A Policy Statement from Northwestern Health Sciences University

One of every five US adults reports chronic pain lasting three or more months. 1 Annually, chronic pain accounts for $560 to $635 billion in direct medical costs, lost productivity, and demand for disability programs. Further, chronic pain has been linked to restricted mobility, opioid dependency, anxiety, depression, and reduced quality of life. 1, 2

Of note, the growing burden of back pain substantially contributes to the already unsustainable cost of health care in the United States. Against the backdrop of over $4 trillion in annual healthcare spending, a recent report estimated that spending for spinal pain, estimated at $134.5 billion, was the largest contributor among 154 health conditions – more than for diabetes, cancer, cardiovascular disease, or chronic kidney disease. 3 Conventional management of common neck and back pain can be disjointed and the use of low-value diagnostic and treatment procedures contribute to high cost. 4 Delayed use of high-value conservative care options, like chiropractic, acupuncture, and exercise interventions, increases the per-episode cost of care, risk of chronicity, and escalation of low-value care. 5, 6, 7

Guidelines recommend the use of evidence-based complementary and integrative healthcare (CIH) interventions for the treatment and management of back pain, including the American College of Physicians, 8 the VA and Department of Defense, 9 and the CDC Clinical Practice Guideline for Prescribing Opioids for Pain. 10, 11 In addition, hospitals are required to provide non-pharmacologic pain treatment modalities in compliance with Joint Commission standards. 1

Despite this clear directive, CIH interventions are not readily available within health systems, delaying or prohibiting timely and effective care. Increasing access to CIH providers, such as chiropractic physicians, licensed acupuncturists, and massage therapists will allow for greater guideline-concordant treatment, care coordination, and reduced costs for both public and private payers.

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