Dr. Brian Anderson and I discuss the article, Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US (2022). We question the relationship between chiropractic and emergency department – ED visits in this paper. Does it makes sense that those who first saw a chiropractor had the lowest out of pocket and overall costs of care, the least hospitalizations and serious illnesses out of any provider type and yet had the highest emergency department – ED visits? Furthermore, those who first saw a chiropractor ranked second lowest of all providers for early opioid prescription, long opioid prescription, MRI/CT imaging, and surgery.

If you have not listened to Dr. Anderson’s podcast episode on chiropractic, treatment escalation, and medical services, please visit here.

Visit Dr. Anderson’s researchgate.net profile and Dr. Smith’s researchgate.net profile.

Below are the articles that are mentioned in this episode of the chiropractic science podcast.

1.Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US.Harwood KJ, Pines JM, Andrilla CHA, Frogner BK.BMC Health Serv Res. 2022 May 23;22(1):694. doi: 10.1186/s12913-022-08092-1.PMID: 35606781 Free PMC article.
2.Influence of Initial Health Care Provider on Subsequent Health Care Utilization for Patients With a New Onset of Low Back Pain: A Scoping Review.Zouch J, Comachio J, Bussières A, Ashton-James CE, Reis AHS, Chen Y, Ferreira P.Phys Ther. 2022 Nov 1:pzac150. doi: 10.1093/ptj/pzac150. Online ahead of print.PMID: 36317766
3.Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas.Acharya M, Chopra D, Smith AM, Fritz JM, Martin BC.J Chiropr Med. 2022 Jun;21(2):67-76. doi: 10.1016/j.jcm.2022.02.007. Epub 2022 May 21.PMID: 35774633 Free PMC article.
4.Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain Among Older Medicare Beneficiaries.Whedon JM, Kizhakkeveettil A, Toler AW, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S.Spine (Phila Pa 1976). 2022 Feb 15;47(4):E142-E148. doi: 10.1097/BRS.0000000000004118.PMID: 34474443
5.Initial presentation for acute low back pain: is early physical therapy associated with healthcare utilization and spending? A retrospective review of a National Database.Marrache M, Prasad N, Margalit A, Nayar SK, Best MJ, Fritz JM, Skolasky RL.BMC Health Serv Res. 2022 Jul 2;22(1):851. doi: 10.1186/s12913-022-08255-0.PMID: 35778738 Free PMC article.
6.Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.Anderson BR, McClellan WS, Long CR.J Manipulative Physiol Ther. 2021 Jun;44(5):372-377. doi: 10.1016/j.jmpt.2021.03.001. Epub 2021 Aug 6.PMID: 34366149
7.Prescription history of emergency department patients prescribed opioids.Hoppe JA, Houghland J, Yaron M, Heard K.West J Emerg Med. 2013 May;14(3):247-52. doi: 10.5811/westjem.2012.2.6915.PMID: 23687544 Free PMC article.
8.Interpreting the National Hospital Ambulatory Medical Care Survey: United States Emergency Department Opioid Prescribing, 2006-2010.Kea B, Fu R, Lowe RA, Sun BC.Acad Emerg Med. 2016 Feb;23(2):159-65. doi: 10.1111/acem.12862. Epub 2016 Jan 23.PMID: 26802501 Free PMC article.
9.Management of patients with low back pain in the emergency department: Is it feasible to follow evidence-based recommendations?Urrutia J, Besa P, Meissner-Haecker A, Gonzalez R, Gonzalez J.Emerg Med Australas. 2020 Dec;32(6):1001-1007. doi: 10.1111/1742-6723.13544. Epub 2020 Jun 18.PMID: 32558273
10.Imaging during low back pain ED visits: a claims-based descriptive analysis.Schlemmer E, Mitchiner JC, Brown M, Wasilevich E.Am J Emerg Med. 2015 Mar;33(3):414-8. doi: 10.1016/j.ajem.2014.12.060. Epub 2014 Dec 31.PMID: 25624075
11.Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective.Friedman BW, Chilstrom M, Bijur PE, Gallagher EJ.Spine (Phila Pa 1976). 2010 Nov 15;35(24):E1406-11. doi: 10.1097/BRS.0b013e3181d952a5.PMID: 21030902 Free PMC article.
12.Review article: Best practice management of low back pain in the emergency department (part 1 of the musculoskeletal injuries rapid review series).Strudwick K, McPhee M, Bell A, Martin-Khan M, Russell T.Emerg Med Australas. 2018 Feb;30(1):18-35. doi: 10.1111/1742-6723.12907. Epub 2017 Dec 12.PMID: 29232762 Review.

Dr. James Whedon

In this episode, Dr. James Whedon and I discuss his research on chiropractic, opioids, adverse events, risk of injury, medicare, and much more.  For instance, his research found the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients.  Dr. Jim Whedon is Director of Health Services Research at Southern California University of Health Sciences and adjunct instructor at The Dartmouth Institute for Health Policy and Clinical Practice. He holds a DC degree from Logan College and an MS from Dartmouth College. He has authored 33 peer reviewed publications. He is advisor to the Project for Integrative Health and the Triple Aim, co-chair of the research working group of The Academic Consortium for Integrative Health, charter member of the Academy of Integrative Health & Medicine, and recipient of the Jerome F. McAndrews DC Memorial Research Fund Award from NCMIC Foundation.

Dr. Jim Whedon is a national award-winning, NIH-funded clinical and health services investigator with interests in trauma, integrative medicine, spinal disorders and Medicare health policy. Experience in clinical database development and medical editing. IRB and editorial advisory board member. Licensed chiropractic physician with 25 years clinical experience. Faculty appointment with Geisel School of Medicine at Dartmouth.

Much of his research has focused upon geographic variations in access to chiropractic services under Medicare. He conducts observational research using claims and registry data.

Dr. Whedon’s long-term research goals are to improve access to health services that people need and want, and to improve quality through systematic care of acute problems and conservative upstream care of chronic problems. He has a particular interest in helping to improve access to care for vulnerable populations.

He is also a member of the Advisory Team, Project for Integrative Health and the Triple Aim, and of the Research Working Group, Academic Consortium for Complementary and Alternative Health Care (ACCAHC).

See Dr. Whedon’s list of publications on researchgate.net.

How to cite this episode:
Smith DL. Chiropractic Science: Chiropractic, Opioids, Adverse Drug Events, and Medicare with Dr. James Whedon [internet]. Eaton, Ohio; Aug 23, 2018. Podcast: 1:05:21. Available from: https://chiropracticscience.com/podcast/drjameswhedon/

Below is a list of the articles Dr. Whedon discusses in this episode:

1. Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events.
Whedon JM, Toler AWJ, Goehl JM, Kazal LA.
J Manipulative Physiol Ther. 2018 Jun;41(5):383-388. doi: 10.1016/j.jmpt.2018.01.004. Epub 2018 May 26.
PMID: 29843912 [PubMed – in process]
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2. Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids.
Whedon JM, Toler AWJ, Goehl JM, Kazal LA.
J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22.
PMID: 29470104 [PubMed – indexed for MEDLINE]
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3. Relevance of Quality Measurement to Integrative Healthcare in the United States.
Whedon JM, Punzo M, Dehen R, Menard MB, Fogel D, Olejownik J.
J Altern Complement Med. 2016 Nov;22(11):853-858. Epub 2016 Sep 23.
PMID: 27660896 [PubMed – indexed for MEDLINE]
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4. The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.
Weeks WB, Leininger B, Whedon JM, Lurie JD, Tosteson TD, Swenson R, O’Malley AJ, Goertz CM.
J Manipulative Physiol Ther. 2016 Feb;39(2):63-75.e1-2. doi: 10.1016/j.jmpt.2016.01.006. Epub 2016 Feb 19.
PMID: 26907615 [PubMed – indexed for MEDLINE] Free PMC Article
Similar articles
5. Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years.
Whedon JM, Mackenzie TA, Phillips RB, Lurie JD.
Spine (Phila Pa 1976). 2015 Feb 15;40(4):264-70. doi: 10.1097/BRS.0000000000000725.
PMID: 25494315 [PubMed – indexed for MEDLINE] Free PMC Article
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6. Risk of stroke after chiropractic spinal manipulation in medicare B beneficiaries aged 66 to 99 years with neck pain.
Whedon JM, Song Y, Mackenzie TA, Phillips RB, Lukovits TG, Lurie JD.
J Manipulative Physiol Ther. 2015 Feb;38(2):93-101. doi: 10.1016/j.jmpt.2014.12.001. Epub 2015 Jan 14.
PMID: 25596875 [PubMed – indexed for MEDLINE] Free PMC Article
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7. Comparing Propensity Score Methods for Creating Comparable Cohorts of Chiropractic Users and Nonusers in Older, Multiply Comorbid Medicare Patients With Chronic Low Back Pain.
Weeks WB, Tosteson TD, Whedon JM, Leininger B, Lurie JD, Swenson R, Goertz CM, O’Malley AJ.
J Manipulative Physiol Ther. 2015 Nov-Dec;38(9):620-8. doi: 10.1016/j.jmpt.2015.10.005. Epub 2015 Nov 5.
PMID: 26547763 [PubMed – indexed for MEDLINE] Free PMC Article
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