Outcomes/Effectiveness

Chiropractic care is more expensive but not more effective than medical care for the treatment of low back pain

Chiropractic care is more expensive than medical care for low back pain, but it is not more effective, according to findings from the first randomized trial to compare treatment costs for low back pain. However, the absence of medication cost data may have underestimated the costs of medical care, cautions Gerald F. Kominski, Ph.D., of the University of California, Los Angeles. In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07755), Dr. Kominski and his colleagues randomly assigned 681 HMO patients receiving care for low back pain in a large group practice to one of four treatment groups. The researchers measured total outpatient costs, excluding medications and clinical outcomes for a period of 18 months following randomization.

The medical care without physical therapy (MD) group was instructed in proper back care and exercises and prescribed bed rest and various medications for symptom relief. The medical care with physical therapy (MDPt) group received medical care and treatment by a physical therapist, including instruction in proper back care and exercises, plus one or more of the following at the discretion of the physical therapist: heat, cold, ultrasound, electrical muscle stimulation, soft tissue and joint mobilization, mechanical traction, and supervised exercise. The chiropractic care (DC) group received spinal manipulation or another spinal-adjusting technique and instruction in proper back care and exercises. The chiropractic care with physical modalities (DCPm) group received chiropractic care plus one or more of the following at the discretion of the chiropractor: heat, cold, ultrasound, and electrical muscle stimulation.

There was little difference in clinical outcomes between the groups during followup, but chiropractic patients were more satisfied than medical care patients. The adjusted mean outpatient costs per treatment group were $369 for MD, $560 for DC, $579 for DCPm, and $760 for MDPt (physical therapy more than doubled the cost of medical care).

See "Economic evaluation of four treatments for low-back pain: Results from a randomized controlled trial," by Dr. Kominski, Kevin C. Heslin, Ph.D., Hal Morgenstern, Ph.D., and others, in the May 2005 Medical Care 43(5), pp. 428-435.

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