Adding to a growing body of evidence for physical therapist treatment of low back pain (LBP), a new study shows that using it as a first-line approach not only saves money, but also dramatically reduces the chance of receiving a prescription for dangerous opioids.
The study, Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs, was published in the May 2018 issue of Health Services Research.
Researchers followed the health insurance claims of more than 150,000 patients for 1 year after an initial visit to a health care provider for LBP. They sought to examine differences in the type of health care utilized and how much it cost over the course of a year for those who saw a physical therapist first, those who saw a physical therapist at a later time after the initial visit, and those who never visited with a physical therapist during the study period.
The team concluded that patients with LBP who received care from a physical therapist first experience lower out-of-pocket pharmacy and outpatient costs. They also reduced their likelihood of receiving an opioid prescription by 87% compared with patients who never visited a physical therapist. The “physical therapist first” group also experienced a 28% lower probability of having imaging services and 15% lower odds of making a visit to an emergency room.
At any given time, about 25% of people in the US will report having low back pain within the previous 3 months. And more than 60% of people with low back pain in the US have a prescription for opioids. The US is struggling to combat an unprecedented opioid epidemic, resulting from the misuse of prescription painkillers, which come with dangerous side effects including depression, addiction, overdose, and death.
In 2016 the Centers for Disease Control and Prevention released opioid prescription guidelines, recognizing that prescription opioids are appropriate in certain cases like cancer treatment, palliative care, and end-of-life care, and in acute care situations if properly dosed. But the guidelines say for other pain management, nonopioid treatments, including physical therapy, should be used.
The American Physical Therapy Association's #ChoosePT campaign raises awareness about physical therapy as a safe and effective alternative to drugs for the treatment of pain. It aligns directly with the Centers for Disease Control and Prevention’s opioid prescription guidelines (March 2016), citing “high-quality evidence” supporting exercise as a part of a physical therapy treatment plan for low back pain, hip or knee osteoarthritis, and fibromyalgia.
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