Whedon James M, Toler Andrew W J, Kazal Louis A, Bezdjian Serena, Goehl Justin M, Greenstein Jay
Southern California University of Health Sciences, Whittier, California.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Pain Med. 2020 Dec 25;21(12):3567-3573. doi: 10.1093/pm/pnaa014.
Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.
We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012-2017.
We included adults aged 18-84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).
The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11-2.17, P = 0.010; in New Hampshire: HR = 2.03, 95% CI = 1.92-2.14, P < 0.0001). Similar differences were observed for the acute groups.
Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.
采用非药物疼痛管理方法可能会避免不必要地使用阿片类药物。我们的目的是评估脊椎按摩疗法的使用对脊椎疼痛患者使用处方阿片类药物的影响。
我们采用回顾性队列设计，分析了2012年至2017年三个相邻州的健康索赔数据。
我们纳入了年龄在18至84岁之间、参加了健康计划且因脊椎疼痛到初级保健医生或脊椎按摩师处就诊的成年人。我们确定了两组研究对象：接受者同时接受初级保健和脊椎按摩疗法，未接受者仅接受初级保健但未接受脊椎按摩疗法。
我们进行了调整后的事件发生时间分析，以比较接受者和未接受者开具阿片类药物处方的风险。我们将接受者群体分为：急性组（诊断后30天内首次接受脊椎按摩治疗）和非急性组（所有其他患者）。
研究对象总数为101,221人。总体而言，与接受者相比，未接受者开具阿片类药物处方的人数多1.55至2.03倍（在康涅狄格州：风险比[HR]=1.55，95%置信区间[CI]=1.11 - 2.17，P = 0.010；在新罕布什尔州：HR = 2.03，95% CI = 1.92 - 2.14，P < 0.0001）。急性组也观察到了类似差异。
看脊椎按摩师的脊椎疼痛患者开具阿片类药物处方的风险降低了一半。在诊断后30天内看脊椎按摩师的患者中，与急性期后首次就诊的患者相比，风险降低幅度更大。
