Patterns of initial treatment and subsequent care escalation among medicare beneficiaries with neck pain: a retrospective cohort study.

Purpose: To compare long-term care escalation encounters among three care patterns for new episodes of neck pain among Medicare beneficiaries.

Methods: We 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.

Results: When 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).

Conclusion: Initial 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.