If chiropractic care helps patients get better faster and costs the patient and/or insurance company less, shouldn’t EVERY low back pain (LBP) patient FIRST see a chiropractor before any other type of doctor? That is in fact, what should be done, based on a 2009 report!

On October 20, 2009, a report was delivered on the impact on population, health, and total healthcare spending. The authors found the addition of chiropractic care for the treatment of neck and low back pain “…will likely increase value-for-dollar in US employer-sponsored health benefit plans.” Authored by an MD and an MD/PhD and commissioned by the Foundation for Chiropractic Progress, the findings are clear: chiropractic care achieves higher satisfaction and superior outcomes for both neck and low back pain in a manner more cost effective than other commonly utilized approaches.

The study reviewed the fact that low back and neck pain are extremely common conditions consuming large amounts of healthcare dollars. In 2002, 26% of surveyed US adults reported having back pain during the previous three months, 14% had neck pain during that time period, and the lifetime prevalence of back pain was estimated at 85%. LBP accounts for 2% of all physician office visits where only routine examinations, hypertension, and diabetes result in more. Annual national spending is estimated at $85 billion in the US with an inflation-adjusted increase of 65% compared with spending from just a little over a decade before in 1997. Treatment options are diverse ranging from rest to surgery, including many various types of medications. Chiropractic care, including spinal manipulation and mobilization, is reportedly also widely utilized with almost half of all patients with persisting back pain seeking chiropractic treatment.

In a review of the scientific literature, the authors noted that chiropractic care is at least as effective as other widely used therapies for low back pain. Chiropractic care, when combined with other modalities such as exercise, appears to be more effective than other treatments for patients with neck pain. Other studies reported patients who had chiropractic coverage included in their insurance benefits found lower costs, reduced imaging studies, and fewer hospitalizations and surgical procedures compared to those with no chiropractic coverage. The authors then utilized a method to compare medical physician care, chiropractic physician care, physiotherapy-led exercise and, and manipulation plus physiotherapy-led exercise for low back pain care. They found utilizing chiropractic care was associated with better outcomes at “…equivalent to an incremental cost-effectiveness ratio of $1837 per QALY (Quality-adjusted Life Year).”

When combined with exercise, chiropractic care was also found to be very cost-effective when compared with exercise alone. This combined approach would achieve improved health outcomes at a cost of $152 per patient, equivalent to an “incremental cost-effectiveness ratio of $4591 per QALY.” When comparing the cost effectiveness of chiropractic care with or without exercise even at 5 times the cost of the care they utilized in their analysis, it was still found to be “substantially more cost-effective” compared with other approaches. It will be interesting given these findings if insurance companies and future treatment guidelines start to MANDATE the use of chiropractic FIRST – it would be in everyone’s best interest!