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Writer's pictureDr. Melissa Adams

Does it matter what type of practitioner you see FIRST if you have low back pain?


Person sitting at desk with both hands on their low back, as though they have low back pain

In a May, 2022, study was published where researchers looked at low back pain insurance claims in a data base containing about 50 million insured individuals, they looked into whether or not it mattered what type of healthcare practitioner a person with low back pain saw FIRST.


Researchers were looking to see if it made a difference in the cost of healthcare, the total utilization of services, opioid use, imaging, hospitalizations, and out-of-pocket costs.


In their research, they found that most people's point of entry into the healthcare system was through Primary Cary Physicians (PCPs), chiropractors, orthopedic surgeons, physical medicine & rehabilitation, and physical therapists. About 50% of individuals began with their PCP or chiropractor.


The researchers found that individuals who saw a PT or chiropractor had lower odds of receiving short- and long-term opioids as compared to a primary care provider.


Generally, individuals who started with a chiropractor, acupuncturist, or physical therapist ranked lowest in health care utilization across most measures of interest, including opioid prescriptions and imaging services (x-ray and MRI/CT).

Those who saw a physical therapist or a chiropractor first had lower odds of receiving short or long term opioids, when compared to those who began with their PCP, physical medicine & rehabilitation provider, or orthopedic surgeon.


When it comes to back surgery, about 7% of those seeing an orthopedic surgeon first had surgery but for those seeing a chiropractor first, it was 0.7%!

Graph comparing each healthcare option (chiropractor, PCP, Emergency Medicine, APRN, Physical Therapist, Physical Medicine & Rehab, Acupuncture, Orthopedic surgeon) in each category of early opioid, long opioid, MRI orders, x ray orders, and back surgery

Total cost of care was lowest for those who initially saw a chiropractor ($5093), and highest for those who saw an orthopedic surgeon ($9434).


When it comes to out-of-pocket costs, patients paid less when they saw a PCP first ($853) and a chiropractor ($911) first. The highest out-of-pocket costs were for those who saw an acupuncturist first ($1415) and a physical medicine and rehabilitation provider ($1238).

Graph of Total cost from lowest to highest cost. Chiropractor $5093, PCP $5659, Emergency Medicine $6708, APRN $6907, Physical Therapist $7413, Physical Medicine & Rehab $8910, Acupuncture $9205, Orthopedic Surgeon $9434

For those with back pain, it can sometimes be a scary time and difficult to make decisions in the moment. This study shows that there are great reasons to start your low back pain recovery journey with a chiropractor and conservative care. This often has a lower out of pocket and total cost, less imaging, and less prescription opioids.


Ultimately, it comes down to your belief system and what it most important to you. It is also worth noting chiropractors have many techniques to choose from, if you would like a more gentle technique - ask about that when you call an office. If you don't want any "twisting," mention than when you call an office. We all have different techniques and approaches, some practice several techniques (like Dr. Adams), and others practice only one technique - really no different than any other profession!



This is not medical advice, always ask a chiropractor if chiropractic care is appropriate for you, and your preferred healthcare provider before making dietary, supplement, or lifestyle changes



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