Associations Between Early Chiropractic Care and Physical Therapy on Subsequent Opioid Use Among Persons With Low Back Pain in Arkansas

Mahip Acharya BPharm , Divyan Chopra MS , Allen M. Smith PharmD , Julie M. Fritz PhD, PT , Bradley C. Martin PharmD, PhD
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引用次数: 4

Abstract

Objective

The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis.

Methods

A retrospective cohort study was conducted using data from Arkansas All Payers’ Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated.

Results

A total of 40 929 individuals were included in the final sample, with an average age of 41 years and 65% being women. Only 5% and 6% received PT and chiropractic service, respectively, within the first 30 days. Sixty-four percent had incident opioid use, and 4% had LTOU in the follow-up period. PT was not associated with incident opioid use (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.98-1.18) or LTOU (OR, 1.19; 95% CI, 0.97-1.45). Chiropractic care decreased the odds of opioid use (OR, 0.88; 95% CI, 0.80-0.97) and LTOU (OR, 0.56; 95% CI, 0.40-0.77).

Conclusion

In this study we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, LTOU in newly diagnosed LBP.

阿肯色州腰痛患者早期捏脊治疗和物理治疗对阿片类药物使用的影响
本研究的目的是评估诊断为腰痛(LBP)的个体早期使用物理治疗(PT)或脊椎指压治疗与阿片类药物使用和长期阿片类药物使用之间的关系。方法采用阿肯色州所有付款人索赔数据库的数据进行回顾性队列研究。2013年7月1日至2017年6月30日期间在初级保健或急诊科诊断的成人LBP事件被确定。参与者被要求在6个月的基线期服用阿片类药物naïve,并且在整个研究期间没有癌症、马尾综合征、骨髓炎、腰椎骨折和截瘫/四肢瘫痪。从腰痛发生之日起的30天内记录PT和捏脊治疗。随访1年评估阿片类药物使用情况和长期阿片类药物使用情况。对控制协变量的多变量logistic回归进行了估计。结果最终样本共40929人,平均年龄41岁,女性占65%。只有5%和6%的人分别在前30天内接受了理疗和脊椎按摩服务。在随访期间,64%的人有阿片类药物使用,4%的人有LTOU。PT与阿片类药物使用事件无关(优势比[OR], 1.07;95%可信区间[CI], 0.98-1.18)或LTOU (or, 1.19;95% ci, 0.97-1.45)。捏脊疗法降低了阿片类药物使用的几率(OR, 0.88;95% CI, 0.80-0.97)和LTOU (OR, 0.56;95% ci, 0.40-0.77)。结论:在本研究中,我们发现接受整脊治疗(尽管不是PT)可能会扰乱对阿片类药物的需求,特别是新诊断的LBP患者的LTOU。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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