Low Back Pain Treatment: Still an Issue

Newswise — Many Medicare patients with new episodes of low back pain receive care inconsistent with current guidelines – including high use of opioids and advanced imaging tests, reports a study in the February issue of Medical Care. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Opioids are prescribed to nearly one-third of older adults with “new and persistent” Low Back pain – in most cases without trying guideline-recommended pain medications or physical therapy, according to the new research by Dan Pham Ly, MD, MPP, of Harvard University. He comments, “This study raises concerns about excessive use of low-value and potentially harmful treatments for the common problem of LBP in older adults, with under-use of evidence-based, guideline-recommended treatments.”

The study used Medicare claims data on more than 162,000 older adults with new LBP from 2011 through 2014. About 70 percent of patients were women; average age was approximately 77. None had received previous opioid treatment. The analysis included information on multiple visits for LBP over the course of a year, providing data on the timing and sequence of care.

Over half of patients (54 percent) made only one healthcare visit for LBP. That’s consistent with evidence that many new episodes of LBP are self-limiting. As stated in the current American College of Physicians guidelines, most patients with LBP “improve over time regardless of treatment.”

Advanced imaging studies – computed tomography (CT) or magnetic resonance imaging (MRI) scans – were used in about 15 percent of patients overall, and 29 percent of those with two or more LBP visits. In about half of cases, CT or MRI scans were performed within six weeks. That’s contrary to an American Academy of Family Physicians statement that most patients don’t need advanced imaging studies for initial evaluation of LBP.

Opioids were prescribed to about one-fourth of patients overall, including one-third of those with two or more LBP visits. In contrast, LBP guidelines suggest that other pain relievers – including nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen – should be tried before opioids.

Physical therapy was prescribed to only 11 percent of patients overall and 17 percent of those with two or more visits. Evidence suggests that early use of physical therapy can avoid the use of opioids in patients with LBP.

Most patients treated with opioids had...

 

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