More than half of chronic pain patients in a managed care setting reported using chiropractic care or acupuncture or both, but many of these patients didn’t discuss this care with their primary care providers. These study results, published today in The American Journal of Managed Care, suggest that better care coordination is needed among patients and physicians.
Researchers surveyed more than 6,000 patients in Oregon and Washington who were Kaiser Permanente members from 2009 – 2011 and had three or more outpatient visits for chronic pain within 18 months. They found that 58 percent of these patients had used chiropractic care or acupuncture or both.
The majority of patients shared information about these alternative therapies with their primary care provider, however a good portion (35 percent of patients who had acupuncture only, and 42 percent of patients who had chiropractic care only) didn’t talk to their providers about this care. Almost all of these patients said they would be happy to share this information if their provider asked.
“Our study confirms that most of our patients with chronic pain are seeking complementary treatments to supplement the care we provide in the primary care setting,” said Charles Elder, MD, MPH, lead author of the study and affiliate investigator at the Kaiser Permanente Center for Health Research. “The problem is that too often, doctors don’t ask about this treatment, and patients don’t volunteer the information.”
Chronic pain affects approximately 100 million Americans each year and costs nearly $600 billion, according to a report from the Institute of Medicine.
Dr. Elder, who is also the physician lead for Kaiser Permanente’s complementary and alternative medicine program, added, “We want our patients to get better, so we need to ask them about the alternative and complementary approaches they are using. If we know what’s working and what’s not working, we can do a better job advising patients, and we may be able to recommend an approach they haven’t tried.”
To find out how patients accessed this care researchers examined the medical records of patients who received acupuncture or chiropractic care in 2011. The majority of patients (66 percent) who received acupuncture accessed the services through their health plan, using a clinician referral or self-referral benefit. About half (45 percent) of patients who received chiropractic care accessed that care through their health plan. The remainder of patients went outside the health plan to access these services, or used a combination of health plan and outside resources to access the services.
The majority of the patients in the study (71 percent) were women, and the mean age was 61. Common complaints included back pain, joint pain, arthritis, extremity, neck and muscle pain, and headache.
Patients completed the survey online or by mail. It included 17 questions about the type of pain patients experienced, and their use of acupuncture, chiropractic care, and other alternative and complementary therapies. This survey was administered as part of a study called RELIEF, which is comparing outcomes among chronic pain patients who receive chiropractic care and acupuncture, and those who don’t.
It was funded by a grant from the National Center for Complementary and Integrative Health. (R01 AT005896)
Additional authors include: Lynn DeBar, PhD, William Vollmer, PhD, John Dickerson, MS, PhD and Lindsay Kindler, PhD, from the Kaiser Permanente Center for Health Research; Cheryl Ritenbaugh, PhD, from the University of Arizona; and Richard A. Deyo, MD, from the Kaiser Permanente Center for Health Research and Oregon Health & Science University.