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Early Chiropractic for Lower Back Pain Sends Fewer Patients to Specialists
Primary care physicians should consider referring patients with lower back pain (LBP) to chiropractors to avoid later high-cost and potentially unnecessary care.
A new study found that patients who were referred to chiropractors within 2 weeks of seeing their physician for LBP were significantly less likely to make visits to a pain specialist, or orthopedist.
Patients also filed fewer claims for advanced imaging or epidural steroid injections and were half as likely to visit an emergency department (ED) within 30 days than those who did not start early chiropractors, according to the study published July 3 in BMC Health Services Research.
“Some lower back pain resolves itself, but often, that recovery is incomplete, leading to increased healthcare and opioid use,” Richard Skolasky, Jr, ScD, director of the Spine Outcomes Research Center at Johns Hopkins Medicine, Baltimore, and a co-author of the study, said. “Our hope is this study helps more primary care physicians embrace nonpharmacologic, first-line treatments.”
LBP accounts for an estimated $1.8 billion annually in healthcare costs among the patients who do not receive surgery for the condition, according to a 2019 JAMA analysis of commercial insurance and Medicare claims. In addition, LBP accounts for approximately 2.7 million ED visits annually, a 2010 study published in Spine showed.
Skolasky and his colleagues assessed 980,000 outpatient claims over a period of almost 4 years that ended in 2014. The researchers used Truven MarketScan, a group of US-based administrative commercial healthcare insurance claims databases. Patients who had a history of conditions that cause LBP, such as endometriosis and spinal fracture, were excluded from the analysis. Approximately 11% of patients in the total sample received early, defined as chiropractic, received within 2 weeks of their initial visit to a primary care clinician.
After adjusting for sex, age, and Charlson Morbidity Index, patients who received chiropractic were about half as likely as those who didn’t to see a pain specialist or have an ED visit within 30 days of their initial appointment. They were about one third as likely to receive an epidural steroid injection, and they were 43% less likely to have claims for advanced imaging, according to the researchers (P < .001 for all).
In addition, the cost of claims was lower for patients who received early chiropractic ($747 vs $799), the researchers found.
The effects diminished somewhat over time but remained statistically significant.
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