• Farabaugh R
• Hawk C
• Taylor D
• Daniels C
• Noll C
• Schneider M
• McGowan J
• Whalen W
• Wilcox R
• Sarnat R
• Suiter L
• Whedon J

• Affiliation / Southern California University of Health Sciences
• Affiliation / University of Pittsburgh
• Affiliation / VA Puget Sound Health Care System
• American Chiropractic Association
• Analgesics, Opioid
• Chiropractic
• Conservative Treatment
• Health Care Costs
• Low Back Pain
• Manipulation, Chiropractic
• Manipulation, Spinal
• Open Access Document
• Patient Acceptance of Health Care
• Texas Chiropractic College

Background: The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

Methods: A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

Results: The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial. All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

Conclusion: Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management. The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted.

Author keywords: Chiropractic - Conservative care - Healthcare costs - Healthcare utilization - Low back pain - Manipulation - Spinal - Opioids

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