Research Explores Cost-Effective Ways to Manage Low Back Pain Effectively

Low back pain is a prevalent cause of disability and a significant contributor to healthcare expenditures.  According to a 2019 study in the Rheumatology International journal, approximately 67% of individuals in the United States seek healthcare for low back pain, with general practitioners, chiropractors, and physical therapists being the primary caregivers.  Medication, exercise, massage therapy and spinal manipulations were the most commonly administered treatments.

The Annals of Internal Medicine published an updated Clinical Practice Guideline for Managing Low Back Pain from the American College of Physicians.   This guideline emphasizes nonpharmacologic treatments such as heat therapy, massage, acupuncture, and spinal manipulation for patients with acute and subacute pain.  For patients with chronic pain, recommendations for first options for doctors and patients include exercise, rehabilitation therapy, acupuncture, motor control exercises (exercises to strengthen the back muscles), low-level laser therapy, and SPINAL MANIPULATION.  They recommended considering medications only after conservative treatments prove ineffective.

Despite these guidelines, a cohort study published in January 2024 highlighted the prevalence of “low-value, non-guideline-based healthcare” for low back pain, resulting in increased costs.  This study was conducted to explore the relationship between Spinal Manipulative Therapy (SMT – commonly called the spinal adjustment or chiropractic adjustment) and “escalated spine care in the form of imaging studies, injection procedures, ED visits, surgery, and/or opioid medications.”

Conducted as a retrospective cohort study on health insurance claims from a self-insured Fortune 500 company (2012-2018), the research categorized 83,025 claims into 11,114 unique episodes.  They defined an episode of care as “a consultation or a series of consultations for LBP, preceded and followed by a 90-day claim free window.”  The episodes were divided into 3 SMT groups based on number of SMT procedures the patient received during an episode of care: low (1 SMT), moderate (2-12 SMT) and high (13 or more SMT).  These groups were then compared to the claims for episodes of care that did not include SMT.

Analysis of these claims revealed interesting comparisons.  Just over 60% of all SMT episodes were represented in the moderate dose cohort.  They found the adjusted relative risk (RR) of any escalated spine care was significantly decreased in both the low and moderate SMT cohorts.  The high dose SMT cohort was associated with increased RR for imaging, but maintained a decreased RR for injection and emergency room visits.

This study aligns with a 2005 retrospective analysis  which reported patients who had chiropractic coverage in their health insurance plans had lower rates of surgery (-32%), advanced imaging (-23%) and plain film radiography (-8%).

To get a clearer understanding, additional research is needed to investigate the factors influencing escalated spine care, including the severity and complexity of low back pain.  The researchers also suggest using different grouping methods of the SMT dose in future research.  This will help to refine treatment recommendations.

In conclusion, low and moderate dose SMT are consistently associated with lower risk of escalated spine care, offering potential pain relief and health care savings benefits for patients with low back pain.

If you or a loved one is experiencing low back pain or other forms of musculoskeletal pain, consulting a chiropractor for individualized, natural treatment options could be beneficial.  This approach may help alleviate pain without resorting to medications and surgery, contributing to more cost-effective and personalized care.  If you do not already have a chiropractor, you can find a TCA member doctor in your area at .



Anderson BR, Whedon JM, Herman PM. Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: A cohort study of insurance claims. PLoS One. 2024 Jan 5;19(1):e0283252. doi: 10.1371/journal.pone.0283252. PMID: 38181030; PMCID: PMC10769084.

Beyera GK, O’Brien J, Campbell S. Health-care utilisation for low back pain: a systematic review and meta-analysis of population-based observational studies. Rheumatol Int. 2019 Oct;39(10):1663-1679. doi: 10.1007/s00296-019-04430-5. Epub 2019 Aug 28. PMID: 31463608.

Tennessee Chiropractic Association.  “American College of Physicians Recommends Spinal Manipulation as a Primary Treatment for Low Back Pain” Posted: February 23, 2017  accessed Feb 5, 2024.

Nelson CF, Metz RD, LaBrot T. Effects of a managed chiropractic benefit on the use of specific diagnostic and therapeutic procedures in the treatment of low back and neck pain. J Manipulative Physiol Ther. 2005 Oct;28(8):564-9. doi: 10.1016/j.jmpt.2005.08.010. PMID: 16226623.