Chiropractors As Pain Treatment Providers

The profession received a big boost in 1980 when the AMA code of ethics was changed to say that it was ethical for physicians to cooperate with chiropractors.  This resulted in more referrals by MDs and increased utilization by consumers.  Then in 1992, a major study was released by the Rand Corp., which was also positive for the field.  It’s findings were picked up by the national media and newswires, and drew a lot of attention.  Among other things, this study concluded that spinal manipulation was appropriate for certain types of low back pain.

In December 1994, the Agency for Health Care Policy and Research (AHCPR) held a press conference and released new federal low back pain guidelines which recommended spinal manipulation and discouraged surgery.  For chiropractors, the most important finding of the multidisciplinary panel was that “manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms.”

In 2000, there were 81,011 active chiropractic licenses in the United States, according to the Federation of Chiropractic Licensing Boards. According to the Bureau of Labor Statistics, there were approximately 50,000 doctors of chiropractic practicing in the United States in 2000. The BLS estimates that 62,000 such professionals will be practicing in 2010, an increase of 24%.

Acute is defined as back pain or discomfort lasting a few days to several weeks.  An episode lasting longer than three months is no longer acute, but chronic.  Thus, although pain clinics and chiropractors do compete to some degree, it should be noted that pain clinics or programs are generally not focused on treating people with acute pain problems.

According to a ACA survey, the vast majority of 94% of patients that are seen are treated for neuromusculoskeletal conditions. The breakdown of conditions treated is:

            low back pain                                    38 %

            neck pain                                          28

            headache                                          14

            extremities                                         8

            other nms condition                             6

            hypertension                                       1

            GI disorders                                        2

            asthma                                                1

            other viscerosomatic conditions              2

Coverage of chiropractic care is offered by nearly two-thirds of all HMOs. When surveyed concerning their policies toward alternative therapies, 43% of HMO representatives reported that they "do not regard chiropractic as an alternative therapy" but as a form of mainstream health care.

 A 2001 study published in the Journal of Neuromusculoskeletal System described aspects of the clinical encounter in diverse chiropractic practices and assessed patient satisfaction among a sample of their patients. The majority of patients were highly satisfied with their care; 85.0% reported that their chiropractor always listened carefully; 85.3% that the DC explained things understandably; 88.2% that the DC showed respect for what they had to say; and 75.6% that he/she involved them in decisions as much as they wanted.

Chiropractic care is covered under programs such as Medicare, Medicaid, and some private insurance plans. No-fault and worker’s compensation also include chiropractic benefits.  Most states prohibit chiropractors from prescribing drugs and performing surgery.  Almost all chiropractors are solo or group practitioners.