Low Back Pain-Arthritis Link with Resultant Hospital vs. Chiropractic Costs: A Retrospective Analysis and Prospective Solution for Saving the Economy of the United States

The American Chiropractic Association (2010) reported that 31 million Americans experience low back pain. This is an epidemic at a staggering rate because what most of the public and doctors alike do not understand is what that sets the patient up for later in life that can be prevented. Stupar, Pierre, French and Hawker (2010) found that 49% of the general population reported a 6 month prevalence of low back pain, with 11% reporting the back pain to be so significant that it seriously limited their activities.


Low back pain and arthritis have now been linked. According to Dawson and Shaffrey (2009), the most common form of arthritis is called osteoarthritis, also known as degenerative joint disease and affects more than 20 million American adults. Osteoarthritis often begins at a slow rate. Early on, joints may be sore after physical work or exercise. The pain of early osteoarthritis dissipates and then returns over time, particularly as a result of overuse of the affected joint.

As Stupar et al. (2010) reported, osteoarthritis or OA has been long associated with back pain and reported comorbidity (they exist together.) 40% of hip or knee osteoarthritis patients have had low back pain. The 2010 study concluded hip osteoarthritis and low back pain is a conclusive predictor for future leg pain and disability and suggested that alleviating low back pain may positively impact future hip pain and function. This will result in preventing disability and alleviating the financial burden to the government, industry and insurers.


Clinically, the author has seen in patients with low back instabilities and persistent pain and degeneration of the spine and hips over a lifetime. This has been termed “subluxation degeneration” The Association of Chiropractic Colleges has defined subluxation as “…a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health” (The Association of Chiropractic Colleges, 2010, http://www.chirocolleges.org/paradigm_scope_practice.html). Simply put, subluxation is a diagnostic entity that denotes the vertebrate is out of position, is fixed or stuck in the wrong position to some degree and has a negative neurological effect. Once the vertebrate is out of position, the body automatically tries to stabilize the spine and mobilizes calcium to use as cement, or glue to prevent further malpositions. This is one of the causes of the degeneration or osteoarthritis as a sequella to malpositions of the vertebrate.


A 2009 study by Aspegren, Enebo, Miller, White, Akuthota, Hyde, & Cox concluded that 81.5% of workers with an acute injury causing low back or neck pain reported immediate post-treatment (manipulative-chiropractic adjustment) relief. That doesn’t take into account those patients who got better over time.


In 2009, Painter reported that Consumer Reports conducted an independent survey of 14,000 subscribers who rated hands-on therapy as the #1 treatment of choice for low back pain. The report went on to say that 88% of those who tried a chiropractic adjustment reported positive outcomes.


Research has concluded that there is a definitive clinical correlation between low back pain and osteoarthritis as a prognostic indicator of significant future problems if the low back pain is not resolved. Research has also concluded that chiropractic care is a safe, highly effective treatment choice for low back pain patients and as a result, low back pain cannot be ignored, especially in light of the fact that it can be treated in a cost-effective manner.


In 2009, Russo, Weir and Elixhauser reported that hospital stays for low back pain were 3.9 out of every 1000 people aged 55-64 years and Osteoarthritis was the #2 reason for hospital stays and fell only behind coronary atherosclerosis. This indicates both of these conditions have reached epidemic proportions in society.


According to Virginia Healthcare and Hospital Association (2010), the average non-surgical hospital stay in Virginia in 2009 was $15,059, while the average hospital stay in Virginia with surgery was $77,107, not including the doctors’ fees and post surgical care. A 2007 study by North, Kidd, Shipley and Taylor revealed that the cost to use spinal cord stimulation to treat failed back surgery syndrome was $117,901 and unsuccessful attempts at reoperation cost $260,584. These are staggering numbers considering that we now have the data and the ability to prevent many of these surgeries; not underwriting the costs of procedures that could have been avoided.


“MEDSTAT is an independent study of the cost of treating many common neuro-musculoskeletal conditions conducted recently under the direction of Miron Stano, Ph.D., a health care economist and Professor at the School of Business, Oakland University, Rochester, MI.” MEDSTAT, as reported by Chiropractic Lifecare of America (2009), concluded that the average chiropractic case is $3,799, far less than our medical counterparts and significantly less than any hospital stay (factoring in the cost of drugs, supports, specialist and rehabilitation referrals and surgeries for both.) It was also found that the percentages of hospital admissions are 29% for medicine and 19% for chiropractic patients.


With governmental agencies in fiscal crisis, including the Federal Government, the Obama administration has taken an unprecedented step to reign in healthcare costs and spending. According to Senate Budget Committee member Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, as reported in the Washington Post, “…bills crafted by House leaders and the Senate health committee does not propose ‘the sort of fundamental changes’ necessary to rein in the skyrocketing cost of government health programs, particularly Medicare” (Montgomery & Murray, 2009, http://www.washingtonpost.com/wp-dyn/content/article/2009/07/16/ AR2009071602242.html).


Whether you are a pro-President Obama Democrat, an anti-President Obama Republican or you fall somewhere in the middle, there is one thing that America can agree on; the health care system is broken and needs to be fixed. Too many sick people are not getting the care needed and doctors that sacrifice their lives for these patients are not getting a fair and equitable reimbursement.


The problem for the public is clear, but for doctors who are getting reimbursed at $20-$30 or less per visit because the carriers have exploited many loopholes in coverage will not be in the profession much longer for financial reasons, nor will they recommend that the future’s brightest minds in the nation go into healthcare. Who will care for our children or our children’s children when they are sick? Who will be available to the public to offer these cost saving, life changing options to the public?


We have established that chiropractic treats and prevents back pain and, therefore, will also mitigate many arthritic conditions as evidenced in the above research. If chiropractic helps only 20-30% of the arthritics and back pain patients (which, based on 30 years of clinical experience is woefully low), then we can rescue the economy on the United States with chiropractic alone by keeping billions of local, federal and insurance money in the system by either preventing needless care and surgeries or trading more expensive care for significantly lower costs with better scientifically and statistically proven outcomes; that is the chiropractic solution.


Dr. Mark Studin is the President of the Academy of Chiropractic (www.TeachChiros.com ) and consults doctors nationally on personal injury practices. He is also a researcher and the clinical director of the US Chiropractic Directory (www.USChiroDirectory.com ,) the largest chiropractic entity in the world that offers research and doctors credentials to the public.



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4. Aspegren, D., Enebo, B. A., Miller, M., White, L., Akuthota, V., Hyde, T. E., & Cox, J. M. (2009). Functional Scores and subjective responses of injured worker with back or neck pain treated with chiropractic care in an integrative program: A retrospective analysis of 100 cases. Journal of Manipulative and Physiological Therapeutics, 32(9), 765-771.

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9. North, R. B., Kidd, D., Shipley, J. & Taylor, R. S. (2007). Spinal cord stimulation versus reoperation for failed back surgery syndrome: A cost effectiveness and cost utility analysis based on a randomized, controlled trial. Neurosurgery, 61(2), 361-368.

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Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2009/07/ 16/AR2009071602242.html

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