Michele Maiers DC, MPH, PhD recently presented an excellent paper which all IME physicians will benefit from. The paper is titled A Role for Chiropractic in Workers Compensation and Occupational Medicine. All IME physicians commenting on chiropractic care will benefit from this article and research.
A Role for Chiropractic in Workers Compensation and Occupational Medicine
Michele Maiers, DC, MPH, PhD
Executive Director of Research and Innovation, Northwestern Health Sciences University
Overview: Chiropractors are best known as spine care experts. They focus on back pain, neck pain, and headache–all major drivers of disability and health care expenditures.
- Chiropractors most commonly use spinal manipulation therapy (also known as a chiropractic adjustment), in addition to exercise, soft tissue techniques, patient education, and wellness counseling.1
- The most common reasons for seeking chiropractic are back pain, neck pain, headache, shoulder symptoms and prevention of musculoskeletal problems.2
- Back pain is the leading cause of years lived with disability in the U.S., outranking other diseases such as diabetes, chronic pulmonary disease, and ischemic heart disease; neck pain and other musculoskeletal complaints rank among the top 10.3
Spine Care: Chiropractors deliver evidence-based best practices in spine care.
- Among complementary therapies, the majority of all health-provider visits for low back pain are to chiropractors4 for spinal manipulative therapy, which has been shown to be as effective as other standard treatments for this pervasive public health problem.5-8
- The American College of Physicians recommend spinal manipulation as a first line treatment for acute, subacute and chronic low back pain.6
- Chiropractic care aligned with evidence-based practice guidelines can result in less disability among acute low back pain patients when compared to physician-directed usual care.9
- Spinal manipulation, mobilization, and exercise are all recommended treatments for individuals with neck pain and whiplash associated disorders.10-12
- A 2012 randomized controlled trial showed spinal manipulative therapy was more effective than medication for acute and sub-acute neck pain.13
- Systematic reviews support the use of spinal manipulation and multi-modal multidisciplinary interventions for the management of migraine and cervicogenic headache.5,14
Safety: Chiropractic treatment is generally considered safe, with relatively minor side effects.
- The most common side effects experienced during chiropractic care (more specifically spinal manipulative therapy) are musculoskeletal in nature and short lasting. These include increased pain or soreness in the back, neck, joints, and muscles.15-21
- The rate of serious complications from spinal manipulative therapy is 5-10 per 10 million adjustments.22
- There is no excess risk of stroke associated with chiropractic care, as compared to primary care.23,24
Occupational Health and Workers Compensation:
- On-site chiropractic services have been shown to reduce radiology and emergency room utilization, and decrease utilization of other outpatient healthcare services.25
- Chiropractic services offered at on-site corporate health clinics resulted in lower costs of care, fewer healthcare visits, and musculoskeletal medication use, compared to off-site physical therapy services.26
- A 1 year retrospective study of Workers Compensation claims demonstrated a lower rate of disability recurrence among chiropractic users compared to those who sought physical therapist or physician services.27
Complementary and Alternative Medicine (CAM) Health Care: CAM users cost the health care system less.
- Attempts to reduce national health care spending by eliminating coverage for CAM has been shown to “have little impact at best”.28
- The inclusion of CAM providers in new delivery systems (e.g. ACOs) is predicted to help slow growth in national health care spending.28
- Health care expenditures for Complementary and Alternative Medicine (CAM) users—primarily Doctors of Chiropractic—is $526 less per person for spine care, and $298 less for total healthcare costs, conservatively.29
Chiropractic: Access to chiropractic services results in lower health care costs, especially for back pain.
- Private insurance beneficiaries with a chiropractic care benefit have lower costs of health services, including reduced spending on medicine and lower use of costly diagnostic tests.30-33
- A study using Blue Cross/ Blue Shield data showed that care initiated with a chiropractor for low back pain cost 20% less compared than when initiated with an MD.34
- Data from several large managed care networks suggest access to chiropractic care may reduce per episode spending for back pain, as well as overall healthcare expenditures.33-36
- Systematic reviews suggest that spinal manipulation is a cost-effective option for treating sub- acute or chronic back pain.37,38
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