Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events

Whedon, James M.; Toler, Andrew; Goehl, Justin M.; Kazal, Louis A.

doi:10.1016/j.jmpt.2018.01.004

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…Several non-pharmacological therapies- including spinal manipulation, therapeutic exercise, and relaxation techniques—are typically offered by chiropractors, and are recommended as first line or adjunctive therapy for spinal pain [ 6 , 7 ]. The utilization of chiropractic care has been reported to be associated with reduced risk of adverse drug events in adults with spinal pain [ 8 ], and large scale observational studies have found that chiropractic care is associated with decreased use of opioids [ 9 – 11 ]. Among more than 101,000 adults with back pain in three contiguous New England states, the risk of filling a prescription for an opioid analgesic over a six-year period was reduced by half for recipients of chiropractic care, and the reduction in risk was greater among those who sought chiropractic care early in the course of treatment [ 11 ].…”

Section: Chiropractic Care As An Alternative To Opioid Analgesia For Spinal Painmentioning

confidence: 99%

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

Whedon

Uptmor²,

Toler

et al. 2022

Chiropr Man Therap

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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.

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Section: Chiropractic Care As An Alternative To Opioid Analgesia For Spinal Painmentioning

confidence: 99%

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

Whedon

Uptmor²,

Toler

et al. 2022

Chiropr Man Therap

Self Cite

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“…The continued rise of the chiropractic movement aggravated the leaders of the AMA and local medical societies. 111 The infrastructure to eradicate alternatives to medicine had been in place from the beginning of the AMA, and the AMA would later use these mechanisms to strike at chiropractic in the following century.…”

Section: Americans Embraced Chiropracticmentioning

confidence: 99%

“…Warts on the hand are caused by luxated dorsal vertebra. 111 Other chiropractors advertised in a style that was commonly used in this era by those eschewed by the AMA.…”

Section: Chiropractic Practicementioning

confidence: 99%

“…110 Another consideration is that chiropractic care offers a drug-free alternative, and therefore may reduce the risk for opioid or other drug addiction for managing certain musculoskeletal conditions. [111][112][113] In the United States, doctors of chiropractic give and receive referrals from medical doctors and other health care providers, order diagnostic services at hospitals, and join hospital medical staffs. There have been collaborations between doctors of chiropractic and doctors of medicine and osteopathy in education and research, and chiropractic institutions have received federal research funding.…”

Section: Chiropractic Todaymentioning

confidence: 99%

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2021

Journal of Chiropractic Education

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“…15 Recent observational studies have found that utilization of chiropractic care for patients with LBP is associated with decreased opioid use, [16][17][18] and reduced risk of ADEs. 19 However, for longterm ongoing supportive care of cLBP, the risk of continuing either OAT or SMT is uncertain, particularly for the highrisk older adult population covered under Medicare Part B. The objective of this study was to compare SMT and OAT to determine the impact of SMT on the risk of ADEs among older adults receiving long-term care for cLBP.…”

mentioning

confidence: 99%

Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries

Whedon

Kizhakkeveettil

Toler

et al. 2021

Spine

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Study Design. Retrospective observational study. Objective. Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT versus SMT with regard to risk of adverse drug events (ADEs) among older adults with cLBP. Summary of Background Data. We examined Medicare claims data spanning a 5-year period on fee-for-service beneficiaries aged 65 to 84 years, continuously enrolled under Medicare Parts A, B, and D for a 60-month study period, and with an episode of cLBP in 2013. We excluded patients with a diagnosis of cancer or use of hospice care. Methods. All included patients received long-term management of cLBP with SMT or OAT. We assembled cohorts of patients who received SMT or OAT only, and cohorts of patients who crossed over from OAT to SMT or from SMT to OAT. We used Poisson regression to estimate the adjusted incidence rate ratio for outpatient ADE among patients who initially chose OAT as compared with SMT.Results. With controlling for patient characteristics, health status, and propensity score, the adjusted rate of ADE was more than 42 times higher for initial choice of OAT versus initial choice of SMT (rate ratio 42.85, 95% CI 34.16 -53.76, P < 0.0001). Conclusion. Among older Medicare beneficiaries who received long-term care for cLBP the adjusted rate of ADE for patients who initially chose OAT was substantially higher than those who initially chose SMT.

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Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events

Cited by 13 publications

References 23 publications

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

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

Full Issue – Digital E-book

Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries

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