Dow Patience M, Coulibaly Neto, Girard Anthony, Merlin Jessica S, Shireman Theresa I, Trivedi Amal N, Gairola Richa, Marshall Brandon D L
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA.
J Integr Complement Med. 2025 Jul;31(7):664-673. doi: 10.1089/jicm.2024.1032. Epub 2025 Apr 3.
Noninvasive nonpharmacologic therapies are recommended for managing acute low back pain (aLBP) and have the potential to mitigate opioid-related harms. However, little is known about whether incorporating nonpharmacologic therapies into aLBP management affects adverse outcomes. The objective was to determine if receiving nonpharmacologic pain therapies, alone or combined with pharmacologic options, is associated with drug-related overdose hospitalizations among Medicare beneficiaries with aLBP. A nested case-control study was conducted using 2016-2019 Medicare claims to identify fee-for-service beneficiaries with new episodes of aLBP (i.e., LBP lasting <3 months). Cases had inpatient claims for drug overdoses within 90 days of aLBP diagnosis. The exposure was mutually exclusive categories for pain therapies: (1) pharmacologic only (opioids and/or gabapentinoids), (2) nonpharmacologic only (physical therapy and/or spinal manipulation therapy), (3) both pharmacologic and nonpharmacologic, and (4) none of these. The outcome was hospitalization involving drug overdose. We conducted conditional logistic regression adjusting for baseline sociodemographic, clinical, and geographic covariates. There were 3,042 cases and 12,168 matched controls. One-third (33.7%) of cases versus 26.8% of controls received pharmacologic therapies only compared with 6.7% (cases) and 10.2% (controls) for nonpharmacologic therapies only. Receipt of both pharmacologic and nonpharmacologic therapies was 7.3% (cases) and 3.2% (controls). Compared with exclusively receiving pharmacologic therapies, receiving nonpharmacologic therapies only was associated with lower odds of overdose-related hospitalization (adjusted odds ratio [aOR] = 0.56, 95% confidence interval [CI]: 0.47-0.66), whereas pharmacologic and nonpharmacologic treatments combined were associated with nearly twofold increased odds of overdose-related hospitalization (aOR = 1.87, 95% CI: 1.55-2.27). Among Medicare beneficiaries with new episodes of aLBP, treatment with only nonpharmacologic therapies was protective of overdose hospitalizations. However, any treatment with opioids and/or gabapentinoids, alone or combined with nonpharmacologic therapies, was associated with increased odds of overdose hospitalization. Implementation research is needed to inform successful adoption of nonpharmacologic pain therapies especially in subgroups with increased risk of adverse outcomes.
推荐采用非侵入性非药物疗法来管理急性下腰痛（aLBP），并且这些疗法有可能减轻与阿片类药物相关的危害。然而，对于将非药物疗法纳入aLBP管理是否会影响不良结局，人们知之甚少。本研究的目的是确定接受非药物疼痛疗法单独使用或与药物疗法联合使用，是否与患有aLBP的医疗保险受益人的药物相关过量住院有关。我们进行了一项嵌套病例对照研究，使用2016 - 2019年医疗保险理赔数据来识别有新发作aLBP（即LBP持续时间<3个月）的按服务收费受益人。病例在aLBP诊断后90天内有药物过量的住院理赔记录。暴露因素是疼痛疗法的相互排斥类别：（1）仅药物疗法（阿片类药物和/或加巴喷丁类药物），（2）仅非药物疗法（物理治疗和/或脊柱推拿疗法），（3）药物和非药物疗法都用，（4）以上都不用。结局是涉及药物过量的住院治疗。我们进行了条件逻辑回归分析，并对基线社会人口统计学、临床和地理协变量进行了调整。共有3042例病例和12168例匹配对照。三分之一（33.7%）的病例仅接受药物疗法，而对照为26.8%；仅接受非药物疗法的病例为6.7%，对照为10.2%。同时接受药物和非药物疗法的比例分别为7.3%（病例）和3.2%（对照）。与仅接受药物疗法相比，仅接受非药物疗法与过量相关住院的较低几率相关（调整后的优势比[aOR]=0.56，95%置信区间[CI]：0.47 - 0.66），而药物和非药物疗法联合使用与过量相关住院的几率增加近两倍（aOR = 1.87，95% CI：1.55 - 2.27）。在患有新发作aLBP的医疗保险受益人中，仅采用非药物疗法进行治疗可预防过量住院。然而，任何使用阿片类药物和/或加巴喷丁类药物的治疗，单独使用或与非药物疗法联合使用，都与过量住院几率增加有关。需要开展实施研究，以促进成功采用非药物疼痛疗法，尤其是在不良结局风险增加的亚组中。
