Risk of Treatment Escalation in Recipients vs. Nonrecipients of SMT for Cervical Spine Disorders
- Dr. Shawn Thistle
Neck pain is one of the leading causes of disability worldwide, with a global age-standardized point prevalence of approximately 3.5%.
Clinical practice guidelines typically recommend education, self-management, exercise, manipulation/mobilization, and nonopioid analgesics for the management of neck pain, although the duration of neck pain is not usually taken into consideration.
The routine use of imaging, opioid medications, injections, and surgery has increased over the past couple of decades, even though this sort of practice contradicts treatment guidelines. In fact, the use of these procedures has been shown to significantly contribute to costs associated with the treatment of spinal pain.
Treatment escalation refers to increasing the complexity of care in the management of a disease, or any care beyond the typical treatment a person uses to manage their condition. Treatment escalation has been well-described in the literature for several conditions, including asthma, eczema, cancer, end-of-life care, and the use of certain medications, but has only been briefly described for musculoskeletal disorders.
The aim of this project was to evaluate the relationship between treatment escalation and type of care in episodes associated with diagnosed cervical spine disorders by analyzing health insurance claims from a large Fortune 500 company. The authors hypothesized that episodes in nonrecipients of spinal manipulation (i.e. ‘other care’) would have a higher risk of treatment escalation than episodes in recipients of spinal manipulation.
THIS WEEK'S RESEARCH REVIEW: “Risk of Treatment Escalation in Recipients vs. Nonrecipients of SMT for Cervical Spine Disorders”
This paper was published in JMPT (2021) and this Review is posted in Recent Reviews, Neck Pain and the 2022 Archive.