JANUARY 3, 2024
Patients with opioid use disorder (OUD) and chronic low back pain (LBP) receive front-line interventions for pain that put them at risk for relapse, according to recent data.
“Despite practice guidelines that recommend nonpharmacologic therapies as first-line [treatment] for pain management, we found that only a minority of Medicare beneficiaries with a new episode of chronic LBP receive any physical therapy [PT] or chiropractic care, and even fewer persist with these services,”
Patients with opioid use disorder (OUD) and chronic low back pain (LBP) receive front-line interventions for pain that put them at risk for relapse, according to recent data.
“Despite practice guidelines that recommend nonpharmacologic therapies as first-line [treatment] for pain management, we found that only a minority of Medicare beneficiaries with a new episode of chronic LBP receive any physical therapy [PT] or chiropractic care, and even fewer persist with these services,” study investigator Patience Moyo Dow, PhD, an assistant professor of health services, policy and practice at Brown University School of Public Health, in Providence, R.I., told Pain Medicine News. “Chronic LBP patients with OUD were much less likely to receive nonpharmacologic pain therapies at all compared with those without OUD.”
Among 607,729 Medicare beneficiaries at least 18 years of age, of whom 11.4% had a diagnosis of OUD, the 12-month prevalence of PT and chiropractic treatment (CT) receipt was 24.7% and 27.1%, respectively (J Pain 2023 Nov 22. doi:10.1016/j.jpain.2023.10.003). Furthermore, PT and CT treatment was lower among beneficiaries with co-occurring OUD (PT: 14.6%; chiropractic: 6.8%) than those without OUD. Beneficiaries with OUD were more likely to belong to treatment trajectories with little to no PT or CT compared with trajectories with increasing or stable PT/CT.
“The implications are that practice guidelines need to be complemented with robust implementation science work that, for example, addresses equity, acceptability, accessibility and affordability of nonpharmacologic therapies,” Moyo Dow said.
A central limitation of the study is that information about patient preferences for pain treatment and clinician referral practices was lacking. “Qualitative work to understand decision making about referrals (among clinicians) and pursuing services (among patients) is needed to address this limitation,” Moyo Dow concluded.
—Myles Starr
Moyo Dow reported receiving grants from the National Institutes of Health during the conduct of the study, serving as a technical expert panelist for an Abt Associates study focused on opioid use and misuse in older adults, and being a member of a National Academies of Sciences, Engineering, and Medicine ad hoc committee on evaluating the effects of opioids and benzodiazepines on all-cause mortality in veterans.
