Researchers from the Boston University School of Public Health (BUSPH) found 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.

The research team 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.

They found that patients who first saw a primary care physician (PCP) for low back pain were 79% more likely to use prescription opioids than patients who first went to a chiropractor, and 71% more likely than those who first went to a physical therapist.

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.

The team says 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.

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.

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

Source: BMJ Open.