Vaillant Jane, Gairola Richa, Merlin Jessica S, Trivedi Amal N, Shireman Theresa I, Dow Patience M
Brown University, Providence, RI, USA.
University of Pittsburgh, PA, USA.
Med Care Res Rev. 2025 May 29:10775587251339917. doi: 10.1177/10775587251339917.
Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.5%-6.7%), chiropractic care (11.0%-11.7%), and gabapentinoid (9.6%-8.9%) receipt were limited, whereas prescription opioid use substantially decreased (26.2%-17.8%). Prescription opioid receipt was higher among individuals under age 65, American Indian/Alaskan Native, non-Hispanic Black/African American, and Hispanic individuals, individuals with opioid use disorder, and in Southern states, while the use of nonpharmacologic pain therapies remained low among these subgroups. It is essential to promote equitable access to multimodal and guideline-recommended approaches for aLBP management including nonpharmacologic therapies.
当代实践指南建议，对于包括急性下腰痛（aLBP）在内的多种疼痛类型，非药物疗法应作为一线治疗方法，而非处方阿片类药物。这项系列横断面研究描述了2016年至2019年期间，在总体以及关键人口统计学、临床和地理亚组中，被诊断为aLBP的医疗保险受益人接受物理治疗（PT）、脊椎按摩治疗、加巴喷丁类药物治疗和开具处方阿片类药物的年度患病率趋势。总体而言，接受PT治疗（从5.5%升至6.7%）、脊椎按摩治疗（从11.0%升至11.7%）和加巴喷丁类药物治疗（从9.6%降至8.9%）的变化有限，而处方阿片类药物的使用大幅下降（从26.2%降至17.8%）。65岁以下人群、美国印第安人/阿拉斯加原住民、非西班牙裔黑人/非裔美国人、西班牙裔人群、患有阿片类药物使用障碍的人群以及美国南部各州开具处方阿片类药物的比例较高，而这些亚组中使用非药物疼痛疗法的比例仍然较低。促进公平获得包括非药物疗法在内的aLBP多模式和指南推荐治疗方法至关重要。
