The Insider Secrets of Back Pain Treatment Revealed

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Approximately 26% of U.S. adults have experienced back pain in the past three months. Treatment ranges from rest to spinal surgery and everything in between. Sturgeon Bay, Wisconsin Chiropractor Dr. J G Moellendorf, DC, ND, LCP discusses recent research into the costs and effectiveness of various treatments for back pain.

“What makes the Mercer Report significant is that we have two highly respected medical researchers concluding that seeing a Chiropractor for back pain is not only the most effective treatment, but probably less costly than other forms of treatment!"

Back pain is very common, affecting 85% of the U.S. population during their lifetime. Spine-related problems cost an estimated $85 billion yearly, along with uncounted hours in lost production. Yet, the current treatment for back pain is often uncoordinated, disorganized, and costly. Most sufferers will consult their medical doctor, receiving muscle relaxant, anti-inflammatory or pain medications, or if that fails, a referral for physical therapy or traction.

After repeated failures in treating their back pain, frustrated chronic back pain sufferers may turn to such alternatives as Chiropractors, Naturopaths, acupuncture, or massage. Each approach has its successes—and its failures. Researchers are beginning to look into ways to increase the patient’s health and satisfaction, while hopefully reducing costs.

Dr. Niteesh Choudhry, MD, PhD of Harvard Medical School and Dr. Arnold Milstein, MD, MPH of Mercer Health and Benefits examined the costs and benefits of the various health care approaches to treating back pain. The full Mercer Report is attached to this article or it can be accessed at

In order to evaluate overall treatment effectiveness and costs, researchers use the Quality Adjusted Life Year (QALY) to compare outcomes. A value of 1 would be symptom-free or “perfect” health, a 0 would be death, and 0.5 would mean moderate pain which limits some self-care abilities. The total costs of a treatment that yields an additional year of ideal health determines the cost per QALY. This incremental cost-effectiveness ratio can then be used to determine the comparative value of various treatments. Interventions with cost-effectiveness ratios below $50000 to $100000 per QALY are generally considered to be cost-effective.

Doctors Choudhry and Milstein reported in the Mercer Report that medical physician care for back pain cost $2355 (not including muscle relaxant, anti-inflammatory or pain medications) with an efficacy (QALY) of 0.618. Physiotherapy-led exercise had an efficacy of 0.635 at a cost of $3192. This results in an incremental cost effectiveness ratio of $49210 (increased cost divided by increased efficacy, numbers have been rounded). This is slightly below the $50000 to $100000 threshold for being acceptable as cost-effective. Chiropractic care had an efficacy of 0.659 at a cost of $2431, with an incremental cost effectiveness ratio of $1837. While Chiropractic was the most effective choice of treatment, it resulted in a slightly increased cost ($75) compared to medical care to achieve its effectiveness.

Because sufficiently detailed drug costs were lacking, drug expenditures were not included in this analysis. This would very likely have increased the medical costs compared to the Chiropractic costs, thereby actually causing a slight cost savings with Chiropractic care.

While it seems intuitive that adding physiotherapy-led exercise to Chiropractic care should increase its efficacy, it actually declined to 0.651 while raising overall cost by another $76 to $2507, resulting in an incremental cost effectiveness ratio of $4591.

Sturgeon Bay, Wisconsin Chiropractor Dr. J G Moellendorf, DC, ND, LCP notes, “What makes the Mercer Report significant is that we have two highly respected medical researchers concluding that seeing a Chiropractor for back pain is not only the most effective treatment, but probably less costly than other forms of treatment!”

The findings of researchers Nelson, Metz, and LaBrot were also noted in the Mercer Report. They observed that when Chiropractic care was utilized, there was reduced use of x-ray, MRI, CT scan, hospitalization, and surgery; resulting in substantial cost savings long term.

Jordan Hospital in Plymouth, Massachusetts studied the use of Chiropractic care in its low back pain program. Out of 402 low back patients, those treated by Chiropractors achieved clinically successful outcomes with an average of 5.2 visits, for only $302 per case. Pain and disability scores were decreased by approximately 70% in just a few weeks, while the satisfaction rate exceeded 95%.

The Mercer Report reported that nearly 50% of chronic spinal pain sufferers consult a Chiropractor for care. Chiropractic was found to be more effective than other modalities in treating back pain. When the cost of medications is added to medical physician expenses, Chiropractic care is probably also the least expensive treatment for low back pain. These results were further confirmed by the Jordan Hospital study.

About: Dr. J G Moellendorf, DC, ND, LCP

Dr. J G Moellendorf, DC, ND, LCP attended the University of Wisconsin—Superior where he majored in Physics and Mathematics, with a minor in art photography. While attending the University of Minnesota—Minneapolis, he assisted in research on ribosomal proteins. Completing his Chiropractic studies at Palmer College of Chiropractic in Davenport, Iowa, he graduated Cum Laude (with high honors) in 1983. He started Moellendorf Chiropractic Office, Ltd. in Sturgeon Bay, Wisconsin in 1983. In 1996, Dr. Moellendorf was awarded his Doctorate in Naturopathy from Trinity School of Natural Health. In 2001, he received Chiropractic’s most prestigious award, the honorary Legion of Chiropractic Philosophers degree, for his thesis “The Workings of Innate Intelligence in Obsessive/Compulsive and Addictive Behaviors.” This paper was chosen for publishing in the book Philosophic Contemplations vol. 2 in 2002. Dr. Moellendorf can be contacted by phone (920) 493-2126, fax (920) 743-1145, email jgmoellendorf(at)itol(dot)com, his website at, or send a carrier pigeon to 44.84722 degrees N and 87.36416 degrees W.

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