to patients not receiving SMT. This makes sense, as these patients are likely to have more severe ailments which require more imaging and SMT, but less likely to receive injections and visit the ER.
While the use of unnecessary, low-value, non-guideline-concordant interventions remains routine for many medical providers, this study adds to the parade of evidence that cries out for referral to conservative, nonpharmacological care like chiropractic. Considering the approximately $87 billion spent each year in treatment costs, the dollars may ultimately motivate payers (and subsequently primary care physicians) to make better decisions, even if the prospect of superior patient care doesn’t.
Reference
- Anderson BR, Whedon JM, Herman PM. Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: a cohort study of insurance claims. PLoS ONE, 2024;19(1):e0283252.
