Preventing costly ‘treatment escalation’ with chiropractic care!

Male chiropractors adjusting a female patient's sore low back

Treatment escalation for low back pain (LBP) is costing our healthcare system a ton of money, despite the fact that most of these expensive interventions and imaging modalities do not improve patient outcomes. So, for us as chiropractors, a relevant question is: how much treatment is needed to avoid unnecessary escalation of care for low back pain patients?

LBP is one of the leading causes of disability worldwide. The one-year prevalence of LBP has been estimated to be 38%, although accurate estimates have been problematic due to heterogeneity between studies and inaccurate population estimates.
Even though treatment guidelines recommend non-pharmacological and conservative care options for the initial management of LBP, patients often receive non-guideline-based care that results in substantially increased costs. The use of these unwarranted interventions, such as routine early use of imaging studies, opioid medications, injection procedures, and surgery, has actually increased in recent years! This is referred to as “treatment escalation”.
Spinal manipulation therapy (SMT) (the most common treatment provided by chiropractors) is a guideline recommended treatment for both acute and chronic LBP. Patient satisfaction among chiropractic patients has been shown to be very high, with 92% of LBP patients indicating they would use chiropractic again for subsequent episodes. In contrast, only 49% of LBP patients who initially saw a primary care physician (PCP) indicated they would choose PCP care for subsequent episodes.
In a previous study on the dose-response relationship between SMT and the clinical outcomes of chronic LBP patients, those who received an increased number of SMT visits experienced improved outcomes with the optimal number being 12 visits. Several studies have investigated the relationship between SMT and healthcare utilization for back pain, which when compared to other forms of care, found decreased utilization of imaging, surgery, opioid medications, injections, specialist visits and emergency department (ED) visits.
The relationship between SMT dose and exposure to escalated spine care is unknown; hence, the purpose of this study was to evaluate this relationship with exposure to escalated spine care comprising imaging studies, injection procedures, ED visits, surgery, and/or opioid medications.  

RESEARCH REVIEW: Relationship Between Dosing of Lumbar Spinal Manipulative Therapy & Escalated Spine Care

This paper was published in PLoS ONE (2024)

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