Chiropractic, Low Back Pain, Neck Pain

Over the last few years, there have been increasing pressures to reduce the costs associated with treating low back pain, while, at the same time, increasing the effectiveness of that treatment. A recent study¹ sums up the problem:

“A growing body of clinical evidence and expert opinion indicates that a more conservative approach to the treatment of low back pain and cervical spine pain is appropriate. The evidence indicates that procedures and practices such as inpatient care, advanced imaging, surgery, and even plain-film radiographs are only infrequently necessary for the successful treatment of most cases of low back pain and neck pain.

“In spite of the evidence, these procedures and practices continue to be used at rates in excess of that which the published literature defines as clinically indicated.”

Previous studies have found that chiropractic adjustments can be an effective treatment modality for certain types of low back and neck pain. In this current study, the authors set out to examine the “effects of managed chiropractic benefit on the rates of specific diagnostic and therapeutic procedures” for the treatment of these patients.

The authors analyzed the claims data from a managed-care health plan over a period of four years. The study looked at four different medical procedures and tests and compared employer groups that provided a chiropractic benefit with those that did not.

The authors found reductions in nearly every area per episode of back pain or neck pain in the groups that had a chiropractic benefit:

This is not the first study to find that chiropractic care reduced overall costs when included in managed care programs. A 2004 study² also found that these patients had a lower utilization of plain film radiographs, MRI, hospitalizations, and surgery.

The 2004 study put forth four possible explanations for these findings:

1. Positive risk selection.
2. Substitution of chiropractic for traditional medical care.
3. More conservative, less invasive treatment protocols.
4. Lower health service costs associated with managed chiropractic care.

These two studies show that not only can chiropractic care be an effective treatment for certain patients with low back or neck pain, it can also reduce the use of unnecessary and expensive interventions:

“Among employer groups with chiropractic coverage compared with those without such coverage, there is a significant reduction in the use of high-cost and invasive procedures for the treatment of low back pain and neck pain…The resultant chiropractic care is far less likely to lead to the use of these invasive procedures.”

1. Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. Journal of Manipulative and Physiological Therapeutics 2005;28:564-569.
2. Legorreta AP, Metz RD, Nelson CF, Ray S, Chernicoff HO, Dinubile NA. Comparative analysis of individuals with and without chiropractic coverage: patient characteristics, utilization, and costs. Archives of Internal Medicine 2004;164(18):1985-1992.