Back pain: initial visit to nonmedical provider tied to less opioid use

  • Kazis LE & al.
  • BMJ Open
  • 20 Sep 2019

  • International Clinical Digest
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Takeaway

  • Patients with lower back pain (LBP) who sought treatment first from a chiropractor, acupuncturist, or physical therapist were 85%-91% less likely to develop short- or long-term opioid use compared with those whose first visit was to a primary care physician (PCP).

Why this matters

  • Emerging research suggests that spinal manipulation, massage, acupuncture, and superficial heat are effective at treating acute LBP and improving function, potentially eliminating the need for medical therapy.

Study design

  • Retrospective cohort study of opioid-naive individuals (age, ≥18 years; n=216,504) who were diagnosed with new-onset LBP from 2008 to 2013.
  • Funding: The American Physical Therapy Association; others.

Key results

  • Opioid fill was received within 30 days (short-term opioid use) in 22% of the patients and within 60 days in 1.2% of the patients.
  • Patients who first visited conservative therapists showed decreased odds for:
    • short-term opioid use:
      • physical therapy (aOR, 0.15; 95% CI, 0.13-0.17),
      • chiropractor (aOR, 0.10; 95% CI, 0.09-0.10),
      • acupuncture (aOR, 0.09; 95% CI, 0.07-0.12).
    • long-term opioid use:
      • physical therapy (aOR, 0.27; 95% CI, 0.15-0.48),
      • chiropractor (aOR, 0.22; 95% CI, 0.18-0.26),
      • acupuncture (aOR, 0.07; 95% CI, 0.01-0.48).

Limitations

  • Patients who want to avoid opioids may choose conservative care.
  • Limited generalisability of findings.

Coauthored with Chitra Ravi, MPharm

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