PCA Deep Dive: When the Evidence Changes, Rethinking Spine Injections for Chronic Pain

September President’s Update: Meet the Board and Connect with Your RegionWhat is PCA working on for Pennsylvania chiropractors, and how can you be part of it? Executive Director Mike Barba shares two opportunities to connect with the association this October.On October 17, PCA invites members and the public to join the Board at the Harrisburg Hilton. Lunch begins at 11:30 a.m. and includes an association update, a look ahead to the year, and time for questions. An optional two-hour live CE course, Physical Rehabilitation of the Injured Athlete, follows. Registration is $25 for lunch and two hours of CE.On October 29, the Bell Region will gather from 7–9 p.m. for updates, Q&A, and time with fellow chiropractors. Mike also discusses PCA’s work on scope modernization, copay reform, PIAA, therapeutic exercise delegation, and insurance issues.Register and RSVP:October 17 Board lunch and CE: https://pca.ce21.com/item/capitol-region-meeting-150637October 29 Bell Region meeting: https://pca.ce21.com/item/bell-regional-meeting-147068Protecting the future of chiropractic takes participation from chiropractors across Pennsylvania. Join a conversation, bring your questions, and get involved.Chapters:00:00 October opportunities 00:14 Board meeting invitation 00:55 Lunch and CE details 01:31 Legislative priorities 01:46 Bell Region meeting 02:25 Connecting with colleagues 02:50 Staying informed 02:59 Why membership matters 03:57 Plans for other regions and CE 04:40 Closing thanksMEMBERSHIP, VOLUNTEERING, AND PCA INFORMATIONPennsylvania Chiropractic Association https://www.pennchiro.org/Membership, committee, working-group, board-service, and regional-meeting inquiries: [email protected] NOTICEThis podcast is provided for general educational and informational purposes. It does not constitute legal, billing, coding, reimbursement, or clinical advice. Insurance policies, regulations, and legislative matters may change. Listeners should confirm requirements applicable to their practices and circumstances.Mike Barba created and produced this for the Pennsylvania Chiropractic Association. AI-assisted tools were used to produce this content. PCA reviewed and approved the final contentPCA, Pennsylvania Chiropractic Association, September President’s Update, The Spinal Chat Podcast, Mike Barba, Pennsylvania chiropractic, chiropractic advocacy, October 17 Board event, chiropractic continuing education, injured athlete rehabilitation, Bell Region meeting, scope modernization, copay reform, HB 1106, therapeutic exercise delegation, PIAA, insurance reimbursement.

PCA Member Intel: Why PCA Cannot Negotiate Chiropractic Reimbursement, and What We Can DoReimbursement is one of the most serious challenges facing Pennsylvania chiropractors, and PCA has heard you loud and clear.Why can’t PCA simply negotiate higher reimbursement rates? Federal antitrust law restricts professional associations from negotiating individual provider fee schedules. That does not mean PCA is standing still.In this episode of The Spinal Chat Podcast, we explain what PCA can legally do to advocate for change. We examine insurer engagement, benefit design, copayments, allowable charges, scope modernization, and the legislative work affecting Pennsylvania chiropractic practices.You will learn:Why PCA cannot negotiate reimbursement rates.How certain copayments can make chiropractic benefits functionally unusable.What PCA is doing with insurers and policymakers.How practices can evaluate their own contracts and reimbursement data.What doctors, patients, and employers can do to support change.Explore the PCA Reimbursement Guide for practical information and useful tips to help your practice navigate insurance reimbursement.PCA members may also contact the Insurance Help Desk for assistance with billing, reimbursement, payer policies, and other insurance-related concerns.Find additional resources and advocacy updates at PennChiro.org.Please like, share, and subscribe. PCA members have permission to share this episode through their professional and personal social media channels. For assistance sharing the podcast, contact the PCA home office at 717-232-5762 or [email protected] NOTICEThis podcast is provided for general educational and informational purposes. It does not constitute legal, billing, coding, reimbursement, or clinical advice. Insurance policies, regulations, and legislative matters may change. Listeners should confirm requirements applicable to their practices and circumstances.Created and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used to produce this content. Final content was reviewed and approved by PCA

August President’s Address: A PCA Town Hall with Dr. Kris Arnold and Mike BarbaIn this President’s Update from The Spinal Chat Podcast, PCA President Dr. Kris Arnold and Executive Director Mike Barba discuss the issues directly affecting your practice and the future of chiropractic in Pennsylvania.The urgent Senate push for HB 1106.Scope modernization through SB 1330.Declining insurance reimbursement, denials, and prior authorization.PCA’s meetings with Highmark and other insurers.Billing assistance and legal resources available to PCA members.PCA membership value and opportunities to become involved.Committees, working groups, districts, and board service.The importance of supporting the PCA PAC.Regional town halls, live continuing education, and the Harrisburg board luncheon.The annual May convention at Seven Springs.PCA newsletters, member groups, and science-based podcast resources.The message is clear: Pennsylvania chiropractic advocacy is not about Republicans or Democrats—“We’re not Rs or Ds. We’re DCs.”CHAPTERS00:00 — HB 1106: A Major Legislative Victory 00:34 — Why Communication Matters 01:34 — Regional Town Halls Are Coming 02:33 — The Insurance Reimbursement Fight 04:15 — Billing Assistance and Member Resources 07:52 — Why Join the PCA? 11:47 — Stop Complaining and Become Involved 12:43 — Ways to Volunteer 14:57 — How PCA PAC Funding Is Used 18:38 — The Senate Push for HB 1106 20:36 — Scope Modernization and SB 1330 23:03 — Legislative Newsletters and Updates 23:38 — Social Media and Podcast Resources 28:21 — Regional Meetings, CE, and the Convention 32:23 — Invitation to the Harrisburg Board Luncheon 34:50 — Final Call to ActionTAKE ACTIONRestore Delegation Rights Through HB 1106 https://pennchiro.org/hb1106/Modernize Pennsylvania’s Chiropractic Scope Through SB 1330 https://pa-chiropractic-moderniz-ur0a2zk.gamma.site/PCA REIMBURSEMENT RESOURCESWhat PCA Can Do About Reimbursement https://pca-reimbursement-guide-944g3e1.gamma.site/For insurance, billing, or legal-support inquiries, contact the PCA office. Your request will be directed to the appropriate team member: [email protected], VOLUNTEERING, AND PCA INFORMATIONPennsylvania Chiropractic Association https://www.pennchiro.org/Membership, committee, working-group, board-service, and regional-meeting inquiries: [email protected] NOTICEThis podcast is provided for general educational and informational purposes. It does not constitute legal, billing, coding, reimbursement, or clinical advice. Insurance policies, regulations, and legislative matters may change. Listeners should confirm requirements applicable to their practices and circumstances.Created and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

PCA Deep Dive: When the Evidence Changes, Rethinking Spine Injections for Chronic PainThe Spinal Chat Podcast: PCA Deep Dive Series examines 2025 BMJ evidence on routine interventional procedures for chronic non-cancer spine pain and asks: When the evidence changes, should the way we deliver and pay for care change with it?A major BMJ systematic review and network meta-analysis included 132 eligible studies, with 81 randomized trials and 7,977 patients contributing to the quantitative analysis. It found that commonly used interventional procedures generally produced little to no clinically meaningful pain relief compared with sham procedures for chronic axial or radicular spine pain. A companion guideline issued strong recommendations against routine use, while interventional pain specialists have raised concerns about patient selection and responsive subgroups.The episode explores sham and contextual effects, regression to the mean, approximately $9 billion in annual U.S. spending on epidural injections, systemic incentives, and guideline-supported conservative care including exercise, education, self-management, rehabilitation, psychological approaches, and manual therapy.00:00 Welcome and Big Question01:42 Scope and Red Flags03:05 BMJ Review Breakdown06:30 Sham Effects Explained09:59 Specialist Backlash12:53 Nine Billion Economics13:55 How We Got Here17:44 Conservative Care Pathway20:25 Spinal Manipulation Role22:59 Policy and Self Advocacy24:57 Final Challenge and WrapKey SourcesWang X, Martin G, Sadeghirad B, et al. Common interventional procedures for chronic non-cancer spine pain: a systematic review and network meta-analysis of randomized trials. BMJ. 2025;388:e079971. DOI: 10.1136/bmj-2024-079971Busse JW, Genevay S, Agarwal A, et al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025;388:e079970. DOI: 10.1136/bmj-2024-079970Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain. Ann Intern Med. 2017;166(7):514-530. DOI: 10.7326/M16-2367Ballantyne JC. Spinal interventions for chronic back pain: Do negative findings demand action? BMJ. 2025;388:r179. DOI: 10.1136/bmj.r179Pennsylvania Chiropractic Association www.pennchiro.org [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

PCA Deep Dive: Medicare Stuck in 1972—The Updated Case for Chiropractic ModernizationThis episode examines H.R. 539 and S. 106, the Chiropractic Medicare Coverage Modernization Act, and the limitations of Medicare’s current chiropractic coverage policy.Medicare generally covers spinal manipulation but does not reimburse doctors of chiropractic for many evaluation, diagnostic, imaging, and therapeutic services they may be authorized to provide under state law. H.R. 539 and S. 106 would expand patient access to existing Medicare-covered benefits when those services fall within a chiropractor’s licensed scope. The legislation does not add new services to Medicare.Review the legislation: H.R. 539 | S. 106Take Action: Help Modernize MedicareComplete the action form and ask your federal elected officials to support and advance H.R. 539 and S. 106.Contact Your Elected OfficialsEpisode Chapters00:00 — Why Medicare Matters02:26 — The Clunking Engine Analogy03:49 — What Medicare Covers Now05:37 — Meet Brenda07:30 — Fragmentation and Treatment Cascades09:52 — The First-Door Effect10:27 — Evidence and Outcomes13:22 — What H.R. 539 and S. 106 Would Do14:50 — Why the Legislation Has Not Passed16:56 — Pennsylvania’s Advocacy Progress18:25 — Your Advocacy Checklist19:53 — Artificial Intelligence and the Data Trap21:29 — Final Summary and Call to ActionThe American Chiropractic Association, International Chiropractors Association, and Make America Healthy Again Chiropractic Hub have aligned around Medicare modernization. ChiroCongress is supporting the broader effort through advocacy resources and its national action campaign. Additional proposed amendments must still move through drafting, review, scoring, committee consideration, and congressional action.PCA reports that its advocacy has helped secure support from 16 of Pennsylvania’s 17 U.S. House members. PCA continues working with Senators John Fetterman and Dave McCormick to build bipartisan support for S. 106.Research and Evidence ReferencedWhedon et al.: chiropractic care and prescription opioid use among patients with spinal pain.Weeks et al.: chiropractic care and healthcare costs among older Medicare patients with chronic low-back pain.Whedon et al.: long-term Medicare costs and adverse drug events associated with opioid and spinal-manipulative care pathways.Research examining access to chiropractic care and Medicare spending on spine-related conditions.Agency for Healthcare Research and Quality: Noninvasive Treatments for Low-Back Pain.Contact PCAPennsylvania Chiropractic Association www.pennchiro.org [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

When Innovation Meets Coverage Rules: P-Stim, TENS, and Coding IntegrityEpisode SummaryIn this Deep Dive, we examine the May 2026 P-Stim billing issue and what chiropractic practices should learn from it. This episode is not an indictment of electrical stimulation, TENS, ancillary services, cash-based care, vendors, or innovation. The issue is narrower: the billing code must match the service performed.Electrical stimulation has helped many patients and remains an important conservative care tool when clinically appropriate, clearly documented, and accurately billed. TENS and standard e-stim are not the issue. The P-Stim cases focused on allegations that surface-applied auricular stimulation devices were billed under codes intended for surgically implanted neurostimulators, creating a major compliance exposure.This episode explains the difference between clinical value and payer coverage, why FDA clearance is not Medicare coverage, and how non-covered services may still be appropriate when offered transparently and responsibly.Key TakeawaysThe device was not the problem. The billing pathway was.Electrical stimulation is not on trial. TENS, standard e-stim, and other conservative tools can support patient care when used properly.Non-covered does not mean inappropriate. Cash-based and ancillary services can be ethical when clinically justified, transparently priced, documented, and explained before care is provided.FDA clearance is not Medicare coverage. A device may be legally marketed but still not qualify for reimbursement.A clinical theory is not a billing code. The claim form must accurately describe what happened in the treatment room.Marketing materials are not payer guidance. Practices should independently verify coding and coverage.Practice QuestionsBefore adopting or billing for a new device or ancillary service, ask:What service was actually performed?What code accurately describes it?Does the payer cover it?Has coverage been independently verified?Does the documentation match the service?If non-covered, was the patient clearly informed before care?PCA MessageChiropractic should not fear innovation. It should adopt innovation with discipline.Responsible use of technology protects patients, strengthens practices, and supports the credibility of conservative care. Accurate coding, clear documentation, patient transparency, and independent verification are not barriers to innovation. They are how innovation survives.Educational DisclaimerThis episode is for educational purposes only and does not constitute legal, billing, coding, or compliance advice. Practices should consult qualified counsel, billing professionals, and payer guidance for practice-specific questions.PCA Website: https://pennchiro.org/PCA Email: [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.TagsP-Stim, TENS, Electrical Stimulation, E-Stim, Auricular Stimulation, Chiropractic Billing, Coding Integrity, Medicare Compliance, Payer Coverage, False Claims Act, Ancillary Services, Cash-Based Care, FDA Clearance, Documentation, Patient Transparency, Conservative Care, Non-Drug Pain Management, Pennsylvania Chiropractic Association, Responsible Innovation.

PCA June President’s Address: Insurance Updates, Sports Chiropractic Progress, and University PartnershipsIn this June President’s Address on Spinal Chat, Pennsylvania Chiropractic Association President Dr. Kris Arnold shares updates on insurance and advocacy efforts, sports chiropractic, and university relationships. He reports that Highmark’s newly rejected codes are not chiropractic-specific, while UPMC has not clarified its denied code set, and he urges precise billing and coding. He notes that Highmark’s Helion system is now updated so Medicare Advantage plans billing only 9894 codes no longer need authorization, though commercial plans and additional modalities still require full authorization. Dr. Arnold highlights PCA insurance resources, including the website insurance help button and the on-demand PCCI coding and compliance course for CE. He describes legislative pressure to address PIAA restrictions preventing chiropractors from return-to-play sign-offs, sports physicals, and sideline care, recognizes sports chiropractor Justin Miller’s X Games work, outlines student outreach and mentoring with chiropractic schools, celebrates Dr. Roy Love’s retirement, and notes Pitt’s chiropractic program has started, joined PCA, and provided legislative support.00:00 Welcome and Overview00:41 Insurance Updates UPMC Highmark01:56 Billing Tips and Authorizations03:54 Member Insurance Resources05:10 Sports Chiropractic PIAA Fight07:01 University Outreach and Students08:28 Retirement Shoutout08:55 Pitt Program Wins09:53 Membership Call to Action10:45 Closing RemarksPCA Website: https://pennchiro.org/PCA Email: [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

PCA Cares: How Chiropractors Can Help Recognize Human Trafficking and Support SurvivorsIn this PCA conversation, Mike Barba, Executive Director of the Pennsylvania Chiropractic Association, sits down with Dr. Eric Harrison and Joe Krysiak to discuss the mission of ChiroHeroes and the role chiropractors can play in helping recognize and respond to human trafficking.ChiroHeroes works to educate chiropractors and the public on signs of human trafficking, raise funds for survivor support and aftercare programs, and build a network of chiropractors willing to provide care to survivors. The conversation also highlights why aftercare matters, why trafficking is not only a border-state issue, and why chiropractic offices must be prepared to recognize warning signs and respond appropriately.Learn more and get involved:ChiroHeroes: https://www.chiroheroes.org/Malouf Foundation: https://malouffoundation.org/OnWatch Training: https://iamonwatch.org/National Human Trafficking Hotline: https://humantraffickinghotline.org/If someone is in immediate danger, call 911. To report suspected trafficking or seek help, contact the National Human Trafficking Hotline at 1-888-373-7888 or text BEFREE to 233733.Thank you to Dr. Eric Harrison, Joe Krysiak, ChiroHeroes, and everyone working to educate, protect, and support survivors.PCA Website: https://pennchiro.org/PCA Email: [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.ChiroHeroesHuman Trafficking AwarenessSurvivor AftercareChiropractic ServicePCA CaresPennsylvania Chiropractic AssociationCommunity ImpactPatient SafetyChiropractic Leadership

PCA Deep Dive: The Pill-First Problem; Ibuprofen, Joint Pain, and Conservative CareIn this Spinal Chat Deep Dive, the Pennsylvania Chiropractic Association explores why joint and musculoskeletal pain often pushes patients toward a medication-first pathway, and why modern care should include earlier access to conservative, non-drug musculoskeletal options.This episode uses recent public-facing articles, patient education resources, federal safety information, and chiropractic research discussions to examine the risks of frequent or long-term NSAID use, the role of movement in joint health, and where chiropractic care fits responsibly within conservative musculoskeletal care.This episode is not anti-medication. Ibuprofen and other medications may be appropriate for some patients. Patients should speak with their healthcare provider before changing medication use.Key Themes:Over-the-counter does not mean risk-free.Frequent or long-term NSAID use can carry gastrointestinal, kidney, cardiovascular, respiratory, fall-risk, and medication-interaction concerns.Movement and exercise are central to joint health and osteoarthritis care.The strongest evidence for chiropractic care is in spine-related pain, especially low back and neck pain.Patients need better pathways, not fewer choices.Conservative care should be easier to access, not harder.Sources and Credits:“A Common Joint Pain Medicine Has Risks Many People Overlook” Author: Anthony Paul Smith Publisher: ScienceAlert, republished from The Conversation Date: June 4, 2026“Beyond Ibuprofen: Conservative Care for Joint Health” Source Type: Text excerpt focused on conservative care and reducing unnecessary reliance on medication-heavy pathways.“How New Research Is Advancing the Field of Chiropractic Medicine” Author: Dr. Gregory Cramer Publisher: National University of Health Sciences Date: June 7, 2023“Joint Pain: An Expert Reveals the Really Effective Remedy... Not the One You Think” Publisher: Thot Cursus Date: Published and updated November 25, 2025“Millions With Joint Pain and Osteoarthritis Are Missing the Most Powerful Treatment” Author: Clodagh Toomey Publisher: ScienceDaily, based on materials provided by The Conversation Date: March 4, 2026NCHM Key Messages / Talking Points Publisher: American Chiropractic Association“Pain and Arthritis Products Containing Hidden Ingredients” Publisher: U.S. Food and Drug Administration Content current as of June 1, 2026“The Best Medicine For Joint Pain Isn’t What You Think, Experts Say” Author: Carly Cassella Publisher: ScienceAlert Date: May 23, 2026“Treating Osteoarthritis Pain: What Works, What Doesn’t” Author: Rachel Nania Publisher: AARP Updated December 22, 2025“Pain Medication and Fall Risks Among Community-Dwelling Older Adults With Arthritis” Authors: Aya Yoshikawa and Richard Fortinsky Source: Academic abstract included in igad104.2564.pdfPCA Note: Spinal Chat Deep Dive is a service of the Pennsylvania Chiropractic Association. These episodes are designed to be shared with patients, healthcare colleagues, elected officials, employers, and the public as educational resources.PCA Website: https://pennchiro.org/PCA Email: [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.

PCA May President's Address with Dr. Kris Arnold PCA President Dr. Kris Arnold’s First Address: Unity, Communication, CE, and AdvocacyIn the first President’s Address on Spinal Chat, Pennsylvania Chiropractic Association President Dr. Kris Arnold outlines goals to strengthen chiropractic in Pennsylvania through greater unity, improved communication, member engagement, and a stronger shared voice. He highlights the sold-out Northeast Chiropractic Summit at Kalahari, encourages members to attend the next Summit on May 1–2, 2027, in Seven Springs, and urges participation via PCA emails, social media, the members-only Facebook page, YouTube, and the Spinal Chat podcast. Dr. Arnold reminds doctors that it is a CE renewal year, requiring 24 credits plus two child abuse credits, and promotes PCA-approved in-person and online options, including PCCI billing/documentation training. He notes upcoming insurance pre-authorization changes affecting United, Highmark, and UPMC, invites members to fill open board seats, recognizes the sports working group’s involvement in the Pittsburgh Marathon, and references upcoming legislative victories in Harrisburg.00:00 Welcome and Episode Setup00:51 Meet Dr Kris Arnold01:25 Unity and Summit Highlights02:16 Next Summit Save the Date02:53 Better Member Communication03:43 CE Credits and Renewal05:07 Insurance Preauth Changes05:37 Open Board Seats06:07 Sports Group Community Outreach06:53 Legislative Wins and Wrap Up07:24 PCA Community Call to ActionPCA Website: https://pennchiro.org/PCA Email: [email protected] and produced by Mike Barba for the Pennsylvania Chiropractic Association. AI-assisted tools were used in the production of this content. Final content was reviewed and approved by PCA.