SCU Awarded NIH Grants for Studies Advancing Our Understanding of Spine Pain Treatment
Southern California University of Health Sciences is pleased to announce the award of two National Institutes of Health (NIH) grants for work to be undertaken in collaboration with Dartmouth College.
Dr. James Whedon
Dr. Anu Kizhakkeveettil
Comparing Spinal Manipulation and Drug Treatment of Chronic Low Back Pain in Medicare Recipients
The first grant, awarded to primary investigators Dr. James Whedon and Dr. Anu Kizhakkeveettil of Southern California University of Health Sciences, pursues research into the effectiveness of spinal manipulation services as compared to prescription drug therapy for the long term treatment of chronic low back pain (LBP) in Medicare patients. This work is critical for a number of reasons, chief among them that extended use of medication for the treatment of LBP can be expensive and carries safety concerns, particularly for the elderly, and that spinal manipulation is commonly limited by insurers because its long term effectiveness has not yet been adequately studied. The study will compare spinal manipulation services and prescription drug treatment for chronic LBP with regard to 1) objective healthcare outcomes, via analysis of nationally representative Medicare data, and 2) patients’ self-reported quality of life and satisfaction with care, via surveys of random samples of the same patient population used in the Medicare data analysis.
As for the study’s collaborative partnership with Dartmouth, Dr. Whedon adds, “Located on the opposite side of the continent, Dartmouth might seem like an unlikely partner for SCU, but we have developed a successful research relationship. In addition to the NIH grants, SCU is currently conducting two privately funded studies of chiropractic care in collaboration with Dartmouth.”
The study aims to increase the access Medicare beneficiaries have to non-pharmacological approaches to chronic LBP by providing evidence of the superior value of spinal manipulation services. “The status quo for the care of chronic low back pain in the US is characterized by ballooning prevalence, escalating costs, and deteriorating outcomes,” says Dr. Kizhakkeveettil. “This project is innovative because it challenges the status quo. Evidentiary support for the value of spinal manipulation for long-term care promises to facilitate a shift away from chronic analgesic use and toward physical and rehabilitative interventions.”
Largest Analysis of Association between Cervical Spine Manipulation and Cervical Artery Tears
The second study, where Dr. Whedon will serve as co-investigator, will assess the risk of cervical artery tears in patients receiving cervical spine manipulation (CSM). Current recommendations from The American Heart and American Stroke Associations on this risk are based on flawed methods that the present research seeks to correct. Describing the present study’s methods, Dr. Whedon says, “To address the limitations of prior studies, we will study a very large sample of the population by analyzing Medicare data over a twelve-year period, and calculate the risk of cervical artery tears following a visit for spinal manipulation. To avoid the bias that occurred in prior studies, we will use propensity scoring to adjust for confounders and match controls. These methods should unmask relationships that might have gone undetected in previous studies due to a combination of exposure bias, selection bias, and recall bias.”
The study will look at Medicare data from 2004-2015 to determine if there is an association between CSM and cervical artery tears. Pilot work indicates a relevant population size much larger (9,000) than what has been included in previous studies.
According to Dr. Whedon, the research is important for it’s potential practical application in the clinical setting. “This study promises to help patients and physicians understand the relative risks of spinal manipulation when compared to other commonly used treatments for spine pain in order to make informed treatment decisions.”