Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
Division of General Internal Medicine, Challenges in Managing and Preventing Pain Clinical Research Center, University of Pittsburgh, Pittsburgh, PA, USA.
J Gen Intern Med. 2024 Aug;39(11):2097-2105. doi: 10.1007/s11606-024-08799-3. Epub 2024 Jun 3.
Practice guidelines recommend nonpharmacologic and nonopioid therapies as first-line pain treatment for acute pain. However, little is known about their utilization generally and among individuals with opioid use disorder (OUD) for whom opioid and other pharmacologic therapies carry greater risk of harm.
To determine the association between a pre-existing OUD diagnosis and treatment of acute low back pain (aLBP).
Retrospective cohort study using 2016-2019 Medicare data.
Fee-for-service Medicare beneficiaries with a new episode of aLBP.
The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date). Using multivariable logistic regressions, we assessed the following outcomes measured within 30 days of the index date: (1) nonpharmacologic therapies (physical therapy and/or chiropractic care), and (2) prescription opioids. Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin. Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date.
We identified 1,263,188 beneficiaries with aLBP, of whom 3.0% had OUD. Two-thirds (65.8%) did not receive pain treatments of interest at baseline. Overall, nonpharmacologic therapy receipt was less prevalent and opioid and nonopioid pharmacologic therapies were more common among beneficiaries with OUD than those without OUD. Beneficiaries with OUD had lower odds of receiving nonpharmacologic therapies (aOR = 0.62, 99%CI = 0.58-0.65) and higher odds of prescription opioid receipt (aOR = 2.24, 99%CI = 2.17-2.32). OUD also was significantly associated with increased odds of opioid doses ≥ 90 morphine milligram equivalents/day (aOR = 2.43, 99%CI = 2.30-2.56) and co-prescription of gabapentin (aOR = 1.15, 99%CI = 1.09-1.22). Similar associations were observed in stratified groups though magnitudes differed.
Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.
实践指南建议将非药物和非阿片类疗法作为急性疼痛的一线治疗方法。然而，对于阿片类药物使用障碍（OUD）患者，他们通常使用这些疗法以及其他药物治疗的情况知之甚少，因为这些治疗方法对他们的危害更大。
确定预先存在的 OUD 诊断与急性腰痛（aLBP）治疗之间的关系。
使用 2016-2019 年医疗保险数据的回顾性队列研究。
有新发作的 aLBP 的按服务收费医疗保险受益人。
主要的独立变量是在首次腰痛索赔（即索引日期）之前测量的 OUD 诊断。使用多变量逻辑回归，我们评估了在索引日期后 30 天内测量的以下结果：（1）非药物治疗（物理治疗和/或整脊治疗），和（2）处方阿片类药物。在阿片类药物使用者中，我们进一步评估了阿片类药物剂量和加巴喷丁的共同处方。分析总体进行，并按接受物理治疗、整脊治疗、阿片类药物处方或加巴喷丁处方的情况在索引日期前 6 个月进行分层。
我们确定了 1263188 名患有 aLBP 的受益人，其中 3.0%患有 OUD。三分之二（65.8%）在基线时没有接受感兴趣的疼痛治疗。总体而言，非药物治疗的接受率较低，而 OUD 患者接受阿片类药物和非阿片类药物治疗的比例高于没有 OUD 的患者。患有 OUD 的患者接受非药物治疗的可能性较低（OR=0.62，99%CI=0.58-0.65），而接受处方阿片类药物的可能性较高（OR=2.24，99%CI=2.17-2.32）。OUD 还与较高的阿片类药物剂量≥90 吗啡毫克当量/天的可能性（OR=2.43，99%CI=2.30-2.56）和加巴喷丁的共同处方显著相关（OR=1.15，99%CI=1.09-1.22）。在分层组中也观察到了类似的关联，但程度不同。
患有 aLBP 和 OUD 的医疗保险受益人非药物疼痛治疗使用率较低，通常接受高剂量阿片类药物治疗，并伴有加巴喷丁。在颁布实践指南的基础上补充实施科学，可以提高基于证据的非药物治疗方法在 aLBP 中的应用。
