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Many Patients Receive Guideline-Nonconcordant Care for Low Back Pain

One-third of patients received opioids, more than half of whom had not received prescription NSAIDs, PT

THURSDAY, Jan. 30, 2020 (HealthDay News) — Many patients who develop new low back pain (LBP) receive advanced imaging and opioids without having been prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or physical therapy (PT), according to a study published in the February issue of Medical Care.

Dan P. Ly, M.D., from Harvard University in Cambridge, Massachusetts, conducted a retrospective analysis of Medicare claims for 162,238 opioid-naive beneficiaries with new LBP to examine care patterns from Jan. 1, 2011, through Dec. 31, 2014. Simple rates of advanced imaging, PT, and opioid and nonopioid medication use were reported.

Ly found that 29.4 percent of patients with two or more visits for new LBP received advanced imaging within the first year; 48.4 percent of these patients received advanced imaging within six weeks of the first visit. Of patients with two or more visits for new LBP, 17.3 percent received PT, 42.2 percent received NSAIDs, 16.9 percent received a muscle relaxant, and 26.2 percent received tramadol. Overall, nearly one-third (32.3 percent) of patients with two or more visits received opioids; 52.4 and 82.2 percent of these patients had not received a prescription NSAID or PT, respectively.

“Many patients who develop new LBP receive guideline nonconcordant advanced imaging and opioids before other modalities like PT and prescription NSAIDs,” Ly writes. “Other studies, including qualitative studies and surveys, may better delineate barriers to the use of these therapies for LBP.”

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