The current available research notes that 52% of all opioid prescriptions are for patients with low back pain. Over two million Americans suffer from opioid use disorder (OUD), with 47,000 dying from OUD in 2017. In light of the opioid epidemic, researchers from Boston University set out to find better options for low back pain management. The high cost of diagnostic tests and invasive treatment and the low level of patient satisfaction with such care was concerning. Their findings revealed that a patient’s initial choice of healthcare provider plays an important role. Their prospects for a successful outcome from the perspective of both the patient and the insurance company.

This prompted a major health insurance carrier to send a notice to their policyholders. Receive initial care for low back pain with either a doctor of chiropractic (DC) or physical therapist (PT). The carrier notes that this move is expected to reduce the use of spinal imaging tests by 21%. Spinal surgeries reduce by 21% and opioid prescriptions by 19%. This lead to lower costs for employers and plan participants.

Low Back Pain Study

This recommendation is in line with guidelines from the American College of Physicians. Non-drug, non-surgical care should be the initial course of treatment for low back pain patients. Also, a growing body of research on the effectiveness of non-surgical, non-drug approaches for managing low back pain:

• A 2020 study found that 22% of patients who initially visited their primary care doctor (PCP) received a short-term opioid prescription, with those first consulting with a PT or DC being 85-90% less likely to require an opioid prescription.
• A 2015 study found patients who first sought care from a DC were more satisfied with their care. Those who visited a PCP first weren’t as satisfied, but the overall treatment costs were lower.
• Back in 2013, researchers reviewed data from Washington state worker’s compensation cases. They found that 43% of workers with a back injury who consulted with a surgeon ended up having surgery. Although, 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain.
• A study published in 2019 found that low back pain patients were less likely to see DC/PTs vs. PCPs. The insurance plan had greater restrictions on DC/PT visits including higher co-pays, deductibles, participation in programs such as a health savings account. The authors stated long-term economic and social benefits would result if health insurance benefit designs were changed to encourage LBP patients to see DC/PT provider types.

Conclusion

BOTTOM-LINE: It’s becoming increasingly clear that conservative treatment approaches like chiropractic care should be strongly recommended. This includes patients with low back pain and other musculoskeletal conditions. This will lead to reduced use of potentially harmful opioids and the issues that can stem from their misuse. There will also be cost savings for patients and insurers. As with most health conditions, the sooner a patient seeks care, the greater their likelihood of a successful treatment outcome.