Less Back Surgery When Chiropractors Seen First
Dear Patients & Friends:
When you injure your back at work, who should you see first? It’s a question patients, supervisors, employers, primary care physicians and insurance companies have had for years. Research from the state of Washington and published in the current issue of the prestigious orthopedic journal Spine gives further evidence that employees should select or be referred to a chiropractor first, rather than last, when their back is injured.
Researchers from Dartmouth, the University of Washington, and Ohio State University followed 1,885 patients who received injury to their back while on the job during a 3-year period of time and found that 174 eventually underwent lumbar spine surgery.
Patients who were most likely to receive surgery included those with higher initial disability, those with greater injury severity, and those who had been seen first by a surgeon. Those who were least likely to receive surgery included patients under the age of 35, women, Hispanics, and patients who first saw a chiropractor. Indeed, 42.7% of workers who first saw a surgeon had surgery, while only 1.5% of patients who first saw a chiropractor eventually had surgery.
Strengths of the research include the fact that the study reviewed the entire population of work related back injuries in the state of Washington during a recent 3-year period. Limitations include the fact that without a prospective randomized trial we can’t be certain whether patients who were either referred to surgeons first, or who decided to go on their own, really needed the surgery or would have benefited from early chiropractic intervention. However, the researchers pointed out that even after controlling for injury severity and other measures, workers who first saw a primary care provider were almost nine times less likely to receive surgery, and workers who were first seen by a chiropractor had even lower odds of eventually having back surgery.
Further, recent studies showing that patients with occupational back injuries who first saw a chiropractor had lower odds of chronic work disability, lower odds of having early receipt of magnetic resonance imaging (MRIs), and had higher rates of satisfaction with back care indicates that chiropractors should be considered for gatekeepers, or providers of first choice or referral, for occupational back pain.
Robert A. Leach, DC, MS, CHES, FICC(h)
To read the most recent research of worker’s compensation back injuries from the state of Washington that found only 1 in 100 back cases first seen by a chiropractor eventually receive back surgery, published in the December 12, 2012 issue of Spine: http://www.ncbi.nlm.nih.gov/pubmed/23238486
To read about less recurrence and disability after work related back pain a year after treatment by chiropractors in research funded by Liberty Mutual Insurance Company: http://www.ncbi.nlm.nih.gov/pubmed/21407100
In 1994 the U.S. Agency for Healthcare Policy and Research predicted that only 1 in 100 backs actually benefit from back surgery: http://www.ncbi.nlm.nih.gov/books/NBK52120/#A34348
In addition to dozens of smaller empirical and survey studies, a very large 2011 sample reported by Consumer Reports indicated consumers were more satisfied with chiropractic than with medications for treatment of their back pain: http://www.consumerreports.org/cro/magazine-archive/2011/september/health/alternative-treatments/back-pain-treatments/index.htm