When experiencing low back pain, patients have a variety of providers to choose from – primary care physicians, orthopedists, emergency medicine physicians, physical therapists, acupuncturists, and chiropractic physicians among others. Evidence-based guidelines for low back pain treatment increasingly recommend conservative care first (chiropractic, acupuncture, physical therapy), but how does the provider seen initially really effect health care and costs? Researchers looked at the records of over 3.5 million low back pain patients to find out.

Imaging (Xrays, MRI, CT)

Patients of conservative care providers (chiropractic, acupuncture, physical therapy) had the lowest rates of imaging while, patients first seeing an orthopedist had the highest rates, with imaging performed multiple times more frequently by orthopedists. For MRIs especially, this can drive up health care costs without always leading to better care.

Hospitalization & Surgery

Patients seeing chiropractors first were the least likely to be hospitalized (5.8%) and those seeing chiropractic physicians or acupuncturists were the least likely to have back surgery (0.7% and 0.5%). This compares to hospitalization rates up to 10% for orthopedists and surgery rates over 5% for orthopedists.

Opioid Use

Early opioid prescription and long-term opioid prescription was lowest for chiropractic (1.7-0.6%) and acupuncture (1.2-0.4%) patients. It was a fraction of the rates seen by Emergency Medicine and Advanced Practice Registered Nurse patients.

Health Care Costs

The total cost of care was lowest for chiropractic patients, averaging less than all other providers and about half as much as orthopedic patients.

Severe Illness Diagnosis

The researchers checked for differences in the diagnosis of severe illness or concerning red flags across providers and found that the frequency of finding these severe issues was similar across provider types and the delay before diagnosis of severe illness was similar as well.

Conclusion

Researchers concluded that health care and costs vary significantly depending on the first provider seen for low back pain. Patients seeing a chiropractor first compare favorably with less imaging utilization, less hospitalization and surgery, and less prescription opioid use, consistent with back pain treatment guidelines. Chiropractic patients also had lower health care costs, providing evidence-based care for a good value. The research supports seeing a chiropractic physician first for low back pain, or at least another conservative care provider.

Concerned parents frequently provide fever reducers like Tylenol to their children when fighting an illness, but the American Academy of Pediatrics (AAP) recommends avoiding medications for fever in most cases. Two specific exceptions noted are when your child is very uncomfortable or has a history of febrile convulsions.

Why NOT Treat a Fever with Medication

The AAP notes “fever may be important in helping fight the infection.” The immune system has a number of tools to combat pathogenic invaders and fever is one of them. It basically tries to burn the infection out. Forcing the body to reduce it’s temperature may be counterproductive to ending the infection resulting in a longer illness.

​But isn’t a fever dangerous?

​The AAP explains, “Even higher temperatures are not in themselves dangerous or significant unless your child has a history of seizures or a chronic disease…If he is eating and sleeping well and has periods of playfulness, he probably doesn’t need any treatment…Remember, a fever less than 105 degrees Fahrenheit is in itself not harmful.”

What can be done for a fever instead of medicine?

The AAP offers a few suggestions:

• Keep the room cool or use a fan and dress the child lightly
• Encourage the child to drink extra water
• Avoid overexertion
• Place the child in a bath of slightly warm water 1-2 inches deep and use a sponge or washcloth to spread the water over his body, causing a cooling effect with evaporation.

It's important to note the more common risk with an infection is dehydration, so keep your child drinking frequently even if it is just sips. Allow your child to rest as much as they can. Mild fevers may actually benefit from a warm bath or steam to help the body fight infection. Keep your child eating nutritious foods like bone broth soup and they should take their vitamins to support their health. Some experts believe a fever is a sign of calcium depletion, which the body uses for more of a first-line response to fighting infections. Working on the body with adjustments and massage has also been found to increase immune cell activity.

Most important is to monitor your child and watch for sign of more serious problems.