Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims

I treat a lot of patient who have seen other doctors before walking into my office. Lots of them have had lots of testing (MRI’s, C.T’s, EMG/NCV) before they even see me. Many of times these tests are a waste of time and money. This study shows if patients see a chiropractor first they would have less testing and in turn save money . This study found patients who did not see a chiropractor first had 2x risk of escalation. This means being sent for  imaging, injection, emergency room, or surgery. A simple rule of thumb to follow is chiropractic first, medicine second and surgery last. A high quality exam will direct care and must be done first. Here’s the study.

Chiropractic FIRST, Medicine SECOND, Surgery LAST.

The Study: Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims

Results

The sample was 55% women, with a mean age of 44 years (range, 18-103). Treatment escalation was present in 42% of episodes overall: 2448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation (95% confidence interval, 2.22-2.55, P = .001).

Conclusion

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation. In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain.

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