Early PT tied to less opioid use for musculoskeletal pain

  • JAMA Netw Open

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients with musculoskeletal shoulder, neck, knee, or low back pain who received early physical therapy (PT) within 90 days of seeking treatment were about 10% less likely to use opioids than those who did not undergo PT.
  • Early PT was associated with a 5%-10% reduction in opioid use among those with shoulder, knee, or low back pain who did receive an opioid prescription, but not those with neck pain.

Why this matters

  • Nearly half of all adults in the United States are affected by musculoskeletal pain.

Study design

  • Insurance claims data used to evaluate 88,985 opioid-naive patients (aged, 18-64 years) with new diagnosis of musculoskeletal shoulder, neck, knee, or low back pain.
  • Funding: National Institute on Drug Abuse.

Key results

  • 29.3% patients received early PT.
  • Early PT was associated with a significant reduction in incidence of any opioid use between 91 and 365 days for patients with:
    • shoulder pain (OR, 0.85; P=.003),
    • neck pain (OR, 0.92; P=.03),
    • knee pain (OR, 0.84; P<.001 and>
    • low back pain (OR, 0.93; P=.004).
  • For patients who did use opioids, early PT significantly reduced opioid use for:
    • shoulder pain (−9.7%; P=.03),
    • knee pain (−10.3%; P=.007), and
    • low back pain (−5.1%; P=.046).
    • Significant difference not observed for neck pain (P=.30).

Limitations

  • Residual confounding.

Coauthored with Antara Ghosh, PhD