Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

Abstract

ObjectiveThis study examined the association of initial provider treatment with early and long-term opioid use in a national sample of patients with new-onset low back pain (LBP).DesignA retrospective cohort study of patients with new-onset LBP from 2008 to 2013.SettingThe study evaluated outpatient and inpatient claims from patient visits, pharmacy claims and inpatient and outpatient procedures with initial providers seen for new-onset LBP.Participants216 504 individuals aged 18 years or older across the USA who were diagnosed with new-onset LBP and were opioid-naïve were included. Participants had commercial or Medicare Advantage insurance.ExposuresThe primary independent variable is type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists).Main outcome measuresShort-term opioid use (within 30 days of the index visit) following new LBP visit and long-term opioid use (starting within 60 days of the index date and either 120 or more days’ supply of opioids over 12 months, or 90 days or more supply of opioids and 10 or more opioid prescriptions over 12 months).ResultsShort-term use of opioids was 22%. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (PCPs) (adjusted OR (AOR) (95% CI) 0.10 (0.09 to 0.10) and 0.15 (0.13 to 0.17), respectively). Compared with PCP visits, initial chiropractic and physical therapy also were associated with decreased odds of long-term opioid use in a propensity score matched sample (AOR (95% CI) 0.21 (0.16 to 0.27) and 0.29 (0.12 to 0.69), respectively).ConclusionsInitial visits to chiropractors or physical therapists is associated with substantially decreased early and long-term use of opioids. Incentivising use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.

Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study

“…For example, although our data were insufficient to analyze for risk of opioid use, several recent studies have found that utilization of nonpharmacologic pain therapies leads to decreased opioid use. [17][18][19][20][21] Future research could explore the benefit of the PSC model in reducing overprescription of opioids. Additionally, we cannot be certain that variation in access to care was identical across the 3 sites; however, the 3 sites are part of the same health care system that strives for standardization, including monitoring a metric from time of patient call to time seen in clinic.…”

Back Pain: Chiropractor’s View

“…There is also evidence from one study that initial visits to chiropractors or physical therapists are associated with substantially decreased early and long-term use of opioids. Patients who received initial treatment from chiropractors or physical therapists had decreased odds of short-term and long-term opioid use compared with those who received initial treatment from primary care physicians (Kazis et al 2019). In the Herman et al 2019a, observational study, 1,835 chronic back pain patients rated their chiropractic provider at the top of the patient satisfaction scale, and 90% reported that they were extremely confident that their chiropractor would be very or extremely successful in reducing their pain, and over 90% would recommend chiropractic to a friend (Herman et al 2019a).…”

Physical therapy and opioid use for musculoskeletal pain management: competitors or companions?

“…The evidence for these changes comes from the recent observational studies examining the association between exposure to nonpharmacological provider first and the effect on opioid prescriptions. Kazis et al 30 and Horn et al 25 reported large reductions in opioid prescriptions when patients would see a nonpharmacological provider first. The nonpharmacological providers included in these analyses were chiropractors, acupuncturists, and physical therapists and in some cases the analysis highlighted differences amongst these providers for influencing healthcare utilization beyond opioid use.…”