Chiropractic Care and Back Pain

Does the government regulate chiropractic?

Chiropractic practice is regulated individually by each state and the District of Columbia. Most states require chiropractors to earn continuing education credits to maintain their licenses.^1,13 Chiropractors' scope of practice varies by state--including with regard to laboratory tests or diagnostic procedures, the dispensing or selling of dietary supplements, and the use of other CAM therapies such as acupuncture or homeopathy.^13,14,23 Chiropractors are not licensed in any state to perform major surgery or prescribe drugs.

^bIn Oregon, chiropractors can become certified to perform minor surgery (such as stitching cuts) and to deliver children by natural childbirth.^14,23,24

Do health insurance plans pay for chiropractic treatment?

Compared with CAM therapies as a whole (few of which are reimbursed), coverage of chiropractic by insurance plans is extensive. As of 2002, more than 50 percent of health maintenance organizations (HMOs), more than 75 percent of private health care plans, and all state workers' compensation systems covered chiropractic treatment.¹ Chiropractors can bill Medicare, and over two dozen states cover chiropractic treatment under Medicaid.²³

If you have health insurance, check whether chiropractic care is covered before you seek treatment. Your plan may require care to be approved in advance, limit the number of visits covered, and/or require that you use chiropractors within its network (read more in the NCCAM fact sheet "Consumer Financial Issues in Complementary and Alternative Medicine").

What has scientific research found out about whether chiropractic works for low-back pain?

 

Are there scientific controversies associated with chiropractic?

Yes, there are scientific controversies about chiropractic, both inside and outside the profession. For example, within the profession, there have been disagreements about the use of physical therapy techniques, which techniques are most appropriate for certain conditions, and the concept of subluxations. Outside views have questioned the effectiveness of chiropractic treatments, their scientific basis, and the potential risks in subsets of patients (for example, the risks of certain types of adjustments to patients with osteoporosis or risk factors for osteoporosis, compared to patients with healthier bone structures^33,36).

Research studies on chiropractic are ongoing. The results are expected to expand scientific understanding of chiropractic. A key area of research is the basic science of what happens in the body (including its cells and nerves) when specific chiropractic treatments are given.

Is NCCAM funding research on chiropractic?

Yes. For example, recent projects supported by NCCAM include:

• Comparing conventional medical care for acute back pain with an "expanded benefits" package (consisting of conventional care plus a choice of chiropractic, massage, or acupuncture)
  
  
• Finding out what happens (through measurement) in the lumbar portion of the spine after chiropractic positioning and adjustment
  
  
• Evaluating the effects of the speed of spinal adjustment on muscles and nerves
  
  
• Studying the effectiveness of chiropractic adjustment for a variety of conditions, including neck pain, chronic pelvic pain, and temporomandibular disorders (TMD) in the jaw

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