Spinal Manipulative Therapy vs. Prescription Drug Therapy for Care of Aged Medicare Beneficiaries with Neck Pain - An estimated 3.9 million older US adults suffer from Neck Pain (NP), the fourth leading cause of disability
worldwide. However, little is known about the comparative value of current treatment approaches to NP. The
management of spine pain in the United States is inefficient, costly, and sometimes hazardous. Thus, there is
an acute need to evaluate non-pharmaceutical treatment alternatives and identify safe, high-value
management strategies. The need is critical for older adults with NP, who tend to be comorbid, vulnerable to
adverse events, and prone to the utilization of high-cost interventions. Prescription drug therapy (PDT) and
spinal manipulative therapy (SMT) are widely used treatment strategies for NP, but their comparative value for
NP is uncertain. Because NP is often persistent, many patients feel compelled to seek ongoing care, but the
chronic use of PDT (primarily opioids and NSAIDs) for NP raises safety concerns, particularly for the elderly.
The utilization of SMT - which shows similar effectiveness to other interventions in systematic reviews - is often
limited by insurers because the value of prolonged treatment is also uncertain. There is, therefore, a pressing
need to compare the long-term value of these two approaches (SMT and PDT) for management of NP in
Medicare beneficiaries. The overall objective of this project is to assess both short- and long-term value of
SMT as compared to PDT for management of NP in older Medicare beneficiaries. With active engagement of
students, this project is also intended to strengthen the research environment at Southern California University
of Health Sciences. The central hypothesis is that utilization of SMT for NP offers superior value as compared
to PDT. The central hypothesis will be tested objectively by pursuing three related but independent specific
aims: (1) compare the short- and long-term safety of SMT vs. PDT as measured by the likelihood of adverse
outcomes, (2) compare the short- and long-term efficiency of SMT vs. PDT as measured by rates of escalation
of care for NP, and (3) compare the short- and long-term costs of SMT vs. PDT as measured by payer
expenditures and patient cost sharing. Rigorous methods intended to reduce risk of bias and confounding will
include weighted propensity scoring and instrumental variable methodology. The approach to this research is
innovative because relatively little is known about the value of non-pharmacological treatment approaches for
NP among older adults. This project promises to challenge the status quo by assessing the value of a non-
pharmacologic alternative to high-risk prescription drugs. Evidence of the superior value of SMT for care of NP
will facilitate an innovative shift away from the hazards of chronic analgesic use and toward non-
pharmacological interventions. The project also includes a practical plan for introducing large-scale health
services research – with student participation - to two educational institutions that train complementary and
integrative healthcare clinicians. The research contribution is expected to be significant because evidence
favoring SMT promises to improve the safety, efficiency, and value of care for older adults with NP.
