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The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

By Frank M. Painter|March 2, 2017|Chiropractic Care, Complementary and Alternative Medicine|

The Association of Complementary and Alternative Medicine Use and Health Care Expenditures for Back and Neck Problems

SOURCE: Med Care. 2012 (Dec); 50 (12): 1029–1036

Brook I. Martin, PhD MPH, Mary M. Gerkovich, PhD, Richard A. Deyo, MD, MPH, Karen J. Sherman, PhD, MPH, Daniel C. Cherkin, PhD, Bonnie K. Lind, PhD, Christine M. Goertz, DC, PhD, and William E. Lafferty, MD

Department of Orthopaedics,
The Geisel School of Medicine at Dartmouth &
Dartmouth-Hitchcock Medical Center,
Lebanon, NH 03756, USA.

This first national study of CAM/chiropractic expenditures for spine conditions finds that neither adds to overall medical spending.From Page 23: A recent study of 12,036 records in the Medical Expenditure Panel Survey (MEPS) investigated the costs of treating patients with low back and neck pain (Martin et al., 2012). The study estimated the expenditures for care among complementary and alternative medicine (chiropractic, homeopathy, herbalism, acupuncture, and massage) users relative to non-users. This study included a chiropractic-specific analysis of expenditures for chiropractic users versus non-users, as approximately 75% of all complementary and alternative medicine services were rendered by doctors of chiropractic.

Survey data were analyzed for the years 2002–2008. The analysis demonstrated that seeing a CAM/chiropractic provider did not add to overall medical spending. In fact, adjusted annual healthcare costs among chiropractic users were $424 lower for spine-related costs when compared to non-CAM users.

Additionally, those who used complementary and alternative providers, including doctors of chiropractic, had significantly lower hospitalization expenditures.

BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.

OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.

RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey.

SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services.

MEASURES: Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics.

RESULTS: A total of 12,036 respondents with spine problems were included, including 4,306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1,470; P = 0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P = 0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

and our

Chronic Neck Pain and Chiropractic Page

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Psychological and Behavioral Differences Between Low Back Pain Populations

By Frank M. Painter|February 25, 2017|Biopsychosocial Model, Chiropractic Care|

Psychological and Behavioral Differences Between Low Back Pain Populations: A Comparative Analysis of Chiropractic, Primary and Secondary Care Patients

The Chiro.Org Blog

SOURCE: BMC Musculoskelet Disord. 2015 (Oct 19); 16: 306

Andreas Eklund, Gunnar Bergström,
Lennart Bodin and Iben Axén

Karolinska Institutet,
Institute of Environmental Medicine,
Unit of Intervention and Implementation Research,
Nobels väg 13, S-171 77,
Stockholm, Sweden.

BACKGROUND: Psychological, behavioral and social factors have long been considered important in the development of persistent pain. Little is known about how chiropractic low back pain (LBP) patients compare to other LBP patients in terms of psychological/behavioral characteristics.

METHODS: In this cross-sectional study, the aim was to investigate patients with LBP as regards to psychosocial/behavioral characteristics by describing a chiropractic primary care population and comparing this sample to three other populations using the MPI-S instrument. Thus, four different samples were compared.

A: Four hundred eighty subjects from chiropractic primary care clinics.

B: One hundred twenty-eight subjects from a gainfully employed population (sick listed with high risk of developing chronicity).

C: Two hundred seventy-three subjects from a secondary care rehabilitation clinic.

D: Two hundred thirty-five subjects from secondary care clinics.

The Swedish version of the Multidimensional Pain Inventory (MPI-S) was used to collect data. Subjects were classified using a cluster analytic strategy into three pre-defined subgroups (named adaptive copers, dysfunctional and interpersonally distressed).

RESULTS: The data show statistically significant overall differences across samples for the subgroups based on psychological and behavioral characteristics. The cluster classifications placed (in terms of the proportions of the adaptive copers and dysfunctional subgroups) sample A between B and the two secondary care samples C and D.

There are more articles like this @ our:

Biopsychosocial Model Page

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A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for Spine Pain in the United States

By Frank M. Painter|February 24, 2017|Chiropractic Care, Cost-Effectiveness|

A Systematic Review Comparing the Costs of Chiropractic Care to other Interventions for
Spine Pain in the United States

The Chiro.Org Blog

SOURCE: BMC Health Serv Res. 2015 (Oct 19) ~ FULL TEXT

Simon Dagenais, O’Dane Brady, Scott Haldeman and Pran Manga

Spine Research LLC,
540 Main Street #7,
Winchester, MA, 01890, USA.

BACKGROUND: Although chiropractors in the United States (US) have long suggested that their approach to managing spine pain is less costly than other health care providers (HCPs), it is unclear if available evidence supports this premise.

METHODS: A systematic review was conducted using a comprehensive search strategy to uncover studies that compared health care costs for patients with any type of spine pain who received chiropractic care or care from other HCPs. Only studies conducted in the US and published in English between 1993 and 2015 were included. Health care costs were summarized for studies examining:

1. private health plans
2. workers’ compensation (WC) plans, and
3. clinical outcomes.

The quality of studies in the latter group was evaluated using a Consensus on Health Economic Criteria (CHEC) list.

RESULTS: The search uncovered 1,276 citations and 25 eligible studies, including 12 from private health plans, 6 from WC plans, and 7 that examined clinical outcomes. Chiropractic care was most commonly compared to care from a medical physician, with few details about the care received. Heterogeneity was noted among studies in patient selection, definition of spine pain, scope of costs compared, study duration, and methods to estimate costs. Overall, cost comparison studies from private health plans and WC plans reported that health care costs were lower with chiropractic care. In studies that also examined clinical outcomes, there were few differences in efficacy between groups, and health care costs were higher for those receiving chiropractic care. The effects of adjusting for differences in sociodemographic, clinical, or other factors between study groups were unclear.

There are more articles like this @ our:

Cost-Effectiveness of Chiropractic Page

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The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

By Frank M. Painter|February 23, 2017|Chiropractic Research, Pain Relief|

The Effect of Spinal Manipulation on Deep Experimental Muscle Pain in Healthy Volunteers

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2015 (Sep 7); 23: 25

Søren O’Neill, Øystein Ødegaard-Olsen and Beate Søvde

Institute of Regional Health Research,
University of Southern Denmark,
Campusvej 55, Odense, 5230 DK Denmark ;

Spine Centre of Southern Denmark,
Lillebælt Hospital, Østre Hougvej 55,
Middelfart, 5500 DK Denmark

BACKGROUND: High-velocity low-amplitude (HVLA) spinal manipulation is commonly used in the treatment of spinal pain syndromes. The mechanisms by which HVLA-manipulation might reduce spinal pain are not well understood, but often assumed to relate to the reduction of biomechanical dysfunction. It is also possible however, that HVLA-manipulation involves a segmental or generalized inhibitory effect on nociception, irrespective of biomechanical function. In the current study it was investigated whether a local analgesic effect of HVLA-manipulation on deep muscle pain could be detected, in healthy individuals.

METHODS AND MATERIALS: Local, para-spinal muscle pain was induced by injection of 0.5 ml sterile, hyper-tonic saline on two separate occasions 1 week apart. Immediately following the injection, treatment was administered as either a) HVLA-manipulation or b) placebo treatment, in a randomized cross-over design. Both interventions were conducted by an experienced chiropractor with minimum 6 years of clinical experience. Participants and the researcher collecting data were blinded to the treatment allocation. Pain scores following saline injection were measured by computerized visual analogue pain scale (VAS) (0-100 VAS, 1 Hz) and summarized as a) Pain duration, b) Maximum VAS, c) Time to maximum VAS and d) Summarized VAS (area under the curve). Data analysis was performed as two-way analysis of variance with treatment allocation and session number as explanatory variables.

RESULTS: Twenty-nine healthy adults (mean age 24.5 years) participated, 13 women and 16 men. Complete data was available for 28 participants. Analysis of variance revealed no statistically significant difference between active and placebo manipulation on any of the four pain measures.

There are more articles like this @ our:

Chiropractic and Spinal Pain Page and the:

Subluxation Neurology Section

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A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain

By Frank M. Painter|February 22, 2017|Chiropractic Care, Low Back Pain|

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

The Chiro.Org Blog

SOURCE: J Altern Complement Med. 2014 (May); 20 (5): A22–23

Michael Schneider, Mitchell Haas, Joel Stevans,
Ronald Glick, Doug Landsittel

University of Pittsburgh,
Pittsburgh, PA, USA

Purpose: The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods: In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results: Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P<.05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

There are more articles like this @ our:

Low Back Pain and Chiropractic

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The Death Knell for the Prescription Rights Movement?

By Frank M. Painter|February 16, 2017|Prescription Rights|

The Death Knell for the Prescription Rights Movement?

The Chiro.Org Blog

SOURCE: A Chiro.Org Editorial

This blog has posted extensively on the nascent prescription rights movement since early 2010.

The recent release (2-14-17) of American College of Physician’s new study ”Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” appears to raise an evidence-based obstacle in the path to adding Rx rights to our profession.

In essence it recommends AGAINST prescribing drugs, although in a nod to prescribers, it does state:

“If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants”

A review of this complete study and its supporting documents, in particular the new review titled: ” Systemic Pharmacologic Therapies for Low Back Pain” clearly reveals that:

— nonsteroidal anti-inflammatory drugs had smaller benefits for chronic low back pain than previously observed

— skeletal muscle relaxants are effective for short-term pain relief in acute low back pain but caused sedation.

If a majority of DCs choose to pursue prescription rights, that is their privilege. Based on Organized Medicine’s reactions against this movement in key States, this looks to be an extended and expensive uphill battle.

I can’t help but wonder: If DCs expended the same amount effort in developing relationships by referring needy patients for drug-based co-management, whether they might achieve wider professional acceptance, cooperation and increased market-share via embracing our status as a non-drug provider?

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