SIB #378- Opioid Usage vs. Initial Provider

The Study:  Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use

 The Facts:

a. The authors wanted to find out if the type of provider that patients suffering from new-onset low back pain saw initially affected early and long term opioid usage.

b. Several previous studies have suggested that seeing a conservative therapist “(defined as chiropractors, physical therapists, acupuncturists)” may decrease the likelihood  of opioid use in low back pain patients as compared to seeing a primary care physician.  

 c. The authors noted that the primary independent variable that they used for this study was the “type of initial healthcare provider including physicians and conservative therapists (physical therapists, chiropractors, acupuncturists)” seeing the patient.

d. There has not been much research looking at the early and the long term use of opioids by patients who initially saw different types of providers.

 e. “ Initial treatment from conservative therapists in those with LBP was associated with a marked decrease in the odds of early and long-term opioid use.”

 f. The authors felt there were a number of factors that might account for the decrease in opioid usage in those seeking conservative therapies.

 g. They noted that it could be because non-physicians do not prescribe opioids, or that the patients who sought care from non-physicians may have “educational level or preferences which may also result in decreased desire for those patients to use opioids” or that the conservative care may result in improvement in pain and back function so the conservative care patients did not have a desire to use opioids.

 h. “the most frequent initial conservative provider seen was chiropractor”

  i. The authors suggest further research into: “Factors related to health plan benefit design such as out-of-pocket costs for treatment alternatives (eg, PT and chiropractor visits, opioids) and impact of gatekeeper requirements on care patterns…”.

 Take Home:

In patients who suffered from new-onset low back pain, opioid usage was lower in patients who initially sought care from chiropractors or physical therapists as opposed to primary care physicians.

 Reviewer's Comments:

The authors noted that in this study the most frequently seen conservative provider was a chiropractor. You know I think that these authors have hit on something when they said that conservative care might result in improvement in low back pain patients so that they did not want to use opioids. As opioid usage is a real problem perhaps there should be more effort made to see that patients had access to chiropractic care.

 Reviewer:  Roger Coleman DC

 Editor: Mark R. Payne DC

 Reference: Lewis E Kazis, Omid Ameli, James Rothendler. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019 Sep 20;9(9):e028633. doi: 10.1136/bmjopen-2018-028633.

  Link to Abstract:

Mark R. Payne DC