Access to physical therapy for low back pain may reduce opioid prescriptions

Patients who first saw a physical therapist or chiropractor for low back pain, rather than a primary care physician, were much less likely to be prescribed opioids.

Low back pain is one of the most common conditions Americans seek care for--and one of the more common reasons for an opioid prescription. Facing the opioid crisis, the American College of Physicians and the CDC now recommend first trying non-pharmacological treatments for low back pain.

A new Boston University School of Public Health (BUSPH) study published in BMJ Open finds that patients who first saw a primary care physician (PCP) for low back pain were 79 percent more likely to use prescription opioids than patients who first went to a chiropractor, and 71 percent more likely than those who first went to a physical therapist.

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 PCPs."

Dr. Lewis Kazis, professor of health law, policy & management at BUSPH and study lead author

Kazis and his colleagues looked at commercial insurance and Medicare Advantage claims data from the OptumLabs database for 216,504 adults across the country who were diagnosed with new-onset low back pain between 2008 and 2013 and had not been prescribed opioids before.

Many factors could cause someone to decide to access non-pharmacological treatments, including the severity of their pain and other medical issues, and their ability to access such treatments. In their analysis, the researchers controlled for as many socio-demographic, geographical, and medical history factors as they could get from the insurance claims data.

The researchers also found that patients in states with provisional or unrestricted access to physical therapy were much more likely to see a physical therapist first than patients in states with limited physical therapy access, illustrating the impact of state-level policy regulations on opioid prescribing.