Cost of Chiropractic vs. Medical Management of Spine-Related Musculoskeletal Pain

This is a very positive study for our profession, supporting the idea that patients with spinal pain should see a chiropractor first!

Spine-related musculoskeletal pain is the leading cause of disability globally and associated healthcare costs have been rising relentlessly, with spinal pain being the costliest medical condition in the United States in 2016.

Treatment options for spine-related pain are varied and differ by type of provider. Chiropractic care is one of the most utilized treatment options for spine-related musculoskeletal pain in the USA and is recommended by the American College of Physicians for the initial management of low back pain (LBP).
 
In addition to clinical outcomes, costs associated with the various strategies for managing patients with spine-related pain are important considerations. The course of care of patients with spine-related pain is often escalated via the use of more invasive, hazardous and costly procedures, whereas these types of patients who initially choose spinal manipulation have been shown to be less likely to experience escalation of care (ex. diagnostic imaging, hospitalization, surgery, etc.).

Downstream costs are those that “may have changed, intentionally or unintentionally, as a result of the implementation strategy and intervention.” Examples of downstream costs include continuing healthcare utilization, patient and caregiver costs, lost productivity costs and costs to other sectors. Downstream costs for spine-related musculoskeletal pain, especially LBP, have been shown to be significantly affected by the specialty of the initial care provider. Some of the most important downstream effects of escalations of care for patients with spine-related musculoskeletal disorders are the human and societal costs resulting from opioid use, abuse and overdose.

A previous systematic review that compared the costs of chiropractic care to other types of health care providers reported that costs were lower when musculoskeletal spine care was managed by chiropractors. However, methodological limitations were present in the studies that were included in the review. Therefore, the purpose of this current review was to update, summarize, and evaluate the evidence comparing the cost of chiropractic care with conventional medical care for management of spine related musculoskeletal pain.

Some Highlights:

• Fifteen studies reported that diagnostic imaging, especially advanced imaging, was used less with chiropractic (DC) care.
• Eleven studies reported that fewer opioid prescriptions were dispensed or filled with DC care.
• Eight studies reported that fewer surgeries were provided with DC care.
• Seven studies reported that there were fewer hospitalizations with DC care.
• When a DC was the first care provider, there were lower downstream costs.
• Five studies reported that there was decreased use of injection procedures with DC care.
• Five studies reported that there were fewer referrals to specialists with DC care.
• Two studies reported that there were fewer emergency department visits associated with DC care.

RESEARCH REVIEW: Cost of Chiropractic vs. Medical Management of Spine-Related Musculoskeletal Pain

This paper was published in Chiropractic & Manual Therapies (2024)

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