Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis

Emary, Peter C.; Brown, Amy L.; Oremus, Mark; Mbuagbaw, Lawrence; Cameron, Douglas F.; DiDonato, Jenna; Busse, Jason W.

doi:10.1016/j.jmpt.2022.06.009

Cited by 4 publications

(3 citation statements)

References 41 publications

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“…The main limitation of this study is the potential for unmeasured confounders to influence results. Certain variables that may influence the likelihood of tramadol prescription are unavailable or poorly represented in the TriNetX dataset, including pain severity,58 60 income,60 insurance type,60 geographic location,60 type of medical clinician seen,74 75 education level,59 marital status,59 patients’ requests for medication (ie, pressure to prescribe), or conversely, reluctance to consider taking a prescription opioid 36 37 76. Although the TriNetX database contains medical record data, we did not have access to detailed patient charts to directly validate our results due to the deidentified, aggregated nature of the dataset sourced from multiple healthcare organisations.…”

Section: Discussionmentioning

confidence: 99%

“…To limit loss to follow-up, patients were required to have an additional healthcare visit any time from 1 day to 1 year after radicular LBP diagnosis (figure 1). We made two alterations to our a priori protocol wherein we (1) controlled for receipt of any prescription medication over the previous year via propensity matching, as a strategy to reduce any potential selection bias related to patients’ preference towards receiving pharmacological versus non-pharmacological care,5 35–37 and serve as an improvement on an E-value sensitivity analysis,38 and (2) added a cumulative incidence graph as a sensitivity analysis to provide greater insights into the timing of tramadol prescription between cohorts.…”

Section: Methodsmentioning

confidence: 99%

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Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data

Trager,

Cupler,

Srinivasan

et al. 2024

BMJ Open

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ObjectivesPatients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care.DesignRetrospective cohort study.SettingUS medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023.ParticipantsOpioid-naive adults aged 18–50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching.InterventionsPatients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care).Primary and secondary outcome measuresRisk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary).ResultsAfter propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts.ConclusionsThis study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data

Trager,

Cupler,

Srinivasan

et al. 2024

BMJ Open

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“…Interestingly, an estimated 85% of chronic low back pain cases are diagnosed as “non-specific low back pain”, not as a result of injury, but as a result of an unknown cause, typically from spinal biomechanical dysfunction [ 1 ]. DCs offer safe [ 2 , 3 , 4 ], non-pharmaceutical, non-surgical approaches to musculoskeletal conditions that have been shown to reduce opioid usage [ 5 , 6 , 7 , 8 ] and decrease surgical intervention [ 9 , 10 ] and disability [ 11 , 12 , 13 ] when compared to other therapies. Research shows that when a patient sees a DC first after a low back injury, surgical intervention is reduced to 1.5% compared to 42.7% when initially evaluated by a surgeon even after considering other important variables [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

Arnone

Kraus²,

Farmen

et al. 2023

JCM

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Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. Survey responses show that, among US DCs, 91.9% indicate PROTS has value beyond identification of pathology, 86.7% indicate that PROTS is important regarding biomechanical analysis of the spine, 82.9% indicate that PROTS is vital to practice, 67.4% indicate that PROTS aids in measuring outcomes, 98.6% indicate the opinion that PROTS presents very low to no risk to patients, and 93.0% indicate that sharing clinical findings from PROTS studies with patients is beneficial to clinical outcomes. The results of the study indicated that based on clinical experience, the majority of DCs find PROTS to be vital to practice and valuable beyond the identification of red flags.

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Patient Characteristics and Clinical Outcomes Associated With Conservative Treatment for Spine Pain in Women Experiencing Socioeconomic Challenges

Morham,

Reichardt,

Toth

et al. 2022

Journal of Manipulative and Physiological Therapeutics

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Association of Chiropractic Care With Receiving an Opioid Prescription for Noncancer Spinal Pain Within a Canadian Community Health Center: A Mixed Methods Analysis

Cited by 4 publications

References 41 publications

Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data

Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data

Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession

Patient Characteristics and Clinical Outcomes Associated With Conservative Treatment for Spine Pain in Women Experiencing Socioeconomic Challenges

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