Gallup, Palmer Release Report About Preferences for Chiropractic Care for Back, Neck Pain

On the heels of various reports that have highlighted the challenges of treating back pain, Palmer College of Chiropractic and Gallup released their fourth annual survey of attitudes about and experiences with chiropractic care. The 2018 Gallup-Palmer College of Chiropractic Annual Report: Managing Neck and Back Pain in America is the latest effort by the college to see if public perceptions of chiropractic care match the ones held internally, said Dennis Marchiori, DC, PhD, Palmer’s chancellor and chief executive officer, in an interview with The American Journal of Managed Care^® (AJMC^®).

The results are based on a nationally representative Gallup study completed by 5377 US adults aged 18 or older earlier this year to determine preferences for neck or back pain care, patient experiences with providers, and the prevalence of various techniques for neck or back pain care in the United States.

“What we found is that we wanted chiropractic to have more of an identity for the public,” said Marchiori. “We definitely feel that the chiropractic profession offers more to the public than what is currently being taken advantage of.”

Read about payer coverage for nondrug ways to manage back pain.

The college also wanted to know more about the patient experience, and Marchiori said there is a lot of data for practitioners to dig into each year. For example, he said, patients think about safety as a concern when they see a provider, even if they don’t talk about it specifically. “Before you adjust a patient, you might want to explain what you are about to do,” he said.

According to the survey, about two-thirds of adults (62%) have had neck or back pain significant enough that they saw a healthcare provider at some point in their lifetime, including 25% who did so in the last 12 months.

While the majority of patients want the option to see a provider who can offer medication or surgery, most (79%) also say they want to try other ways to treat pain before taking medication prescribed by a doctor. Marchiori said concerns spurred by opioid use are definitely fueling this trend, but noted that more aggressive measures still have a place for pain management.

“I’m not suggesting that opioids and surgery aren’t important,” he said, but “let’s look at conservative measures before we move them up the ladder.”

Indeed, a series of papers published earlier this year in The Lancet found that patients suffering from back pain worldwide are being treated with an overuse of inappropriate tests and treatments such as imaging, opioids and other medications, and surgery, instead of being educated about their condition and the importance of staying active.

Marchiori said concerns about the use of opioids are behind patient preferences to try to avoid medications as a first-line therapy for back and neck pain.

The survey found that use of over-the-counter medications is common among adults who suffer from significant back or neck pain. Nearly 3 in 4 patients (73%) took a nonsteroidal anti-inflammatory drug (NSAID) in the past 12 months, and half took acetaminophen. More than 1 in 5 patients used prescription pain medication—22% took opioids, and 22% said they took benzodiazepines or muscle relaxants. Just 12% said they took a neurotransmitter gamma-aminobutyric acid drug.

He also cited a comparative effectiveness clinical trial conducted by Palmer and other organizations that found that adding chiropractic care to usual medical care for active military members with low back pain resulted in improved patient-reported pain and disability scores.

“It lays out the success of conservative management,” he said.

According to the Gallup-Palmer study released Wednesday, 62% saw a medical doctor for neck or back pain, 53% saw a chiropractor, and a little more than one-third (34%) saw either a physical therapist or massage therapist.

Marchiori said there are side benefits to what he called “more active therapies” as people generally report that they feel better overall. “Wellness is the ultimate goal,” he said.

Other survey findings include:

• 52% of adults said one of the biggest reasons they chose chiropractic care was because “this healthcare professional provides the most effective treatment for my pain.”
• 54% of adults said a chiropractor “provides the safest treatment for my pain with the fewest side effects.”
• 38% of adults who saw a medical doctor and 47% who saw a physical therapist (47%) also listed insurance coverage as a major reason they chose that provider.

Chiropractors also scored higher on characteristics like empathy and listening compared with physicians: 93% of adults said their chiropractor often listens; provides convenient, quick access to care (93%); demonstrates care/compassion (91%); and explains things well (88%).

For doctors, 72% of adults said their medical doctor often listens; 53% said their doctor often provides convenient, quick access to care; 66% said they often demonstrate care/compassion; and 67% said they often explain things well.