Acharya Mahip, Chopra Divyan, Smith Allen M, Fritz Julie M, Martin Bradley C
Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah.
J Chiropr Med. 2022 Jun;21(2):67-76. doi: 10.1016/j.jcm.2022.02.007. Epub 2022 May 21.
The objective of this study was to estimate the association between early use of physical therapy (PT) or chiropractic care and incident opioid use and long-term opioid use in individuals with a low back pain (LBP) diagnosis.
A retrospective cohort study was conducted using data from Arkansas All Payers' Claims Database. Adults with incident LBP diagnosed in primary care or emergency departments between July 1, 2013, and June 30, 2017, were identified. Participants were required to be opioid naïve in the 6-month baseline period and without cancer, cauda equina syndrome, osteomyelitis, lumbar fracture, and paraplegia/quadriplegia in the entire study period. PT and chiropractic treatment were documented over the ensuing 30 days starting on the date of LBP. Any opioid use and long-term opioid use (LTOU) in 1-year follow-up were assessed. Multivariable logistic regressions controlling for covariates were estimated.
A total of 40 929 individuals were included in the final sample, with an average age of 41 years and 65% being women. Only 5% and 6% received PT and chiropractic service, respectively, within the first 30 days. Sixty-four percent had incident opioid use, and 4% had LTOU in the follow-up period. PT was not associated with incident opioid use (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.98-1.18) or LTOU (OR, 1.19; 95% CI, 0.97-1.45). Chiropractic care decreased the odds of opioid use (OR, 0.88; 95% CI, 0.80-0.97) and LTOU (OR, 0.56; 95% CI, 0.40-0.77).
In this study we found that receipt of chiropractic care, though not PT, may have disrupted the need for opioids and, in particular, LTOU in newly diagnosed LBP.
本研究的目的是评估早期使用物理治疗（PT）或整脊治疗与腰痛（LBP）诊断患者的阿片类药物使用及长期阿片类药物使用之间的关联。
利用阿肯色州所有支付方索赔数据库的数据进行一项回顾性队列研究。确定2013年7月1日至2017年6月30日期间在初级保健或急诊科诊断为新发LBP的成年人。参与者在6个月的基线期内需未使用过阿片类药物，且在整个研究期间无癌症、马尾综合征、骨髓炎、腰椎骨折和截瘫/四肢瘫。从LBP诊断日期开始的接下来30天内记录PT和整脊治疗情况。评估1年随访期间的任何阿片类药物使用和长期阿片类药物使用（LTOU）情况。估计控制协变量的多变量逻辑回归。
最终样本共纳入40929人，平均年龄41岁，65%为女性。在最初30天内，分别只有5%和6%的人接受了PT和整脊服务。64%的人在随访期间有阿片类药物使用，4%有LTOU。PT与阿片类药物使用（比值比[OR]，1.07；95%置信区间[CI]，0.98 - 1.18）或LTOU（OR，1.19；95% CI，0.97 - 1.
