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

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