Study: Which Provider Should Be Seen First for Low Back Pain?

The low back pain provider seen first makes a difference

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.

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