Archive for chiropractic care
Here in Arizona, chiropractic care is not included in the Medicaid system (termed AZ Health Care Cost Containment System, or AHCCCS). As an active member of my state association, I have been in the front lines trying to get chiropractic care included in this system. Here is how it usually goes:
- Arizona Chiropractic Association: We would like you to add chiropractic care to AHCCCS member who need chiropractic care.
- Insurance companies: Chiropractic care is expensive and the state budget will have to absorb the costs.
- Legislator: We’d love to, but the insurance company says it will drive up costs to small business.
- Chambers of Commerce: We’d love this as well, but the insurance companies say small businesses will pay much more.
Sounds like a wrap, huh? After all, some insurance companies actually sell chiropractic as a rider, meaning your employer will pay extra to offer it (if this fits you, stick around–you’ll be burning up in anger in just a little bit…).
Now that the emotional side has had it’s say, let’s look at the common sense side of things.
First, it is very clear that chiropractors are conservative providers who do not use drugs or surgery. Here in AZ, we can order all the imaging and labs we’d like, but I think you’ll find that chiropractors, as a group, are very conservative with ordering advanced imaging like MRI or CT scans (you can read more about the exact statistics in a previous blog article by clicking here).
Next, it has been clear from several studies that those patients undergoing treatment from a chiropractor have lower medication, imaging, hospitalization and surgical costs (you can read about how much money insurance companies blog on expensive and ineffective procedures in a previous blog post here) . It just makes sense.
So, overall, chiropractic care is safer with better outcomes and costs less.
If chiropractic care saves money for your own care, how much less will it cost for the health plan? I’m glad you asked, because this particular article was designed to address just this question. Researchers looked at a group of 12,036 insured individuals with self reported neck or low back pain who did or did not use complementary and alternative medicine (CAM). Here is what they found:
- Average annual spending for CAM users (based on propensity matching) was $526 lower for spine-related costs.
- Annual costs for CAM users was $298 lower for total health costs.
- Cost differences were primarily due to lower hospital inpatient costs for CAM users.
While CAM does not related specifically to chiropractic care, this is the largest chunk within this group–large enough to be considered equivalent.
Back to my comment earlier about charging to add a rider for chiropractic care on a health plan. They are charging your employer MORE to provide chiropractic care, but the reality is, that by adding this service, they are likely saving money per life insured. How’s that for making money at both ends of a deal??
Musculoskeletal pain in Europe
As a chiropractic physician, I am not surprised that the authors were basically beating up on the medical profession in their handling of musculoskeletal complaints. I see many patients in my office who’s cases were not handled properly. I do not fault allopathic medicine for their lack of training and knowledge in musculoskeletal medicine–there is so much to learn it really is its own curriculum There just is not enough time in medical school to learn all of it. What I do have a problem with is physicians handling musculoskeletal complaints when they are not familiar or trained in them.
Ann Rheum Dis — Abstracts: Woolf et al. 63 (4): 342 -
Effectiveness of Multidisciplinary Intervention in Treatment of Migraine
Wow!! A multidisciplinary trial that would use the best of all worlds!! It was great to see chiropractic added in here… Oops…they didn’t add chiropractic. Am I missing something? Does the term “pink elephant in the room” ring any bells here? How is it that I get wonderful results with headaches in my office and yet never seen trials or comments including chiropractic care in mainstream medical journals? Can the rest of the medical profession truly be that ignorant of what chiropractic does??? I feel much better now…Synergy Abstract
Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication
Okay. Let me get this straight. Study after study (with millions being spent) to determine which blood pressure lowering medication is best (and it turns out to be the cheapest–the brand new “fancy dancy” BP meds are less effective and much more expensive) and, when all the cards are laid out on the table, BP meds have had very little effect on the overall drop in BP over a decade. So, insurance companies want to limit chiropractic care to 6.7 visits per year, but they’ll pay indefinitely for meds to lower BP when they’re not shown to be effective over the long run. Sign me up for the lifestyle changes.
A perspective for considering the risks and benefits of spinal manipulation in patients with low back pain
Well, can’t tell you how upsetting this news is to me. Patient who were given exercises to do but did NOT receive adjustments were 8 X more likely to experience a worsening of their disability. Can I share probably one of the best kept secrets in healthcare?
Chiropractic care is more effective and more cost effective for many musculoskeletal conditions. Period. Add into that some aggressive soft tissue work and you’ve got a group of physicians that can rule the world.
The ADVANTAGE Seeding Trial: A Review of Internal Documents
A seeding trial is a trial done under the guise of research, but is actually created and administered by the marketing department. This particular study was run and published purely to get doctors used to writing prescriptions for Vioxx when it was first released.
Really. I’ve said it before that if the public truly knew how they were manipulated by drug companies with drugs with marginal effectiveness and frequent side effects for conditions THEY DON’T EVEN FIX–Chiros would be on the top of the health care pile. This also makes you wonder, if the physicians in these studies are so easily manipulated, are they truly acting as “physicians” or more like technicians being trained to give drug A for condition A?
COULD CHIROPRACTIC SAVE YOUR LIFE? It’s far too common to have a patient come into my office that has been given some heavy duty pain meds, frequently among the opioid class (Vicodin, Oxycotin).
Recent studies have even shown that a large number of primary care doctors will even prescribe these on a patient’s first visit for acute low back pain, which is disturbingly against all the recommendations. As a chiropractic physician, I can tell you that it is a major goal of the treatment of any patient to reduce, avoid or eliminate their need for any type of pain control. It is rare that we are not successful.
Hopefully, this report from the CDC will enlighten you on just how dangerous this class of drugs is. The number of annual deaths in 2006? 26,400. And we spent billions of dollars on the swine flu???? What is sometimes frustrating as a chiropractor is that, when entities (like here in AZ for AHCCS or insurance companies) look at costs for our care, they only rarely look at cost SAVINGS for care. They just look at chiropractic care as a line item expense, despite the fact that we save up to 30% on orthopedic costs alone. These numbers do NOT take into account how many patients are able to go off of, reduce their usage or not go on prescription opioids in the first place.
WHAT ELSE CAN I DO TO HELP WITH MY SHOULDER PAIN? It’s still the prevailing opinion that chiropractic care is for patients with low back pain. However, there is much research suggesting that manipulation is effective for a variety of other conditions.
This particular study found that the addition of manipulation to a standard course of care for shoulder pain was more effective. In my office, the addition of unique soft tissue approaches like NMR and Graston to more completely effect the soft tissues (fascia, muscles, ligaments, tendons) means that shoulder pain will be a thing of the past for most patients. And we rarely need to use anything beyond some simple elastic tubing home exercises for recovery.
Given the initials after my name, you can assume there’s going to be a bias in this post. Let’s just go ahead and assume it’s going to be a big one. The overall question, however, is–how many neck pain sufferers have not seen a chiropractor?
I’m sure the number is far too high. I remember sitting in the ER with a friend about 4 years ago. The ER was overcrowded and we were in the hall separated by a curtain. I could clearly hear the clinician talking with the patient in the area next to us (so much for HIPPA, huh?) and it was all I could do to not step next door, step in and suggest that I would be better off handling this.
Can we just accept that mainstream medicine gets a very poor education in musculoskeletal problems? Just like you wouldn’t want me removing your gallbladder or discussing whether you should take 10 or 80 mg of Lipitor (yeah–like THAT would even be on the discussion board…), we really need to accept that the average PCP does not have the training necessary to adequately manage most musculoskeletal problems.
I had a new patient in last week that has relatively straightforward non-specific low back pain. I expect her to be doing much, much better within 3-5 visits. The problem is she has been under medical care for a year which has included cortisone injections, an MRI and now Percocet, ibuprofen and gabapentin. She then mentions to me that her family has always had somewhat of a fear of chiropractors, and this is why she has been hesitant to see one.
Huh? Afraid of chiropractors? Let’s look a little closer at her care:
- She’s had maybe $5K-15K worth of services
- One YEAR of pain (which now has her unemployed and unable to work)
- She has been told by the pain management doctor that there are no other options
- She’s on a drug that the manufacturer paid $2.3 BILLION to the Justice Dept for offlabel promotion of gabapentin
- The list of dangerous side effects of NSAIDs like ibuprofen is so long as to be its own blog post
- Narcotic pain relievers (Percocet) now exceed illicit drugs in deaths and ER visits in this country
While her case is for low back pain, the clinical scenario with neck pain is not much different. This particular study just confirms what every practicing chiropractor already knows–chiropractic manipulation, in both the short and long term, was more effective than the medications typically used to treat them.
And, to my knowledge, no one’s ever experienced their stomachs rupturing with subsequent internal bleeding following an adjustment…
It doesn’t happen all the time, but it is not uncommon for a patient to call our office to cancel an appointment because they went to their PCP, the PCP ordered an MRI and now they have to see a specialist. Sound reasonable?
There are multiple layers of “wrong” in this scenario. First and foremost is that, in most situations, we have already identified whether a disc bulge / sciatica was present based on talking to the patient and our exam finding. At this point, without any type of red flags, it is never, ever recommended to order an MRI this early in the treatment. Happens all the time, but apparently, those ordering the MRI are not reading the studies.
Not only is this a tremendous waste of resources, but it is well documented that this starts the patient on a MRI to epidural to surgery pathway, despite evidence that this is not the best pathway for the patient. It is also far too common for the PCP to steer the patient away from chiropractic care to a specialist–when chiropractic care is exactly what they need.
So what about the epidural’s effectiveness in the case of chronic (>12 weeks) radiculopathy (leg pain)? This particular study finds it worse than worthless—actually giving a small injection of saline was massively more beneficial than the steroid injection (Oswestry change after 52 wks– saline 14.3 points improvement, epidural 1.9 points worse). So basically, the epidural clearly made the patient worse as time went on.
The bottom line is that chiropractic care, for all musculoskeletal complaints, is the best place to go to get the best outcomes for your pain. Let the chiropractor decide if an MRI and epidural is appropriate.