The Study:  Predictors of Visit Frequency for Patients Using Ongoing Chiropractic Care for Chronic Low Back and Chronic Neck Pain; Analysis of Observational Data            

 

The Facts:

a. Chronic spine pain is a significant problem.

b. The condition is common and expensive.

c. The authors looked at chronic neck pain (CNP) and chronic low back pain (CLBP) patients seeking chiropractic care in the offices of United States chiropractors.

d. They determined the number of treatment visits on a monthly basis for a period of three months.

e. They included 852 CLBP patients and 705 CNP patients.

f. These patients were from 20 different chiropractic clinics in 6 different regions of the country.

g. They found that almost half of the patients had suffered from their pain for 10 years or more.

h. The frequency of visits ranged from 0 to 14.7 per month for the CLBP patients.

i. The frequency of visits ranged from 0 to 13.6 per month for the CNP patients.

j. The CNP patients had higher pain intensities as well as worse function and they were more likely to suffer from both CNP and CLBP.

k. Four percent of CNP cases and seven percent of CLBP patients ended care during the last 2 months of this 3 month study.

l. The authors concluded that while chronic pain is not usually cured, it can be managed.

m. They state, “Several provider- based nonpharmacologic therapies have been recom- mended for chronic spinal pain, and these therapies may be used on a long-term ongoing basis by patients for pain management. Despite this need, ongoing provider- based care is not well-addressed in the evidence or supported in health and payer policies, [25–27] and this adds another barrier to the use of these recommended nonpharmacologic therapies.” 

Take Home:

Chiropractic care may be useful in the management of CNP and CLBP. The frequency of patient visits varies widely in these cases. While you may not usually be able to “cure” these cases you may well be able to help with their pain management. Unfortunately, health care payor policies do not seem to include this concept and therefor create an additional barrier for suffering patients attempting to access chiropractic care.

 Reviewer's Comments:

If your loved one suffered from chronic neck and/or low back pain, what is the frequency of chiropractic visits that you would want them to have? I think most of us would want them to be able to see their doctor as needed to manage their pain effectively.

Reviewer:  Roger Coleman DC

Editor’s Comments: from 4-7% of patients in this three month study ended their care prematurely. I wonder how much of this might be due to financial barriers. While I realize that some constraints must be placed by third party payors to prevent the moral hazards of over prescription/utilization. Insurers have been able to manage payment programs for chronic pain patients who require continued narcotic management. It doesn’t seem unreasonable that they could figure out how to allow continued access to chiropractic for the subset of our patients who will always require some measure of treatment for pain management and prefer to avoid dangerous narcotics.

Editor: Mark R. Payne DC 

Reference: Patricia M Herman, Sarah E Edgington, Eric L Hurwitz, Ian D Coulter. Predictors of Visit Frequency for Patients Using Ongoing Chiropractic Care for Chronic Low Back and Chronic Neck Pain; Analysis of Observational Data. BMC Musculoskelet Disord. 2020 May 13;21(1):298. doi: 10.1186/s12891-020-03330-1.

 Link to Abstract: https://pubmed.ncbi.nlm.nih.gov/32404152/?from_term=chiropractic+and+pain&from_filter=simsearch2.ffrft&from_sort=date&from_pos=1

Link to Article: https://bmcmusculoskeletdisord.biomedcentral.com/track/pdf/10.1186/s12891-020-03330-1