Low back pain patients who receive physical therapy
less likely to be prescribed opioids

Patients covered by Medicaid have a higher risk for opioid abuse
Low back pain (LBP) is one of the most common and expensive healthcare conditions. The care that LBP patients receive varies widely, and the strategy used to treat them will affect the costs of health care down the line. Education and physical therapy are both commonly recommended for patients with LBP, and these treatments have been found to improve outcomes and reduce costs overall. Early physical therapy, in particular, is associated with less use of health care and lower costs for patients; however, only 7-20% of patients actually receive early physical therapy. To understand why these costs are lower, it’s important to understand what factors lead to a physical therapy consult and which influence actual participation in physical therapy. This is particularly important for patients with Medicaid, who have a higher occurrence of LBP and a higher risk for opioid abuse than those who are covered privately. With this in mind, a study was conducted to investigate the factors associated with Medicaid patients with LBP receiving physical therapy, and how this affected the use of other treatments like opioids.

About half of patients are referred to physical therapy
To conduct the study, researchers identified patients between the ages of 17-60 who visited their primary doctor with a new complaint of LBP. They then applied specific criteria to this group of patients so that only relevant cases were used in their analysis. This process led to 505 patients being identified as adult Medicaid enrollees with a new consult for LBP. Of these, 454 patients initiated the course of care with their primary care doctor, and 215 of these (47%) were referred to physical therapy. After establishing this group, researchers investigated their use of physical therapy over one year and how it affected the use of other treatments, as well as the overall costs of care.

Both physical therapy consult and participation reduce chances of opioid prescription
Of the 215 patients referred to physical therapy, 81 (37%) attended at least one visit within 90 days of the referral, at an overall average of 21 days. Patients were more likely to participate in physical therapy if they had two or more conditions or if they received an X-ray. On the other hand, patients were less likely to participate in physical therapy if they were given multiple orders—such as seeing a specialist—in addition to the referral, or if they had a history of opioid abuse. Within one year of the initial doctor visit, the most commonly used intervention was an opioid prescription (42%), followed by X-rays (17%) and a visit to the ER (13%). Receiving a physical therapy consult was not associated with a decrease in X-ray use or ER visits, but was associated with a reduction in opioid prescriptions. In addition, participation in physical therapy further reduced the odds of an opioid prescription during this time. These findings suggest that a course of physical therapy may not only improve LBP patients’ condition, but might also reduce their chances of receiving an opioid prescription. Since opioids are commonly associated with abuse and addiction, this approach to treatment has the potential to help patients avoid powerful prescription drugs entirely and increase the chances of a successful outcome with far fewer risks involved.

-Summarized by Greg Gargiulo

-As reported in the Nov.-Dec. ’17 issue of JABFM