“Chiropractic care and physical therapy are among the best options we have for treating low back pain, and can help reduce reliance on treating pain with opioids and other pain medications,” said Eric J. Roseen, DC, PHD, Director of the Program for Integrative Medicine and Health Disparities at Boston Medical Center. “Guidelines released during the study period went from recommending these approaches as second line treatment, after other treatments fail, to first line treatment to be used before traditional pain medications. While the modest increases in use of these treatments we observed may be a sign of guideline adoption, most Americans with back pain are not receiving this type of care.”

Chiropractic care and physical rehabilitation are evidence-based approaches for managing low back pain, a very common and disabling health condition. The strength of evidence for these treatments has increased over the past 20 years, and guidelines from the American College of Physicians now strongly recommend these as initial treatment for acute or chronic low back pain.

Researchers used data from the CDC’s National Health Interview study from 2002 to 2018 involving 146,087 Americans who experienced low back pain in the prior three months. Between 2002 and 2018, only one third of adults with lower back pain reported use of either chiropractic care or physical rehabilitation, including occupational and physical therapy. Rates did not change until 2016 when uptake among adults modestly increased with the introduction of new clinical guidelines, but disparities by race and ethnicity remained despite the stronger recommendations.

Researchers believe that health insurance and policy changes are needed to increase access to non-pharmacological care for low back pain, particularly in underserved communities.

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