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Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain: A Systematic Review

By Frank M. Painter|May 8, 2024|Cost-Effectiveness of Chiropractic, Initial Provider, Spinal Pain|

Cost of Chiropractic Versus Medical Management of Adults with Spine-related Musculoskeletal Pain: A Systematic Review

SOURCE: Chiropractic & Manual Therapies 2024 (Mar 6); 32: 8

OPEN ACCESS

Ronald Farabaugh • Cheryl Hawk • Dave Taylor • Clinton Daniels • Claire Noll • Mike Schneider • John McGowan • Wayne Whalen • Ron Wilcox • Richard Sarnat • Leonard Suiter • James Whedon

American Chiropractic Association,
2008 St. Johns Avenue,
Highland Park, Illiois. 60035
Arlington, VA, USA.

FROM: Houweling, JMPT 2015

Background: The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

Methods: A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

Results: The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

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COST-EFFECTIVENESS Section and the

SPINAL PAIN MANAGEMENT Section and the

INITIAL PROVIDER/FIRST CONTACT Section

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Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

By Frank M. Painter|April 24, 2024|Neurology, Subluxation|

Vertebral Subluxation and Systems Biology: An Integrative Review Exploring the Salutogenic Influence of Chiropractic Care on the Neuroendocrine-Immune System

The Chiro.Org Blog

SOURCE: Cureus 2024 (Mar 15); 16 (3): e56223

OPEN ACCESS

Amy Haas • Jonathan Chung • Christopher Kent • Brooke Mills and Matthew McCoy

Foundation for Vertebral Subluxation
4390 Bells Ferry Road
Kennesaw, Georgia 30144

In this paper we synthesize an expansive body of literature examining the multifaceted influence of chiropractic care on processes within and modulators of the neuroendocrine-immune (NEI) system, for the purpose of generating an inductive hypothesis regarding the potential impacts of chiropractic care on integrated physiology. Taking a broad, interdisciplinary, and integrative view of two decades of research-documented outcomes of chiropractic care, inclusive of reports ranging from systematic and meta-analysis and randomized and observational trials to case and cohort studies, this review encapsulates a rigorous analysis of research and suggests the appropriateness of a more integrative perspective on the impact of chiropractic care on systemic physiology. A novel perspective on the salutogenic, health-promoting effects of chiropractic adjustment is presented, focused on the improvement of physical indicators of well-being and adaptability such as blood pressure, heart rate variability, and sleep, potential benefits that may be facilitated through multiple neurologically mediated pathways. Our findings support the biological plausibility of complex benefits from chiropractic intervention that is not limited to simple neuromusculoskeletal outcomes and open new avenues for future research, specifically the exploration and mapping of the precise neural pathways and networks influenced by chiropractic adjustment.

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SUBLUXATION Section

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Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

By Frank M. Painter|March 17, 2024|Cauda Equina Syndrome, Low Back Pain|

Association Between Chiropractic Spinal Manipulation and Cauda Equina Syndrome in Adults With Low Back Pain: Retrospective Cohort Study of US Academic Health Centers

The Chiro.Org Blog

SOURCE: PLoS One 2024 (Mar 11); 19 (3): e0299159
Robert J. Trager • Anthony N. Baumann • Jaime A. Perez
Jeffery A. Dusek • Romeo-Paolo T. Perfecto • Christine M. Goertz

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, Ohio, United States of America.

Background: Cauda equina syndrome (CES) is a lumbosacral surgical emergency that has been associated with chiropractic spinal manipulation (CSM) in case reports. However, identifying if there is a potential causal effect is complicated by the heightened incidence of CES among those with low back pain (LBP). The study hypothesis was that there would be no increase in the risk of CES in adults with LBP following CSM compared to a propensity-matched cohort following physical therapy (PT) evaluation without spinal manipulation over a three-month follow-up period.

Methods: A query of a United States network (TriNetX, Inc.) was conducted, searching health records of more than 107 million patients attending academic health centers, yielding data ranging from 20 years prior to the search date (July 30, 2023). Patients aged 18 or older with LBP were included, excluding those with pre-existing CES, incontinence, or serious pathology that may cause CES.
Patients were divided into two cohorts:

(1) LBP patients receiving CSM or
(2) LBP patients receiving PT evaluation without spinal manipulation.

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LOW BACK PAIN Section

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Our Blog is a Tool. Learn How to Use It Now

By Frank M. Painter|February 19, 2024|Announcement|

Our Blog is a Tool.
Learn How to Use It Now

The Chiro.Org Blog

A Chiro.Org Editorial

Every Blog post is an announcement of new material that was just added to one of our many Sections.

I have been compiling (and archiving) peer-reviewed articles since early 1996, and to date we have thousands of Abstracts, and many hundreds of Full-Text articles on a wide variety of subjects.

When enough material, relating to a particular topic was collected,
it was gathered into a new Topical Page in one of our many Sections.

Each Topical page is located in the Section most associated with that topic.
Thus, our Attention Deficit Page is located (is a part of) our Pediatrics Section You get the idea.

Almost ALL of our Sections contain some, or many Topical collections. The LINKS Section is the most extreme example,
because it contains 86 different topical pages.

All of the following are “active” Sections that are constantly adding new (and important) materials:

Acupuncture
Alternative Healing Abstracts
Case Studies
Chiropractic Assistants
Chiropractic Research
Chronic Neck Pain
Conditions That Respond Well
Cost-Effectiveness of Chiropractic
Documentation
Global Burden of Disease
Headache and Chiropractic
Initial Provider/First Contact and Chiropractic
The LINKS
Low Back Pain and Chiropractic
Medicare Info
Non-pharmacologic Therapy and Chiropractic
Nutrition
Pediatrics
Radiology
The SEARCH Section
Stroke and Chiropractic
What is the Chiropractic Subluxation?
Whiplash and Chiropractic

These other Sections are “archival” in nature, and contain valuable tools:

Chiropractic History
ChiroZine
Free Images
New DC’s
Office Forms
R.C. Schafer’s Rehab Monographs
The Wilk Antitrust Lawsuit

How Blog Posts Work

The following is a Graphic “screen grab” of a Blog Post from our Home Page.
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Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

By Frank M. Painter|February 18, 2024|Failed Back Surgery Syndrome, Low Back Pain, Lumbosacral Radiculopathy|

Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord 2024 (Jan 10); 25 (1): 46
Robert J. Trager, Jordan A. Gliedt Collin M. Labak,Clinton J. Daniels, and Jeffery A. Dusek

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, OH, USA.

Background: Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up.

Methods: We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.

Results: Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).

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FAILED BACK SURGERY Section

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A Randomized Controlled Trial Comparing Different Sites of High-velocity Low Amplitude Thrust on Sensorimotor Integration Parameters

By Frank M. Painter|January 29, 2024|Sensorimotor Integration, Subluxation|

A Randomized Controlled Trial Comparing Different Sites of High-velocity Low Amplitude Thrust on Sensorimotor Integration Parameters

The Chiro.Org Blog

SOURCE: Scientific Reports 2024 (Jan 12); 14 (1): 1159

Imran Khan Niazi • Muhammad Samran Navid • Christopher Merkle • Imran Amjad • Nitika Kumari • Robert J Trager • Kelly Holt • Heidi Haavik

Centre for Chiropractic Research,
New Zealand College of Chiropractic,
Auckland, New Zealand

Increasing evidence suggests that a high-velocity, low-amplitude (HVLA) thrust directed at a dysfunctional vertebral segment in people with subclinical spinal pain alters various neurophysiological measures, including somatosensory evoked potentials (SEPs). We hypothesized that an HVLA thrust applied to a clinician chosen vertebral segment based on clinical indicators of vertebral dysfunction, in short, segment considered as “relevant” would significantly reduce the N30 amplitude compared to an HVLA thrust applied to a predetermined vertebral segment not based on clinical indicators of vertebral dysfunction or segment considered as “non-relevant”. In this double-blinded, active-controlled, parallel-design study, 96 adults with recurrent mild neck pain, ache, or stiffness were randomly allocated to receiving a single thrust directed at either a segment considered as “relevant” or a segment considered as “non-relevant” in their upper cervical spine. SEPs of median nerve stimulation were recorded before and immediately after a single HVLA application delivered using an adjusting instrument (Activator). A linear mixed model was used to assess changes in the N30 amplitude. A significant interaction between the site of thrust delivery and session was found (F_1,840 = 9.89, p < 0.002). Pairwise comparisons showed a significant immediate decrease in the N30 complex amplitude after the application of HVLA thrust to a segment considered "relevant" (- 16.76 ± 28.32%, p = 0.005). In contrast, no significant change was observed in the group that received HVLA thrust over a segment considered "non-relevant" (p = 0.757). Cervical HVLA thrust applied to the segment considered as "relevant" altered sensorimotor parameters, while cervical HVLA thrust over the segment considered as "non-relevant" did not. This finding supports the hypothesis that spinal site targeting of HVLA interventions is important when measuring neurophysiological responses. Further studies are needed to explore the potential clinical relevance of these findings.

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SUBLUXATION Section

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