Patients with new-onset low back pain (LBP) who initially consulted a chiropractor or physical therapist vs a primary care physician (PCP) were found to have a reduced risk for long-term opioid use, according to retrospective study results published in BMJ Open.

In the study, the claims of patients aged ≥18 years who were opioid-naïve and consulted a healthcare practitioner (HCP) for new-onset LBP between 2008 and 2013 were examined (n=216,504). Patients had commercial or Medicare Advantage insurance. The study’s primary outcome was short- and long-term opioid use after a consultation for new-onset LBP (ie, within 30 days and starting within 60 days of the index date and either a ≥120-day supply of opioids over 12 months or a ≥90-day supply of opioids and ≥10 opioid prescriptions over 12 months, respectively), and the study’s primary independent variable was the type of HCP initially consulted (ie, physical therapists, chiropractors, or acupuncturists).

A total of 53.0% of participants (n=114,782) initially saw a PCP, 23.1% (n=50,041) saw a chiropractor, 1.6% (n=3499) saw a physical therapist, and 0.8% (n=1839) saw an acupuncturist, and 22% of patients had short-term opioid use.

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Participants who received initial treatment from chiropractors or physical therapists vs PCPs had a decreased risk for short- and long-term opioid use (adjusted odds ratio [aOR], 0.10; 95% CI, 0.09-0.10 and aOR, 0.15; 95% CI, 0.13-0.17, respectively).

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In a propensity score matched sample, initial visit to a chiropractor or physical therapist vs a PCP was associated with a decreased risk for long-term opioid use (aOR 0.21; 95% CI 0.16 to 0.21; aOR 0.29; 95% CI 0.12 to 0.69, respectively).

Study limitations include the limited generalizability of results as the study examined commercial and Medicare Advantage claims data.

“Further research in other settings and prospective pragmatic trials will be useful to confirm our findings and to better understand other factors that influence choice of initial providers for LBP,” noted the researchers.

Disclosure: This clinical trial was supported by The American Physical Therapy Association, OptumLabs, and UnitedHealthCare. Please see the original reference for a full list of authors’ disclosures.


Kazis LE, Ameli O, Rothender J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. [published online September 20, 2019]. BMJ Open. doi:10.1136/ bmjopen-2018-028633

This article originally appeared on Clinical Pain Advisor