Unnecessary Surgery

The Association of First Provider Seen With Time Loss From Work Among Workers With Back Injury: A Cohort Study

By Frank M. Painter|May 27, 2026|Unnecessary Surgery, Workers' Compensation|

The Association of First Provider Seen With Time Loss From Work Among Workers With Back Injury: A Cohort Study

SOURCE: Am J Ind Med 2026 (May 26) [EPUB]
Brian Chin PhC, MSPH • Sean D. Rundell PT, DPT, PhD • Jeanne M. Sears PhD, RN • Deborah Fulton-Kehoe PhD, MPH • June T. Spector MD, MPH • Gary M. Franklin MD, MPH

Washington State Department of Labor and Industries,
Tumwater, Washington, USA.

FROM: Weeks ~ JMPT 2016 (Feb) Hurwitz ~ JMPT 2016 (May)

Background: Prior evidence suggests that seeking initial care from a chiropractor for back pain, compared to seeing a primary care provider first, is associated with better clinical outcomes. However, prior studies have not comprehensively adjusted for potential confounders and few studies have focused on work-related outcomes.

Methods: This population-based prospective cohort study analyzed data from workers’ compensation claimants with a work-related back injury who initiated care with either a chiropractor or a primary care physician. We evaluated the association of seeing a chiropractor first, compared to seeing a primary care physician first, with receipt of wage replacement benefits for temporary total disability (time loss) at 1 year after claim initiation. Association was estimated using logistic regression adjusting for potential confounders including patient sociodemographic characteristics, employment details, self-reported pain and physical function, injury severity, healthcare factors, and psychological factors. The E-value was used to assess unmeasured confounding.

Results: Of 1,219 participants (mean age = 39, 67.5% male, 72.1% non-Hispanic White), 541 (44.4%) initiated care with a chiropractor. Participants who saw a chiropractor first, compared to a primary care physician first, were less likely to be on time-loss at 1 year as estimated by adjusted multivariate logistic regression (4.8% vs. 11.8%; adjusted odds ratio [OR]: 0.45, 95% CI: 0.24-0.86; E-value: 3.8).

There is more like this @ our

Return to WORKERS’ COMPENSATION Section and the

Return to INITIAL PROVIDER/FIRST CONTACT Section

(more…)

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Choice: It Really Does Matter!

By Frank M. Painter|December 19, 2012|Chiropractic Care, Spinal Manipulation, Unnecessary Surgery|

Choice: It Really Does Matter!

The Chiro.Org Blog

SOURCE: Spine (Phila Pa 1976). 2012 Dec 12. [Epub ahead of print]

Keeney, Benjamin J. PhD; Fulton-Kehoe, Deborah PhD, MPH; Turner, Judith A. PhD; Wickizer, Thomas M. PhD; Chan, Kwun Chuen Gary PhD; Franklin, Gary M. MD, MPH

Department of Orthopaedics, Geisel School of Medicine at Dartmouth College, Lebanon, NH 03756, USA. Benjamin.J.Keeney@Dartmouth.edu

This review, by scientists at the Department of Orthopaedics at the Geisel School of Medicine, clearly suggests that the first doctor you choose to see will have a profound effect on whether you end up having spinal surgery.

Just look at these stats:

42.7% of workers who first saw a surgeon ended in surgery, as opposed to only

1.5% of those who (first) saw a chiropractor.

The authors conclude: “There was a very strong association between surgery and first provider seen for the injury, even after adjustment for other important variables.”

The Abstract:

Study Design Prospective population-based cohort study

Objective To identify early predictors of lumbar spine surgery within 3 years after occupational back injury (more…)

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European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

By Frank M. Painter|June 25, 2010|Guidelines, Low Back Pain, News, Unnecessary Surgery|

European Guidelines for the Management of Acute and Chronic Nonspecific Low Back Pain in Primary Care

The Chiro.Org Blog

You will enjoy these recent European evidence-based guidelines for the management of acute and chronic low back pain.

Both the Acute Back Pain Guideline and the
Chronic Back Pain Guideline recommend spinal manipulation
as an effective conservative treatment.

Interestingly, MOST of what’s considered “standard medical treatment” are listed as
Invasive treatments, that should NOT be recommended for non-specific CLBP.

Non-recommended medical treatments include:

Bed rest,

Acupuncture,

intradiscal injections,

epidural corticosteroid injections,

intra-articular (facet) steroid injections,

local facet nerve blocks,

trigger point injections,

prolotherapy,

botulinum toxin,

radiofrequency facet denervation,

intradiscal radiofrequency lesioning,

intradiscal electrothermal therapy,

radiofrequency lesioning of the dorsal root ganglion,

and spinal cord stimulation

(more…)

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Why Do Spinal Surgery Rates Continue To Rise?

By Frank M. Painter|April 10, 2010|Iatrogenic Injury, Low Back Pain, News, Unnecessary Surgery|

Why Do Spinal Surgery Rates Continue To Rise?

The Chiro.Org Blog

A Chiro.Org Editorial

First, let’s review some history. In 1974, the Congressional Committee on Interstate and Foreign Commerce held hearings on unnecessary surgery. Their findings from the First Surgical Second Opinion Program found that 17.6% of recommendations for surgery were not confirmed. The House Subcommittee on Oversight and Investigations extrapolated these figures to estimate that, on a nationwide basis, there were 2.4 million unnecessary surgeries performed every year, resulting in 11,900 deaths, at an annual cost of $3.9 billion. [1]

With the total number of lower back surgeries having been estimated in 1995 to exceed 250,000 in the U.S., at a hospital cost of $11,000 per patient. [2] This could suggest that the total number of unnecessary back surgeries each year in the U.S. could be 44,000, costing as much as $484 million. [3]

So, the first risk of spinal surgery is that it may not be necessary.

A most-recent review suggests that:

Back Surgery Fails 74% of the Time

(more…)

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