Whedon James M, Toler Andrew W J, Goehl Justin M, Kazal Louis A
1 Health Services Research, Southern California University of Health Sciences , Whittier, CA.
2 Community and Family Medicine, Geisel School of Medicine at Dartmouth , Hanover, NH.
J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22.
Pain relief resulting from services delivered by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects. The objective of this investigation was to evaluate the association between utilization of chiropractic services and the use of prescription opioid medications.
The authors used a retrospective cohort design to analyze health insurance claims data.
The data source was the all payer claims database administered by the State of New Hampshire. The authors chose New Hampshire because health claims data were readily available for research, and in 2015, New Hampshire had the second-highest age-adjusted rate of drug overdose deaths in the United States.
The study population comprised New Hampshire residents aged 18-99 years, enrolled in a health plan, and with at least two clinical office visits within 90 days for a primary diagnosis of low-back pain. The authors excluded subjects with a diagnosis of cancer.
The authors measured likelihood of opioid prescription fill among recipients of services delivered by doctors of chiropractic compared with nonrecipients. They also compared the cohorts with regard to rates of prescription fills for opioids and associated charges.
The adjusted likelihood of filling a prescription for an opioid analgesic was 55% lower among recipients compared with nonrecipients (odds ratio 0.45; 95% confidence interval 0.40-0.47; p < 0.0001). Average charges per person for opioid prescriptions were also significantly lower among recipients.
Among New Hampshire adults with office visits for noncancer low-back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients. The underlying cause of this correlation remains unknown, indicating the need for further investigation.
脊椎按摩治疗师提供的服务所带来的疼痛缓解可能使患者减少阿片类药物的使用剂量或频率，从而降低不良反应风险。本研究的目的是评估脊椎按摩治疗服务的使用与处方阿片类药物使用之间的关联。
作者采用回顾性队列设计来分析健康保险理赔数据。
数据来源是新罕布什尔州管理的全支付者理赔数据库。作者选择新罕布什尔州是因为健康理赔数据易于获取用于研究，且在2015年，新罕布什尔州的年龄调整药物过量死亡率在美国排名第二。
研究人群包括年龄在18 - 99岁、参加了健康计划且在90天内因原发性腰痛进行至少两次临床门诊就诊的新罕布什尔州居民。作者排除了患有癌症诊断的受试者。
作者测量了脊椎按摩治疗师服务接受者与非接受者相比开具阿片类药物处方的可能性。他们还比较了两组人群阿片类药物处方的开具率和相关费用。
与非接受者相比，接受者开具阿片类镇痛药物处方的调整后可能性低55%（优势比0.45；95%置信区间0.40 - 0.47；p < 0.0001）。接受者的阿片类药物处方人均费用也显著更低。
在因非癌症性腰痛进行门诊就诊的新罕布什尔州成年人中，与非接受者相比，脊椎按摩治疗师服务接受者开具阿片类镇痛药物处方的可能性显著更低。这种相关性的潜在原因尚不清楚，表明需要进一步调查。
