Clinical guideline research commissioned by the World Health Organization (WHO) contends that healthcare providers should first recommend drug-free and non-surgical care to back pain patients. 
In an article in the Bulletin of the World Health Organization, “Care for low back pain: can health systems deliver?” researchers reviewed six sets of updated international guidelines for managing low back pain (LBP), pointing out that all recommend avoiding medication and surgery, if possible. They also stress that after educating patients about LBP and urging them to remain active, providers ought to consider recommending therapies such as spinal manipulation, most often performed by a doctor of chiropractic (DC), as well as massage and exercise. International guidelines also prioritize psychological and complementary therapies, such as stress reduction, yoga, acupuncture and tai chi, over medical and surgical interventions.
The growing consensus that LBP management should not begin, or even involve, medications and surgery means patient care requires a multidisciplinary team effort. For example, a primary care physician would collaborate with a DC, a physical therapist or a psychologist, or all of the above to help reduce patients’ pain without potentially harmful medications such as opioids, which recent evidence shows are ineffective for managing long-term LBP. 
Team-Based Care Works
Care for LBP that involves a multidisciplinary team, including DCs, has been shown to be very effective in managing the condition. For example, one of the most comprehensive studies involved nine medical facilities with on-site chiropractic care, including five hospitals and four clinics. The study included 135 stakeholders including DCs, other clinicians, support staff, administrators and patients. Researchers found chiropractic care was perceived to have high value among patients, medical providers and the administration. Patient satisfaction scores for chiropractic care were reported as being among the highest of all providers. 
Another study of 750 active-duty U.S. military personnel at three sites across the country, found that those who received collaborative care that included chiropractic manipulation integrated with usual medical care reported more improvement in LBP intensity and disability compared with those who did not receive spinal manipulation.
 Less Costly Options
DCs are also less costly members of the care team, according to data presented at a National Academy of Sciences, Engineering, and Medicine Workshop in December 2018. Findings presented by Optum, the health services subsidiary of UnitedHealth Group, showed that a conservative care approach involving chiropractic care or physical therapy for LBP costs the insurer approximately $619 per episode, while primary care costs $728 and care from a specialist costs $1,728. The insurer expects it could save $230 million and reduce opioid prescribing by 26 percent over two years if half of their members would first pursue a conservative approach for their LBP.
These benefits align with the WHO’s research findings and recommendations, as well as the growing body of evidence on LBP management. The next step will likely be helping patients access conservative care methods through health-plan incentives such as lower co-pays and fewer benefit restrictions so they can experience long-term relief and improved mobility.