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Initial Provider Choice and Future Low Back Pain-Related Costs

Initial Provider Choice and Future Low Back Pain-Related Costs
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Low back pain (LBP) is a global health problem that will affect most adults at least once in their lifetime. For many, LBP may become a chronic issue that can significantly affect their ability to work and carry out normal activities of daily living. While we often discuss how chiropractic care serves as an excellent front-line treatment for LBP, it’s seldom discussed how seeing a doctor of chiropractic first can save a patient and their insurer from future healthcare expenditures involving medications, advanced imaging, surgery, and adverse effects that can result from these services.

Advanced imaging such as MRI are often used to confirm a diagnosis, and in many cases, the findings can save lives. However, when it comes to low back pain, unnecessary imaging can lead to immediate costs and treatment that may not resolve the patient’s LBP and may place them at risk for harm. In 2018, researchers conducted a chart review of 313 patients referred for MRI and found that 130 imaging requests were unnecessary, which corresponded to a previous 2014 study that found 46.7% of MRI for LBP are inappropriate. A 2012 study that looked at data from the Washington State Worker’s Compensation system found that about 1 in 5 workers with LBP underwent an MRI within six weeks of their injury. Those who first went to a chiropractor were half as likely to be referred to MRI while those who first visited a surgeon were 78% more likely to receive advanced imaging.

While typically not advised in treatment guidelines, patients with chronic low back pain are often prescribed opioids. In a 2022 study that looked at long-term outcomes for Medicare beneficiaries with new-onset low back pain, researchers observed that those who visited a chiropractor first were 2.2 times less likely to be prescribed opioids within the following four years. Prolonged opioid use is associated with an elevated risk for misuse, as well as abuse of more serious and illicit drugs.

Treatment guidelines generally frown upon surgical intervention as a first step outside of emergency circumstances; however, a 2022 study found that 41.7% of patients who underwent back surgery in a sample of 2.5 million low back pain patients had minimal non-pharmaceutical, non-operative treatment in the six months before their operation. In fact, another study that used the Washington State Workers Compensation dataset found that low back pain patients were 29 times less likely to end up in the operating room if they first consult with a chiropractor. Not only is surgery costly and comes with a risk for complications and prolonged recovery, but in a July 2022 study, the authors noted that the failure rate of spinal surgeries may be as high as 40% with the majority of failures linked to misdiagnosis!

A June 2023 study that looked at data from a large insurer regarding more than 30,000 patients with new-onset LBP found that seeing a chiropractor first led to an immediate and long-term reduction in healthcare costs and the data “…provides a compelling case for the influence of the first provider on an acute episode of LBP.” Not only is chiropractic care a great conservative treatment option for individuals with low back pain but encouraging chiropractic as a first choice for care can not only provide immediate and long-term savings in healthcare expenditures, but it can also free up those resources for patients with healthcare conditions that may better benefit from their availability.


Thousands of Doctors of Chiropractic across the United States and Canada have taken "The ChiroTrust Pledge":“To the best of my ability, I agree to
provide my patients convenient, affordable,
and mainstream Chiropractic care.
I will not use unnecessary long-term
treatment plans and/or therapies.”

To locate a Doctor of Chiropractic who has taken The ChiroTrust Pledge, google "The ChiroTrust Pledge" and the name of a town in quotes.

(example: "ChiroTrust Pledge" "Olympia, WA")