Where should you go for musculoskeletal pain?

Having trouble getting treatment for some musculoskeletal pain?  We see loads of patients who have been through this familiar process: GP to painkillers – to back to GP – to more powerful painkillers – to back to GP – to an MRI – to back to GP – to a Pain clinic – to “Good luck”. When what they really needed was a sharp thumb stuck in their glute muscles. A study has recently shown that we could do this whole thing better.  At the same time, we could save the NHS money and spare the GPs to concentrate on the important stuff.

The study:

This Swiss study looked at the relative benefits of chiropractic care compared to medical care.  This was for the most common types of musculoskeletal pain issues. The authors examined data from people who reported spinal, hip or shoulder pain (so, a wide range of complaints).

403 patients saw a medical doctor for relief and 316 people saw a chiropractor. Four months after treatment, the patients were asked to fill out a survey reporting on their recovery.

The authors found that:

  • “Patients initially consulting MDs had significantly less reduction in their numerical pain rating score…”
  • Also, patients who saw MDs were significantly less satisfied with the care they received and the outcome of that care.
  • And, patients who saw a chiropractor had significantly lower healthcare costs for their treatment.

The conclusion:

The authors conclude that patients should first be sent to a chiropractor for musculoskeletal problems, rather than a medical doctor:

“The findings of this study support first-contact care provided by DCs as an alternative to first-contact care provided by MDs for a select number of musculoskeletal conditions. Restrictive models of care in which patients are required to contact a medical provider before consulting a chiropractic provider may be counterproductive for patients experiencing the musculoskeletal conditions investigated and possibly others. In addition to potentially reducing health care costs, direct access to chiropractic care may ease the workload on MDs, particularly in areas with poor medical coverage and hence enabling them to focus on complex cases. The minority of patients with complex health problems initially consulting a chiropractic provider would be referred to, or comanaged with, a medical provider to provide optimal care.”

Houweling TAW, Braga AV, Hausheer T, et al. First-Contact Care With a Medical vs Chiropractic Provider After Consultation With a Swiss Telemedicine Provider: Comparison of Outcomes, Patient Satisfaction, and Health Care Costs in Spinal, Hip, and Shoulder Pain Patients. Journal of Manipulative and Physiological Therapeutics 2015;38(7):477-83.

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