Physical Therapist or Chiropractor Visit for Back Pain May Reduce Opioid Use

Patients who see a physical therapist or chiropractor for new-onset low back pain (LBP) prior to seeing a primary care physician may be less likely to use opioids, according to new findings.

“The American College of Physicians and the Centers for Disease Control recommend non-pharmacological treatments including exercise, physical therapy (PT), spinal manipulation, acupuncture and massage [for LBP],” the researchers wrote. “These guidelines indicate that opioids should not be considered as a treatment option for LBP unless recommended treatments fail and if the benefits of their use outweigh the risk for the individual patient. Prior to the release of these recommendations, physician visits for new-onset LBP were much more common than non-pharmacological therapies like chiropractic care, PT and acupuncture.”

The research findings appeared in BMJ Open.

The retrospective cohort study included 216,504 patients who experienced new-onset LBP between 2008 and 2013. All patients were aged ≥ 18 years, were opioid-naïve, and had commercial or Medicare Advantage insurance. Patients were stratified based on who their provider was on their initial visit, including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists). The primary outcomes were short-term opioid use (within 30 days of the index visit) and long-term opioid use (within 60 days of the index visit and either ≥ 120 days’ supply of opioids over 12 months, or ≥ 90 days’ supply of opioids and ≥ 10 opioid prescriptions over 12 months).

Overall, the short-term opioid use rate was 22%. Patients whose initial treatment providers were chiropractors or physical therapists had lower odds of both short- and long-term opioid use compared to patients whose initial treatment was provided by a primary care physician (adjusted odds ratio [aOR] [95% CI] 0.10 [0.09 to 0.10] and 0.15 [0.13 to 0.17], respectively). When propensity-score matching, initial visits to chiropractors and physical therapists, compared to primary care physicians, were also associated with lower odds of long-term opioid use (aOR [95% CI] 0.21 [0.16 to 0.27] and 0.29 [0.12 to 0.69], respectively).

The findings may call for changes in incentives provided by insurers, posited lead study author Lewis Kazis, ScD, professor of health law, policy, and management at Boston University School of Public Health.

“To reduce the risks of short- and long-term opioid use, insurers should incentivize patients to see physical therapists or chiropractors first or early on following a bout of low back pain, before seeing [primary care physicians],” Dr. Kazis said in a press release.