Avoid Surgery, Drugs and More

By Editorial Staff

A recent study examined how the use of chiropractic spinal manipulative therapy (SMT) impacts the use of "escalated spine care" for low back pain (LBP) patients. Escalated spine care is defined as "imaging studies, injection procedures, emergency department visits, surgery, and opioid medication use." For this study, patients receiving chiropractic SMT care categorized based on use per episode of back pain: low – one visit, moderate – 2-12 visits, and high – 13+ visits.

The investigators examined health insurance claims from 2012 – 2018 for this retrospective cohort study. Their dataset included 83,025 claims representing 11,114 unique back pain episodes. They computed the relative risk of each form of escalated spine care for each of the three SMT groups compared to those patients who did not receive any chiropractic SMT:

Low SMT Group

• 47% less likely to receive imaging
• 70% less likely to get injections
• 92% less likely to end up in an emergency department
• 51% less likely to undergo surgery
• 67% less likely to take opioids

Moderate SMT Group

• 27% less likely to receive imaging
• 74% less likely to get injections
• 79% less likely to end up in an emergency department
• 60% less likely to undergo surgery
• 63% less likely to take opioids

The high SMT group saw a reduction in the risk of injections (RR .46) and emergency department visits. Surgery and opioid use were about even compared to patients not receiving SMT, and these patients were more likely to get imaging. This makes sense, as these patients are likely to have more severe ailments which require more imaging and SMT, but less likely to receive injections and visit the ER.

While the use of unnecessary, low-value, non-guidelines concordant interventions remains routine for many medical providers, this study adds to the parade of evidence that cries out for referral to conservative, nonpharmacological care like chiropractic. Avoid surgery. Avoid medication. Try chiropractic.