Why were chi­ro­prac­tors over­looked in spine care ar­ti­cle?

Modern Healthcare - - COMMENT -

The ar­ti­cle “Re­think­ing spine care” (March 24, p. 14) was cer­tainly timely. But I found it in­ter­est­ing that nowhere in the ar­ti­cle was men­tion made of chi­ro­prac­tic care in ad­dress­ing the cur­rent boon­dog­gle of spine man­age­ment in this coun­try, even though it’s highly rec­om­mended as a first-line treat­ment by both na­tional and in­ter­na­tional guide­lines, as well as pres­ti­gious sci­en­tific jour­nals.

Of the 56 mil­lion Amer­i­cans who have back pain, only 5% need surgery, says Dr. Charles Rosen, an or­tho­pe­dic sur­geon and co-founder of the As­soci- ation for Med­i­cal Ethics. Yet there are nearly 1.2 mil­lion un­sus­pect­ing pa­tients un­der­go­ing surgery for spinal prob­lems ev­ery year who face a fail­ure rate ap­proach­ing 74% (Spine, Feb 15, 2011). Thus, even in the face of ev­i­dence-based re­search, spine surgery rates con­tinue to es­ca­late, leav­ing a wake of im­pair­ment and disability, as well as opi­oid de­pen­dency and huge costs.

En­ter the so­lu­tion: con­ser­va­tive care. In the wake of the Pa­tient Pro­tec­tion and Af­ford­able Care Act and its man­date to re­im­burse providers for ev­i­dence­based care only, sys­tems are turn­ing to con­ser­va­tive providers to treat that 95% co­hort of spine pain pa­tients who might other­wise un­dergo an un­nec­es­sary sur­gi­cal pro­ce­dure. The most re­cent, bet­ter-de­signed stud­ies strongly sug­gest that chi­ro­prac­tic care can not only re­duce the im­me­di­ate cost of an episode of care, but re­duce spine pain re­cidi­vism. Two rep­re­sen­ta­tive stud­ies worth not­ing are: Con­sumer Re­ports (May 2009), sur­veyed more than 14,000 con­sumers and found that 88% of those who tried chi­ro­prac­tic ma­nip­u­la­tion said it “helped a lot,” and 59% were “com­pletely” or “very” sat­is­fied; the Jour­nal of Oc­cu­pa­tional and En­vi­ron­men­tal Medicine (April 2011) pub­lished a joint study from the Cen­ter for Disability Re­search at the Lib­erty Mu­tual Re­search In­sti­tute, the Univer­sity of Mas­sachusetts Low­ell and the Cen­ter for Health Eco­nom­ics, Epi­demi­ol­ogy and Sci­ence Pol­icy of United Biosource Corp., that con­cluded that there is a two-to-one chance of disability un­der a phys­i­cal ther­a­pist’s care rather than care un­der a doc­tor of chi­ro­prac­tic (D.C.), and a 60% chance of disability un­der M.D. care, rather D.C. care. The study rec­om­mended chi­ro­prac­tic as a first-line treat­ment.

The ma­jor sav­ings from chi­ro­prac­tic man­age­ment come from fewer and lower costs of aux­il­iary ser­vices, far fewer hos­pi­tal­iza­tions and a highly sig­nif­i­cant re­duc­tion in re­cur­rence and chronic­ity of spine prob­lems, as well as disability.

All ma­jor re­search in the field of spine care now rec­om­mends chi­ro­prac­tic care prior to ad­vanced imag­ing and/or a sur­gi­cal con­sult. Yet chi­ro­prac­tic is sys­tem­at­i­cally over­looked—why? Peter Furno, D.C. In­di­anapo­lis

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