Primary Spine Care Practitioners

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2011 (Jul 22); 19: 17 ~ FULL TEXT

The following is an interesting and well crafted article that posits yet another fanciful way to bring chiropractic “out of the closet”.   I do have some issues with a few of Dr. Murphy’s recommendations, however:

1. In the Necessary Skill Set section of the article under point#2, he states that the “primary spine care practitioner” would employ those methods shown to be evidence-based, minimally invasive and cost-effective…one of them being the prescription of non-steroidal anti-inflammatory and non-opioid analgesics to their patients.

Our Iatrogenic Injury Page contains numerous articles detailing how NSAIDs and other analgesics are associated with the death of tens of thousands of people every year, for solely relying on them for pain relief. I just don’t see me EVER recommending them.

This is a genuine scientific conundrum:
how can anything that kills that many people still be referred to as “evidence-based”?

UPDATE: (2-14-17) The Annals of Internal Medicine pre-published a new article titled:

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

and in it the authors stated:

The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.

2. In the Obstacles To The Implementation section under point#5, Dr. Murphy states that “For whatever profession or professions that respond to the need for a primary spine care practitioner, this will be a significant disruption to the traditional practice patterns or self-image of these professions. As a result, the role that we are introducing here will be actively resisted”. Oh how true!

When you look closely at the “expanded practice” movement, the first thing I noticed was that this movement is being promoted by the chiropractic schools that have the lowest enrollment of students.

I suspect that they are hoping to (or already have) developed an “expanded practice” program that will attract more students, and that’s understandable, if expanding your income is your primary objective.

3. Finally, there is the subtle hint that becoming an “expanded practice chiropractor” (or “medi-practor”) will increase the doctor’s “market share”. That may even be true. But, if that also means embracing the kind of evidence-based care that kills thousands every year, I say “No thank you, sir”.

Please don’t get me wrong: I have tremendous respect for Dr. Murphy and the other authors of the following article.

This article is very well written and logical… up to a point. I am posting it on our blog because I agree that our profession needs to review this material and see if and how it can be tweaked. Most of their suggestions are valid. I just don’t see the need to grab for prescription rights….not when there’s such considerable scientific evidence for recommending Omega-3 fatty acids for pain relief.

I hope you will enjoy the following new article:

The Establishment of a Primary Spine Care Practitioner and its Benefits to Health Care Reform in the United States

Donald R Murphy
Brian D Justice
Ian C Paskowski
Stephen M Perle
Michael J Schneider


One of the most talked about issues in the United States (US) is health care reform. In other countries as well, discussion commonly revolves around the issue of how health care services can be improved while containing costs. Many in the US have described the current health care situation as a “crisis” [1-4]. In March 2010, the US Congress passed and the President signed into law the Affordable Care Act, which puts in place comprehensive health care reform measures [5]. While various models for providing care to patients have been considered, such as accountable care organizations [6], it is recognized that any meaningful approach to health care reform will require three goals to be achieved:

1.   improved patient health;
2.   improved patient experience;
3.   decreased per capita costs [7].

Spine-related disorders (SRDs) are among the most common, costly and disabling problems in Western society. For the purpose of this commentary, we define SRDs as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. Virtually 100% of the population is affected by this group of disorders at some time in life. Low back pain (LBP) in the adult population is estimated to have a point prevalence of 28%-37%, a 1-year prevalence of 76% and a lifetime prevalence of 85% [8, 9]. Up to 85% of these individuals seek care from some type of health professional [10, 11]. Two-thirds of adults will experience neck pain some time in their lives, with 22% having neck pain at any given point in time [12].

Read the rest of this Full Text article now!