Patterns of Initial Treatment and Subsequent Care Escalation
Among Medicare Beneficiaries with Neck Pain:
A Retrospective Cohort StudyThis section is compiled by Frank M. Painter, D.C.
Send all comments or additions to: Frankp@chiro.org
FROM: European Spine J 2024 (Dec 26) [EPUB]
Brian R Anderson Todd A MacKenzie Jon D Lurie Leah Grout James M Whedon
Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady St,
Davenport, IA, 52803, USA.
Purpose: To compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries.
Methods: We examined Medicare claims spanning a four-year period for beneficiaries with new episodes of neck pain beginning in 2019. All patients were continuously enrolled under Medicare parts A, B, and D and aged 65-99 years. We calculated the cumulative frequency and propensity- weighted rate ratios for escalated care encounters across three distinct, index-visit related neck pain treatment cohorts: 1) Spinal manipulative therapy; 2) Primary care without prescription analgesics within 7 days; 3) Primary care with prescription analgesics within 7 days.
Results: When compared to the primary care without analgesics cohort, the spinal manipulative therapy cohort was associated with a 64% lower rate (RR 0.36, 95% CI 0.35,0.37) for long-term care escalation encounters, while the primary care with prescription analgesics cohort was associated with an 8% higher rate (RR 1.08; 95% CI 1.05,1.10).
Conclusion: Initial spinal manipulative therapy was associated with a significant reduction in downstream care escalation encounters among Medicare beneficiaries with new episodes of neck pain. Our study contributes to a growing body of evidence supporting the integration of non-pharmacological care strategies for neck pain management.
Keywords: Health care utilization; Neck pain; Prescription drugs; Primary care physicians; Spinal manipulation.
Authors and Affiliations
Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady St, Davenport, IA, 52803, USA
Brian R. Anderson
Geisel School of Medicine,
Dartmouth College,
Hanover, NH, USA
Todd A. MacKenzie & Jon D. Lurie
Southern California University of Health Sciences,
Whittier, CA, USA
Leah Grout & James M. Whedon
Conflict of interest
Declarations. Conflict of interest: The authors declare no conflicts of interest. This research was supported by the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (award number 2R15AT010035-02). Ethics approval: The project protocols were reviewed and approved by the Institutional Review Board of the Southern California University of Health Sciences.
Ethics approval
The project protocols were reviewed and approved by the Institutional Review Board of the Southern California University of Health Sciences.
References:
Patel K, Dansie E, Guralnik J, Turk D (2013)
Prevalence and impact of pain among older adults in the United States:
findings from the national health and aging trends study.
J Pain 14:S12.
https://doi.org/10.1016/j.jpain.2013.01.057Dieleman JL, Cao J, Chapin A, Chen C, Li Z, Liu A et al (2020)
US Health Care Spending by Payer and Health Condition, 1996-2016
JAMA 2020 (Mar 3); 323 (9): 863884Manchikanti L (2020)
Update of utilization patterns of facet joint interventions in managing
spinal pain from2000 to 2018 in the US Fee-for-service Medicare population.
Pain Physician.
https://doi.org/10.36076/ppj.2020/23/E133Lopez CD, Boddapati V, Lombardi JM, Sardar ZM, Dyrszka MD, et al (2020)
Recent trends in Medicare utilization and reimbursement
for anterior cervical discectomy and fusion.
Spine J 20:17371743.
https://doi.org/10.1016/j.spinee.2020.06.010Medicare Monthly Enrollment.
Cent Medicare Medicaid Data n.d.
https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/
medicare-and-medicaid-reports/medicare-monthly-enrollment
(accessed July 1, 2024).Whedon JM, Haldeman S, Petersen CL, Schoellkopf W, MacKenzie TA (2021)
Temporal trends and geographic variations in the supply of clinicians
who provide spinal manipulation to Medicare beneficiaries:
a serial cross-sectional study.
J Manipulative Physiol Ther.
https://doi.org/10.1016/j.jmpt.2021.02.002Chen B, Brown HS, Douphrate D, Janak J, Gabriel KP, Peng T (2024)
National trends in the utilization and expenditure of chiropractic care
in US adults: analysis of the 20072016 medical expenditure panel survey.
J Manipulative Physiol Ther.
https://doi.org/10.1016/j.jmpt.2024.08.005Choudry E, Rofι KL, Konnyu K, Marshall BDL, Shireman TI, Merlin JS et al (2023)
Treatment patterns and population characteristics of nonpharmacological
management of chronic pain in the United States Medicare population:
a scoping Review.
Innov Aging.
https://doi.org/10.1093/geroni/igad085Parikh P, Santaguida P, Macdermid J, Gross A, Eshtiaghi A (2019)
Comparison of CPGs for the diagnosis, prognosis and
management of non-specific neck pain: a systematic review.
BMC Musculoskelet Disord 20:81.
https://doi.org/10.1186/s12891-019-2441-3Institute of Medicine (US) and
Committee on Quality of Health Care in America. (2001)
Crossing The Quality Chasm: A New Health System For The 21st Century
Washington (DC): National Academies Press (US); March 2001.- There are many more articles like this at our:
Hartvigsen J, Kamper SJ, French SD (2022)
Low-value Care in Musculoskeletal Health Care:
Is There a Way Forward?
Pain Practice 2022 (Sep); 22 (Suppl 2): 6570
LOW BACK PAIN Section- There are many more articles like this at our:
George SZ, Lentz TA, Goertz CM (2021)
Back and Neck Pain: In Support of Routine Delivery of
Non-pharmacologic Treatments as a way to Improve
Individual and Population Health
Translational Research 2021 (Apr 24); S1931-5244 (21) 00088-8
NON-PHARMACOLOGIC THERAPY SectionRamachandran S, Salkar M, Bentley JP, Eriator I, Yang Y (2021)
Patterns of long-term prescription opioid use among older adults in
the United States: a study of Medicare administrative claims data
Pain Physician 24:3140Smith-Bindman R, Kwan ML, Marlow EC, Theis MK, Bolch W et al (2019)
Trends in use of medical imaging in US health care systems
and in Ontario, Canada, 20002016.
JAMA 322:843.
https://doi.org/10.1001/jama.2019.11456- There are many more articles like this at our:
Fenton JJ, Fang S-Y, Ray M, Kennedy J, Padilla K, Amundson R et al (2023)
Longitudinal Care Patterns and Utilization Among Patients
with New-Onset Neck Pain by Initial Provider Specialty
Spine (Phila Pa 1976) 2023 (Oct 15); 48 (20): 14091418
CHRONIC NECK PAIN SectionMakris UE, Abrams RC, Gurland B, Reid MC (2014)
Management of persistent pain in the older patient: a clinical review.
JAMA 312:825.
https://doi.org/10.1001/jama.2014.9405- (April 16, 2020).
Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, et al.
Noninvasive Nonpharmacological Treatment for Chronic Pain:
A Systematic Review Update
Rockville (MD): Agency for Healthcare Research and Quality (US);Deyo RA, Dworkin SF, Amtmann D, Andersson G, Borenstein D et al (2015)
Report of the NIH Task Force on Research Standards for Chronic Low Back Pain
Journal of Pain 2014 (Jun); 15 (6): 569585Dahill M, Powter L, Garland L, Mallett M, Nolan J (2013)
Improving documentation of treatment escalation decisions in acute care.
BMJ Qual Improv Rep 2:u200617.
https://doi.org/10.1136/bmjquality.u200617.w1077- There are many more articles like this at our:
Whedon JM, Kizhakkeveettil A, Toler AW, Bezdjian S, Rossi D, et al. (2022)
Initial Choice of Spinal Manipulation Reduces Escalation of Care
for Chronic Low Back Pain Among Older Medicare Beneficiaries
Spine (Phila Pa 1976) 2022 (Feb 15); 47 (4): E142E148
INITIAL PROVIDER/FIRST CONTACT SectionCoverage For Chiropractic Services n.d.
https://www.medicare.gov/coverage/chiropractic-services
(accessed June 24, 2024).Stokes A, Lundberg DJ, Sheridan B, Hempstead K, Morone NE et al (2020)
Association of obesity with prescription opioids for painful
conditions in patients seeking primary care in the US.
JAMA Netw Open 3:e202012.
https://doi.org/10.1001/jamanetworkopen.2020.2012Fu JL, Perloff MD (2022)
Pharmacotherapy for spine-related pain in older adults.
Drugs Aging 39:523550.
https://doi.org/10.1007/s40266-022-00946-xAnderson BR, McClellan SW (2021)
Three Patterns of Spinal Manipulative Therapy for Back Pain and
Their Association With Imaging Studies, Injection Procedures,
and Surgery: A Cohort Study of Insurance Claims
J Manipulative Physiol Ther 2021 (Nov); 44 (9): 683689Anderson BR, McClellan WS, Long CR (2021)
Risk of treatment escalation in recipients versus nonrecipients of spinal
manipulation for musculoskeletal cervical spine disorders:
an analysis of insurance claims.
J Manipulative Physiol Ther 44:372377.
https://doi.org/10.1016/j.jmpt.2021.03.001Anderson BR, Whedon JM, Herman PM (2024)
Dosing of lumbar spinal manipulative therapy and its association with
escalated spine care: a cohort study of insurance claims.
PLoS ONE 19:e0283252.
https://doi.org/10.1371/journal.pone.0283252Zou G (2004) A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702706. https://doi.org/10.1093/aje/kwh090
Funk MJ, Westreich D, Wiesen C, Stόrmer T, Brookhart MA (2011)
Doubly robust estimation of causal effects.
Am J Epidemiol 173:761767.
https://doi.org/10.1093/aje/kwq439SAS Institute Inc.
SAS Software, Version 9.4.
Cary, NC: SAS Institute Inc. n.d.- There are many more articles like this at our:
Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD (2015)
Risk of Stroke After Chiropractic Spinal Manipulation in Medicare B
Beneficiaries Aged 66 to 99 Years With Neck Pain
J Manipulative Physiol Ther. 2015 (Feb); 38 (2): 93101
STROKE AND CHIROPRACTIC SectionGliedt JA, Spector A, Schneider MJ, Williams J, Young S (2023)
Disparities in chiropractic utilization by race, ethnicity and
socioeconomic status: a scoping review of the literature.
J Integr Med 21:159167.
https://doi.org/10.1016/j.joim.2023.02.002- There are many more articles like this at our:
Weigel PAM, Hockenberry JM, Wolinsky FD (2014)
Chiropractic Use in the Medicare Population: Prevalence,
Patterns, and Associations With 1-Year Changes
in Health and Satisfaction With Care
J Manipulative Physiol Ther. 2014 (Oct); 37 (8): 542-551
PATIENT SATISFACTION Section- There are many more articles like this at our:
Farabaugh R, Hawk C, Taylor D, Daniels C, Noll C, Schneider M et al (2024)
Cost of Chiropractic Versus Medical Management of
Adults with Spine-related Musculoskeletal Pain:
A Systematic Review
Chiropractic & Manual Therapies 2024 (Mar 6); 32: 8
COST-EFFECTIVENESS Section
Return to the MEDICARE Page
Return to COST-EFFECTIVENESS
Return to INITIAL PROVIDER/FIRST CONTACT
Since 12-26-2024
| Home Page | Visit Our Sponsors | Become a Sponsor |
Please read our DISCLAIMER |