This systematic review pooled 44 studies, 26 cohort studies, 17 cost analyses and one randomised controlled trial, comparing downstream healthcare costs for adults with spine-related pain who saw a chiropractor first against those managed medically first from the outset.
What was studied?
The review looked at costs, imaging rates, opioid prescriptions, surgery, hospitalisation, emergency visits, specialist referrals and injection procedures, including one representative study reporting average yearly costs for each care pathway.
What did they find?
Patients who saw a chiropractor first consistently incurred lower downstream costs, averaging roughly $5,093 a year against $9,434 for those seen by orthopaedic specialists first. They were also 56% less likely to be prescribed an opioid.
Why it matters
The pathway of care taken first can meaningfully affect how much further treatment, imaging and medication a patient ends up needing. Fewer unnecessary scans and lower opioid exposure both matter for wellbeing, not just cost.
Why we included it
It illustrates how the first point of contact in a care pathway shapes everything that follows, supporting a selective, non-routine approach to imaging and medication rather than defaulting to more intensive care.
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What was studied?
The review looked at costs, imaging rates, opioid prescriptions, surgery, hospitalisation, emergency visits, specialist referrals and injection procedures, including one representative study reporting average yearly costs for each care pathway.
What did they find?
Patients who saw a chiropractor first consistently incurred lower downstream costs, averaging roughly $5,093 a year against $9,434 for those seen by orthopaedic specialists first. They were also 56% less likely to be prescribed an opioid.
Why it matters
The pathway of care taken first can meaningfully affect how much further treatment, imaging and medication a patient ends up needing. Fewer unnecessary scans and lower opioid exposure both matter for wellbeing, not just cost.
Why we included it
It illustrates how the first point of contact in a care pathway shapes everything that follows, supporting a selective, non-routine approach to imaging and medication rather than defaulting to more intensive care.