Nonpharmacologic Therapies

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

By Frank M. Painter|December 27, 2021|Chiropractic Management, Nonpharmacologic Therapies|

Are Nonpharmacologic Interventions for Chronic Low Back Pain More Cost Effective Than Usual Care? Proof of Concept Results From a Markov Model

SOURCE: Spine (Phila Pa 1976) 2019 (Oct 15); 44 (20): 1456–1464

Patricia M. Herman, ND, PhD; Tara A. Lavelle, PhD; Melony E. Sorbero, PhD; Eric L. Hurwitz, DC, PhD; Ian D. Coulter, PhD

RAND Corporation,
Santa Monica, CA

Study design: Markov model.

Objective: Examine the 1-year effectiveness and cost-effectiveness (societal and payer perspectives) of adding nonpharmacologic interventions for chronic low back pain (CLBP) to usual care using a decision analytic model-based approach.

Summary of background data : Treatment guidelines now recommend many safe and effective nonpharmacologic interventions for CLBP. However, little is known regarding their effectiveness in subpopulations (e.g., high-impact chronic pain patients), nor about their cost-effectiveness.

Methods: The model included four health states: high-impact chronic pain (substantial activity limitations); no pain; and two others without activity limitations, but with higher (moderate-impact) or lower (low-impact) pain. We estimated intervention-specific transition probabilities for these health states using individual patient-level data from 10 large randomized trials covering 17 nonpharmacologic therapies. The model was run for nine 6-week cycles to approximate a 1-year time horizon. Quality-adjusted life-year weights were based on six-dimensional health state short form scores; healthcare costs were based on 2003 to 2015 Medical Expenditure Panel Survey data; and lost productivity costs used in the societal perspective were based on reported absenteeism. Results were generated for two target populations: (1) a typical baseline mix of patients with CLBP (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain) and (2) high-impact chronic pain patients.

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Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

By Frank M. Painter|June 8, 2021|Nonpharmacologic Therapies|

Back and Neck Pain: In Support of Routine Delivery of Non-pharmacologic Treatments as a way to Improve Individual and Population Health

The Chiro.Org Blog

SOURCE: Translational Research 2021 (Apr 24);

OPEN ACCESS

Steven Z George, Trevor A Lentz, Christine M Goertz

Department of Orthopaedic Surgery and
Duke Clinical Research Institute,
Duke University,
Durham, North Carolina.

Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain.

First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.

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For Bad Backs, It May Be Time to Rethink Biases

By Frank M. Painter|May 1, 2017|Chiropractic Care, Nonpharmacologic Therapies|

For Bad Backs, It May Be Time to Rethink Biases About Chiropractors

The Chiro.Org Blog

SOURCE: The New York Times ~ 5-01-2017

Aaron E. Carroll, MD, MS

Indiana University School of Medicine

About two of every three people will probably experience significant low back pain at some point. A physician like me might suggest any number of potential treatments and therapies. But one I never considered was a referral for spinal manipulation.

It appears I may have been mistaken. For initial treatment of lower back pain, it may be time for me (and other physicians) to rethink our biases.

Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer.

Most back pain resolves over time, so interventions that focus on relief of symptoms and allow the body to heal are ideal. Many of these can be nonpharmacological in nature, like the work done by chiropractors or physical therapists.

Physicians are traditionally wary of spinal manipulation (applying pressure on bones and joints), in part because the practitioners are often not doctors and also because a few chiropractors have claimed they can address conditions that have little to do with the spine. Patients with back pain haven’t seemed as skeptical. A large survey of them from 2002 through 2008 found that more than 30 percent sought chiropractic care, significantly more than those who sought massage, acupuncture or homeopathy.

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