Association between chiropractic care and use of prescription opioids among older medicare beneficiaries with spinal pain: a retrospective observational study

Abstract

Background The burden of spinal pain can be aggravated by the hazards of opioid analgesics, which are still widely prescribed for spinal pain despite evidence-based clinical guidelines that identify non-pharmacological therapies as the preferred first-line approach. Previous studies have found that chiropractic care is associated with decreased use of opioids, but have not focused on older Medicare beneficiaries, a vulnerable population with high rates of co-morbidity and polypharmacy. The purpose of this investigation was to evaluate the association between chiropractic utilization and use of prescription opioids among older adults with spinal pain. Methods We conducted a retrospective observational study in which we examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. We measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following diagnosis of spinal pain. Using Cox proportional hazards modeling and inverse weighted propensity scoring to account for selection bias, we compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription. Results The adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients (hazard ratio 0.44; 95% confidence interval 0.40–0.49). Conclusions Among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription.

The association between chiropractic integration in an Ontario community health centre and continued prescription opioid use for chronic non-cancer spinal pain: a sequential explanatory mixed methods study

“…Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

“…A subsequent observational study of 216,504 opioid-naive patients with new-onset low back pain who received initial treatment from chiropractors versus primary care physicians had 90% lower odds of short-term opioid use (adjusted OR = 0.10; 95% CI, 0.09 to 0.10) and 78% lower odds of long-term opioid use (adjusted OR = 0.22; 95% CI, 0.18 to 0.26) [18,19]. Similar findings have been reported by two other recent observational studies [20,21]; however, the association between receipt of chiropractic services and continued opioid use in patients with existing opioid prescriptions is uncertain [22][23][24]. Moreover, previously published studies on the topic of chiropractic care and opioid prescribing have lacked in-depth, contextual understanding because they have been exclusively quantitative in nature [17][18][19][20][21][22][23][24].…”

“…Several observational studies have reported an association between use of chiropractic services and reduced opioid prescribing [17][18][19][20][21]61] or reduced opioid use [22][23][24]. Previous observational research [34][35][36][37][38][39] also suggests that integrating chiropractic services with physician management of spine-related pain is associated with improved patient outcomes and potential for cost savings (e.g., reductions in advanced imaging, GP visits, and specialist referrals).…”

“…We obtained informed consent from participants before the start of each interview. Five members of our research team (PCE, ALB, MO, LM, JWB) developed the patient and GP interview guides (see Additional files 3 and 4, respectively) based on relevant literature [17][18][19][20][21][22][23][24]27] and our quantitative findings. Three of the five members (PCE, ALB, JWB) also have content expertise in the subject area of our study.…”

“…Emerging evidence suggests that early access to chiropractic treatment is associated with lower initiation of opioid prescribing among patients with non-cancer spinal pain [17][18][19][20][21]. A 2020 systematic review and metaanalysis of six cohort studies found that patients with acute or chronic non-cancer spinal pain who received chiropractic services early in their complaint were 64% less likely than non-chiropractic users to be prescribed opioids (pooled odds ratio [OR] = 0.36; 95% confidence interval [CI], 0.30 to 0.43) [17].…”