Spotlight Patricia Herman, RAND: Four Papers Focus on Patient Use of Provider-Based Nonpharmacological Care for Chronic Spinal Pain

We asked AACIPM Advisory Committee member, Patricia Herman, ND, PhD, Senior Behavioral Specialist, RAND Corporation, why this series was created.

“Our hope was to provide some real-world information to payers regarding how patients use ongoing provider-based care for chronic conditions. Of course, these studies are all based on observational data, but at least it’s a beginning.”

Comprehensive integrative pain management includes access to various evidence-based, safe and effective services based on individual needs and preferences of the person with pain. This month, Pain Physician published the final article in a series of four papers addressing how people use chiropractic care on an ongoing basis for chronic spinal pain. The first paper and the data collection were funded by NCCIH and the last three papers were funded by NCMIC Foundation.

Dr. Herman added,  “We haven’t found any other papers that addressed these issues. That’s why we did these studies, and we happened to have the data for chiropractic care.”

As many clinical guidelines recommend nonpharmacological interventions for chronic spinal pain, there is still much to be understood.  Each person living with chronic pain pursues diagnosis and treatment services based on their unique biopsychosocial experience and will find support from different methods of treatment and intervention.  These studies about the services provided by Chiropractors offer useful insights into the use of one type of provider-based care.  When, why, and how are chiropractic services used as the treatment of choice by patients with chronic spine pain?

Below are the paper topics and a highlight from Dr. Herman on what they are essentially about:

1. Patient Willingness to Pay for Reductions in Chronic Low Back Pain and Chronic Neck Pain, Journal of Pain, 2019: With their making and paying for appointment, patients seem to be “buying” a reduction in pain from what they think it might be if they don’t get the care rather than an actual reduction from current pain.
2. Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care, Journal of Alternative and Complementary Medicine, 2019: Most patients have a treatment goal of pain management; only 31% have a goal of cure (complete resolution of symptoms); most payer and healthcare systems’ policies are based on a curative model.
3. Predictors of Visit Frequency for Patients Using Ongoing Chiropractic Care for Chronic Low Back and Chronic Neck Pain; Analysis of Observational Data, BMC Musculoskeletal Disorders, May 2020: On average, patients utilized 2.3 chiropractic visits per month, but this varied by the characteristics of the patient (more visits with worse function, just starting care, and with CLBP and insurance coverage) and their treating chiropractor (more visits when chiropractor saw more patients per day or had fewer years of experience).
4. Visit Frequency and Outcomes for Patients Using Ongoing Chiropractic Care for Chronic Low-Back and Neck Pain: An Observational Longitudinal Study, Pain Physician, 2021: These patients were improving, although slowly; may have reached maximum therapeutic improvement; and could be considered to be successfully managing their chronic pain using a variety of chiropractic visit frequencies.