Physical Therapist Or Chiropractor Visit For Back Pain May Reduce Opioid Use

By DocWire News

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.