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

Abstract

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.

Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review

“…I 2012–2018 Anderson [ 28 ] 2021 CO Insurance claims 7951 unique neck pain initial episodes SMT vs any care without SMT (PT included as “other care”) Imaging, injections, emergency room, or surgery 6 years Using SMT as reference (1.0), risks for other care: 2012–2018 Imaging 1.8; injection 6.5; ED 16.9; surgery 7.3. Risk of escalation 2.1 for any group that did not receive SMT Davis [ 30 ] 2021 CO Medicare claims 39,278 MC chiropractic users Use of medical services among chiropractic users who relocated and had decreased access to chiropractic vs those who did not # of visits to PC MDs, surgeries, and overall costs for spine conditions 2 years before versus 2 years after relocation Reduced DC access: Increased rate of PCMD visits for spine conditions Increased rate of spine surgeries Overall additional costs of medical services = $114,967 per 1,000 beneficiaries Whedon [ 43 ] 2021 CO Medicare claims 28,160 MC beneficiaries with long-term management of cLBP with SMT or OAT SMT vs OAT Adverse drug events (2) 12 months Any ADE: 2012–2016 SMT 0.9%; OAT 18.3% Opioid dependence/abuse: SMT 0.3%; OAT 14.3% ADE 51% lower in an outpatient setting with SMT. Long term care was 5X higher in OAT Whedon [ 42 ] 2021 …”

“… Opioids Eleven studies found that fewer opioid prescriptions were dispensed or filled with DC care. Ten of these were published 2018–2022 [ 5 , 12 , 29 , 36 , 37 , 39 , 43 – 46 ], and only one between 1991 and 2017 [ 40 ]. Surgery Eight studies found fewer surgeries with DC care; four published 2018–2022 [ 27 – 30 ] and 4 published 1991–2017 [ 26 , 51 , 54 , 61 ].…”

“…The potential human and societal cost savings of avoiding overuse of opioid analgesics, with the possibility of overdoses and addiction, is another important emerging concept in the literature. We found that 10 studies published since the U.S. government declared the opioid epidemic in 2017 found reduced dispensing of opioid prescriptions when DCs were the first provider [ 5 , 12 , 29 , 36 , 37 , 39 , 43 – 46 ]. Only one study published in the earlier time period (1991–2017) included opioid prescribing as a comparison [ 41 ].…”

Treatment Patterns and Population Characteristics of Nonpharmacological Management of Chronic Pain in the United States’ Medicare Population: A Scoping Review

“…Twenty-nine studies reported overall sample sizes that ranged from 551 to 17.7 million ( 26–55 ). Twenty studies reported a mean age between 69.5 and 81.7 years ( 27 , 28 , 30–34 , 36 , 38–44 , 46 , 48–50 , 56 , 57 ). Three studies reported the age range for participants included in their studies ( 45 , 57 , 58 ).…”

“…Twenty studies reported a mean age between 69.5 and 81.7 years ( 27 , 28 , 30–34 , 36 , 38–44 , 46 , 48–50 , 56 , 57 ). Three studies reported the age range for participants included in their studies ( 45 , 57 , 58 ). Twenty-nine studies provided the biological sex of the study population and the percentage of females ranged between 55% and 73% in the included studies ( 26–50 , 52 , 54 , 56–59 ).…”