Adjusting expectations: Chiropractic, pain, and an evolving American health care system

As a therapeutic system chiropractic developed over one hundred years ago in reference to the political and economic dominance of biomedicine in American health care. During the past twenty years chiropractic has experienced an explosion in its growth and acceptance by health insurance and health management organizations. This is the result of chiropractic's aggressive tactics to be recognized by the medical bureaucracy and by popular and political attempts to reduce gross health care costs. To understand how chiropractic has survived where many other alternative therapies have disappeared or been absorbed into biomedical practice, it is essential to review and understand how chiropractic differs from traditional medicine. This dissertation focuses on the experiences patients have had in chiropractic treatment. In particular, how notions and concepts of pain are navigated in defining patients' understandings of sickness and health and how these meanings locate chiropractic, biomedicine, and other therapeutic systems in relation to each other. In the conclusion, this research finds that the strength of chiropractic is in its unique treatment and management of pain. Chiropractors' empowerment of patients to participate in the therapeutic relationship and the high level of physical and social relationship building underlies the chiropractic experience. This research also concludes that chiropractic's new found success in the face of political-economic changes in health care management is in direct contradiction to these fundamental chiropractic practices; that to effectively integrate itself as a profession into a managed health care model may necessitate the abandonment of those unique features. Chiropractors will have to come to terms with these professional contradictions if they are to remain true to what their patients report to be the foundations of their success. Chiropractic has a history of surviving in the face of bureaucratic political pressures. This may represent just one more challenge in that history.