• Brian R Anderson, Todd A MacKenzie, Jon D Lurie, Leah Grout, and James M Whedon.
• Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady St, Davenport, IA, 52803, USA. Brian.anderson@palmer.edu.
• Eur Spine J. 2024 Dec 26.

PurposeTo compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries.MethodsWe examined Medicare claims spanning a four-year period for beneficiaries with new episodes of neck pain beginning in 2019. All patients were continuously enrolled under Medicare parts A, B, and D and aged 65-99 years. We calculated the cumulative frequency and propensity- weighted rate ratios for escalated care encounters across three distinct, index-visit related neck pain treatment cohorts: 1) Spinal manipulative therapy; 2) Primary care without prescription analgesics within 7 days; 3) Primary care with prescription analgesics within 7 days.ResultsWhen compared to the primary care without analgesics cohort, the spinal manipulative therapy cohort was associated with a 64% lower rate (RR 0.36, 95% CI 0.35,0.37) for long-term care escalation encounters, while the primary care with prescription analgesics cohort was associated with an 8% higher rate (RR 1.08; 95% CI 1.05,1.10).ConclusionInitial spinal manipulative therapy was associated with a significant reduction in downstream care escalation encounters among Medicare beneficiaries with new episodes of neck pain. Our study contributes to a growing body of evidence supporting the integration of non-pharmacological care strategies for neck pain management.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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