Evidence for the Effectiveness of Chiropractic
Numerous studies throughout the world have shown that
chiropractic treatment, including manipulative therapy
and spinal adjustment, is both safe and effective. Many
other studies have shown that chiropractic care can
contain costs and get workers back on the job in less
time than other treatments. The following are excerpts
from a few of the more recent studies:
For Acute Low-Back Problems:
"For patients with acute low-back symptoms without
radiculopathy, the scientific evidence suggests spinal
manipulation is effective in reducing pain and perhaps
speeding recovery within the first month of symptoms."
- Clinical Practice Guidelines, AHCPR (1994)
For Long-Term Low-Back Problems:
"There is strong evidence that manipulation is
more effective than a placebo treatment for chronic
low-back pain or than usual care by the general practitioner,
bed rest, analgesics and massage." - Spine, Van
Tulder and Bouter et al. (1997)
"...improvement in all patients
at three years was about 29% more in those treated by
chiropractors than in those treated by the hospitals.
The beneficial effect of chiropractic on pain was particularly
clear." - British Medical Journal, Meade et al.
"Manipulative therapy and physiotherapy
are better than general practitioner and placebo treatment.
Furthermore, manipulative therapy is slightly better
than physiotherapy after 12 months." - British
Medical Journal, Koes et al. (1992)
"...patients suffering from back and/or neck complaints
experience chiropractic care as an effective means of
resolving or ameliorating pain and functional impairments,
thus reinforcing previous results showing the benefits
of chiropractic treatment for back and neck pain."
- Journal of Manipulative and Physiological Therapeutics,
Verhoef et al. (1997)
"...for the management of low-back
pain, chiropractic care is the most effective treatment,
and it should be fully integrated into the government's
health care system." - The Manga Report (1993)
"Cervical spine manipulation was associated with
significant improvement in headache outcomes in trials
involving patients with neck pain and/or neck dysfunction
and headache." - Duke Evidence Report, McCrory,
Penzlen, Hasselblad, Gray (2001)
"The results of this study show
that spinal manipulative therapy is an effective treatment
for tension headaches. . . Four weeks after cessation
of treatment . . . the patients who received spinal
manipulative therapy experienced a sustained therapeutic
benefit in all major outcomes in contrast to the patients
that received amitriptyline therapy, who reverted to
baseline values." - Journal of Manipulative and
Physiological Therapeutics, Boline et al. (1995)
For the Elderly:
"[Elderly] chiropractic users were less likely
to have been hospitalized, less likely to have used
a nursing home, more likely to report a better health
status, more likely to exercise vigorously, and more
likely to be mobile in the community. In addition, they
were less likely to use prescription drugs." -
Topics in Clinical Chiropractic, Coulter et al. (1996)
For Containing Costs and Getting Workers
Back on the Job:
"The overwhelming body of evidence" shows
that chiropractic management of low-back pain is more
cost-effective than medical management, and that "many
medical therapies are of questionable validity or are
clearly inadequate." - The Manga Report (1993)
First contact chiropractic care for
common low back conditions costs substantially less
than traditional medical treatment and "deserves
careful consideration" by managed care executives
concerned with controlling health care spending. - Medical
Care, Stano and Smith (1996)
Synopsis of Cost Effectiveness Research
Manga, Pran. "Enhanced chiropractic coverage under
OHIP (Ontario Health Insurance Plan) as a means for
reducing health care costs, attaining better health
outcomes and achieving equitable access to health services."
Report to the Ontario Ministry of Health, 1998.
This study demonstrates the ways in
which individuals in Ontario are deterred from the use
of chiropractic care because it is not covered under
OHIP. Greater chiropractic coverage under OHIP would
result in a greater number of individuals visiting chiropractors
and going more often. The study shows that despite increased
visits to DCs, this would result in net savings in both
direct and indirect costs. It is very costly to manage
neuromusculoskeletal disorders using traditional medicine.
If individuals were able to visit chiropractors under
OHIP a great amount of money would be saved by the government.
Direct savings for Ontario's healthcare system could
be as much as $770 million and at the very least $380
Manga, Pran; Angus, Doug; Papadopoulos,
Costa; Swan, William. "The Effectiveness and Cost-Effectiveness
of Chiropractic Management of Low-Back Pain." Richmond
Hill, Ontario: Kenilworth Publishing, 1993
This study demonstrates that an increase
in use of chiropractic care to manage low back pain
would save an enormous amount of money. The study reveals
that if management of low back pain was taken from physicians
and given to chiropractors there could be a potential
savings of millions of dollars every year. The study
also revealed that spinal manipulation is both safe
and more effective than drugs, bed rest, analgesics,
and general practice medical care for managing low back
Mosley, Carrie; Cohen, Ilava; Arnold
Roy. "Cost-effectiveness of chiropractic care in
a managed care setting." The American Journal of
Managed Care 1996; 2: 280-282.
In this study the cost of health care
for back or neck pain for individuals belonging to an
HMO who used chiropractic care or other methods of treatment
were evaluated. In this study the cost of surgery, use
of diagnostic imaging, and the satisfaction of patients
were evaluated. Claims that were paid from October 1,
1994 through October 1, 1995 were evaluated and analyzed.
The cost of healthcare for back and neck pain was much
lower for patients using chiropractic care than those
using other treatments. Surgical costs and the satisfaction
of patients was nearly the same for those who used chiropractic
care and those who did not. The conclusion of the study
is that chiropractic care yields similar outcomes to
other forms of care at a much lower cost.
Dean, David; Schmidt, Robert. "A
comparison of the cost of chiropractors versus Alternative
Medical Practitioners." Richmond, VA: Virginia
Chiropractic Association, 1992.
This study is an assessment of the difference
in cost of treatment between chiropractors and other
practitioners in dealing with individuals who have similar
back-related problems. This study analyzed individuals
who had medical visits in 1980 and had a combination
of eleven health problems including arthritis, disc
disorders, bursitis, low back pain, spinal related sprains,
strains, and dislocations. Chiropractic care had a lower
cost option for many back ailments.
Wolk, Steve. "An Analysis of
Florida Workers' Compensation Medical Claims for Back-Related
Injuries." Journal of the American Chiropractic
Association 1988; 27(7): 50-59.
This study is an analysis of worker's
compensation claims in Florida from June through December
of 1987. All of the claims analyzed were related to
back injuries. The greater purpose of this study was
to compare the cost of osteopathic, medical and chiropractic
doctors. The cost of drugs were not included in the
analysis. The results of the study lead to the finding
that individuals who had compensable injuries and were
treated by chiropractors often times were not forced
to be hospitalized. It was also revealed that chiropractic
care is a "relatively cost-effective approach to
the management of work-related injuries."
Johnson, Marjorie. "A Comparison
of Chiropractic, Medical and Osteopathic Care for Work-Related
Sprains/Strains." Journal of Manipulative and Physiological
Therapeutics 1989; 12(5): 335-344.
This study analyzed data on Iowa state
record from individuals in Iowa who filed claims for
back or neck injuries in 1984. The study compared benefits
and the cost of care received by individuals from MDs,
DCs and DOs. There was a focus on individuals who missed
days of work and were compensated because of their injuries.
Individuals who visited DCs missed on average at least
2.3 days less than individuals who visited MDs and 3.8
days less than individuals who saw DOs. Less money was
dispersed as employment compensation on average for
individuals who visited DCs. On average, the disability
compensation paid to workers for those who visited DCs
was $263.66, $617.85 for those who visited MDs, and
was $1565.05 for those who visited DOs.
Nyiendo, Joanne, Lamm, Lester. "Disability
Low Back Oregon Workers' Compensaion Claims. Part I:
Methodology and Clinical Categorization of Chiropractic
and Medical Cases." Journal of Manipulative and
Physiological Therapeutics 1991 14(3): 177-184.
This study examined 201 randomly selected
workers' compensation cases that involved low back injuries
that were disabling. Study found individuals who visited
DCs less often initially went to the hospital for their
injuries than those visiting MDs. Those who visited
DCs often had a history of chronic back pain.
Nyiendo, Joanne. "Disability
Low Back Oregon Workers' Compensation Claims. Part II:
Time Loss." Journal of Manipulative and Physiological
Therapeutics 1991 14(4): 231-239.
Report on loss of time for individuals
who visited DCs and those who visited MDs for treatment
of low back pain. Median missed days of work for individuals
with similar severity of injury was 9.0 days for those
visiting DCs and 11.5 for individuals visiting MDs.
Individuals visiting chiropractors more often returned
to work having missed one week or less of work days.
There was no difference in time lost for individuals
visiting DCs and MDs with no previous history of low
back pain. The median of days missed of work for individuals
who had chronic back pain and visited MDs was 34.5 days
while the median of days missed of work for those visiting
DCs was 9 days.
Branson, Richard. "Cost Comparison
of Chiropractic and Medical Treatment of Common Musculoskeletal
Disorders: A Review of the Literature after 1980."
Topics in Clinical Chiropractic. 1999; 6(2): 57-68.
Comparison of costs of care provided
by DCs and general and specialist MDs for individuals
with musculoskeletal conditions. Study found that the
majority of retrospective studies had positive results
for chiropractic care.
Jarvis, Kelly; Phillips, Reed; Morris,
Elliot. "Cost Per Case Comparison of Back Injury
Claims of Chiropractic versus Medical Management for
Conditions with Identical Diagnostic Codes." Journal
of Occupational Medicine 1991; 33(8): 847-852.
Comparison of cost between MD and DC
providers for injuries related to the back. The average
number of treatments for medical claims was 4.93 as
compared to 12.89 for chiropractic claims. Average days
of care was 34.25 for medical claims and 54.49 for chiropractic
claims. Average compensation cost for work time lost
was $668.39 for medical claims and $68.38 for chiropractic
claims. Average cost of care for medical claims was
$684.15 and $526.84 for chiropractic claims. This study
demonstrates that although individuals who receive chiropractic
care usually have a greater number of visits to DCs
than those who visit MDs the cost of care and the worker's
compensation dispersed is lower for those visiting DCs.
Stano, Miron. "A Comparison
of Health Care Costs for Chiropractic and Medical patients."
Journal of Manipulative and Physiological Therapeutics
1993: 16(5): 291-299.
Comparison of cost for patients who
received chiropractic care for neuromusculoskeletal
problems versus those who received medical and osteopathic
care. A fourth of patients analyzed were treated by
chiropractors. These patients had lower health care
costs. "Total cost differences on the order of
$1000 over the two year period were found in the total
sample of patients as well as in sub-samples of patients
with specific disorders." Lower costs are attributed
to lower inpatient utilization.
Stano, Miron. "The Economic
Role of Chiropractic Further Analysis of Relative Insurance
Costs for Low Back Care." Journal of the Neuromusculoskeletal
System 1995; 3(3): 139-144.
Comparison of costs of care for common
lumbar and low back conditions when a chiropractor is
the first provider and when an MD is the first provider.
Total payments for inpatient procedures were higher
for MD episodes and especially episodes that lasted
longer than a single day. Outpatient payments were much
higher for MD initiated treatments as well.
Stano, Miron; Smith, Monica. "Chiropractic
and Medical Costs of Low Back Care." Medical Care
Comparison of health insurance payments
and patient utilization patterns for common lumbar and
low back pain for patients who receive treatment from
MDs and DCs. The results found that there were lower
costs for episodes in which DCs were the first providers.
The mean total payment when DC's were the first providers
was $518 whereas the mean payment for cases in which
a MD was the first provider was $1020.
Smith, Monica; Stano, Miron. "Costs
and Recurrences of Chiropractic and Medical Episodes
of Low Back Care." Journal of Manipulative and
Physiological Therapeutics 1997: 20(1): 5-12.
Comparison of health insurance payments
and patient utilization patterns for individuals suffering
from recurring lumbar and low back pain visiting DCs
vs. MDs. Insurance payments were higher for medically
initiated episodes. Those who visited chiropractors
paid a lower cost and were also satisfied with the care
given. Because of this the study suggests that chiropractic
care should be given careful attention by employers
when using gate-keeper strategies.
"Utilization, Cost, and Effects
of Chiropractic Care on Medicare Program Costs"
Muse and Associates. American Chiropractic Association
Study examines cost, utilization and
effects of chiropractic services on Medicare costs.
The study compared program payments and service utilization
for Medicare beneficiaries who visited DCs and those
who visited other types of physicians. The results indicated
that chiropractic care could reduce Medicare costs.
Medicare beneficiaries who had chiropractic care had
an average Medicare payment of $4426 for all Medicare
services. Those who had other types of care had an average
of $8103 Medicare payment for all Medicare services.
The per claim average payment was also lower with chiropractic
patients having an average of $133 per claim and individuals
who did not have chiropractic care had an average of
$210 per claim.
Prescription Drug Information
Using prescription drugs has become commonplace for
many Americans. Because of the regular role prescription
drugs play in daily life, few take the time to think
of the seriousness of the problems that can arise from
the use of such drugs. In 2000 reactions to drugs was
the fourth leading cause of death in the United States.
 This puts reactions to drugs in the ranks of lung
cancer, heart disease and stroke. Lack of full knowledge
of the effects of prescription drugs coupled with a
somewhat lackadaisical approach to the use of prescription
drugs is a volatile combination.
In their September newsletter, the Agency
for Healthcare Research and Quality (AHRQ) released
information regarding prescription drug costs. According
to their newsletter, "prescription drug spending
doubled from $60.8 billion in 1995 to $121.8 billion
in 2000 and is expected to reach $160.9 billion in 2002."
 AHRQ is launching research projects that will seek
to find instances in which, "older, less expensive
drugs or no drug treatment can work just as well as
newer, more expensive drugs." Although prescription
drugs are continuing to increase in price, AHRQ points
out that, "very few studies have measured the cost
benefits of new drugs."  Individuals are being
forced to pay more for prescription drugs without truly
knowing the benefits, and in regard to newer prescription
drugs and older prescription drugs "little information
is available to doctors to determine which therapy works
best."  Billions of dollars are spent annually
for treatments whose effects are not entirely clear.
The above is especially disturbing when
one considers the May 1998 Journal of the American Medical
Association study which stated that an estimated 106,
000 hospital patient deaths and 2.2 million injuries
occur each year as a result of adverse reactions to
prescription drugs.  With prescription drug costs
dramatically escalating and the safety of these drugs
being questioned the time seems especially right to
demonstrate the benefits of drug-free treatments and
interventions, such as chiropractic care.
- Robert H. Shmerling, M.D. A perspective
from Harvard Medical School. January 22, 2003.
- Kass-Bartelmes BL, Bosco L, Rutherford
MK. Prescription drug therapies: reducing costs and
improving outcomes. Rockville (MD): Agency fro healthcare
Research and Quality; 2002. Research in Action Issue
8. AHRQ Pub. No. 02-0045.
- Thomas J. Moore; Bruce M. Psaty,
MD, PhD; Curt D. Furberg, MD, PhD Time to Act on Drug
Safety JAMA / volume:279 (page: 1571) May 20, 1998
This information is reprinted with permission
of the American Chiropractic Association. Copyright