Chiropractic in the United States: Trends and Issues

Abstract

From its origins as an unconventional therapy in the late 19th century through decades of marginalization during the 20th century, chiropractic has acquired legitimacy and prominence (Meeker and Haldeman 2002). Signs of its success abound. They include a broadening of the laws and regulations affecting its licensure, scope of practice, and reimbursement; greater acceptance by both physicians and health plans; and a sustained demand for its services. Chiropractic's political base is strong, and it enjoys a high degree of patient satisfaction. Moreover, it is at the vanguard of complementary and alternative medicine (CAM), which receives ever greater proportions of health expenditures (Eisenberg et al. 1993, 1998) and which is being increasingly integrated into conventional medicine (Macy Foundation 2001). Even so, chiropractic's future seems uncertain. Recent expansions of chiropractic colleges are swelling the ranks of practitioners while managed care is restricting payment for what chiropractors do and evidence‐based medicine is demanding that what they do must have demonstrable value. Chiropractic is the best established of the alternative health care professions. Although marginalized for much of the 20th century, it has entered the mainstream of health care, gaining both legitimacy and access to third‐party payers. However, the profession's efforts to validate the effectiveness of spinal manipulative therapy, its principal modality, have yielded only modest and often contrary results. At the same time, reimbursement is shrinking, the number of practitioners is growing, and competition from other healing professions is increasing. The profession's efforts to establish a role in primary care are meeting resistance, and its attempts to broaden its activities in alternative medicine have inherent limitations. Although patients express a high level of satisfaction with chiropractic treatment and politicians are sympathetic to it, this may not be enough as our nation grapples to define the health care system that it can afford.

Colorado workers' compensation: medical vs chiropractic costs for the treatment of low back pain

“…7,16,26,27 Patients consistently express more satisfaction with chiropractic care than allopathic care and also return more often to doctors of chiropractic when their symptoms recur. 7 It was found that 95.8% of chiropractic patients indicated an overall satisfaction with chiropractic care and chiropractic services. 26 Chiropractic patients have reported receiving more self-care advice, as well as clearer explanations about their conditions and rationale for treatment, than do patients of MDs.…”

“…However, up to 50% of back disorder cases lack a precipitating event, leading researchers to conclude that most LBP is a multifactorial syndrome. 6 Symptoms are usually attributed to one or more potential causes including poor muscle tone; muscle tension; muscle tears; injury to tendons, ligaments, nerves, or disks; and the resulting inflammation, 7 although in most cases there is no definite diagnosis made of the pain generator.…”

“…7 Spinal manipulation therapy has been reported to prevent the onset of a chronic disorder associated with immobility and result in successful recovery, especially when the patient actively participates in strength and conditioning exercises and practices good body mechanics to help restore and maintain health. 8 Doctors of chiropractic focus on manual therapies, nutrition, and other physical modalities to restore and maintain health.…”

“…8 Doctors of chiropractic focus on manual therapies, nutrition, and other physical modalities to restore and maintain health. 7 The average duration of care for chiropractic patients with nonspecific, uncomplicated LBP is approximately 3 to 6 weeks; for more severe cases with significant loss of spinal mobility, up to 10 weeks of care has been reported. 9 Allopathic physicians (MDs) tend to favor medications, such as analgesics, muscle relaxants, and antiinflammatory medications, as the primary treatment of nonspecific LBP.…”

“…9 Allopathic physicians (MDs) tend to favor medications, such as analgesics, muscle relaxants, and antiinflammatory medications, as the primary treatment of nonspecific LBP. 7 Prescription drug expenditures for back pain have increased more rapidly than any other expenses involved in relieving LBP and account for more than 15% of the total health care expenses. 10 In addition to nonnarcotic medication, MDs may also recommend bed rest for no more than 4 days, aerobic exercise, physical therapy modalities, and work conditioning programs to help decrease LBP while retaining function.…”