RRS Education Chiropractic BLOG - Musculoskeletal Research Reviews

Because of their similarities, this Research Review combines 2 recent studies that were done by the same author group, which investigated long-term outcomes of older Medicare recipients with chronic low back pain (cLBP) who received Opioid Analgesic Therapy (OAT) or Spinal Manipulative Therapy (SMT). One study focused on the escalation of patient care and the other on the risk of adverse drug events (ADEs).
Chronic low back pain (cLBP) has been shown to affect 70% to 85% of the elderly population at least once in their lifetime, with 90% of those afflicted having more than one episode. LBP can be disabling, limiting an older person’s ability to perform common everyday tasks, many of which are required to support independent living as we age!
There has been a dramatic increase in treatment costs for LBP among Medicare beneficiaries, although such increases have not correlated with improved outcomes. Furthermore, little evidence supports the use of many invasive and expensive spine care procedures. The use of OAT for cLBP patients is still common, even though its long-term safety is unknown, and overprescribing is thought to be the leading cause of the opioid crisis in the USA. The risks of opioid medications are amplified and potentially worse in older patients!
Both pharmacological and nonpharmacological approaches to the management of cLBP are included in clinical guidelines, though it is uncertain how utilization of OAT affects the escalation of care of cLBP patients as compared with SMT. Treatment escalation (or, escalation of care) refers to additional, more complex health care interactions or interventions being required, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP. Previous studies have reported that use of chiropractic care for patients with LBP is associated with decreased opioid use and reduced risk of ADEs. However, the efficiency and value of long-term care of cLBP for either OAT or SMT are uncertain.

The objectives of these studies were:

1. to compare long-term outcomes for SMT and OAT concerning escalation of care for patients with cLBP, and
2. to compare SMT and OAT to determine their impact on the risk of ADEs among older adults receiving long-term care for cLBP.
Chiropractors can play an important role in preventing treatment escalation and adverse drug events in elderly patients, which I discuss more in “Older & Bolder: Chiropractic Care for Healthy Aging” - available via in-person Seminar or on-demand, online E-Seminar!
THIS WEEK'S RESEARCH REVIEW: “Spinal Manipulation Reduces Escalation of Care & Risk of Adverse Drug Events for Older Chronic LBP Patients”
These papers were both published in Spine (2021 & 2022) and this Review is posted in Recent Reviews, Low Back Pain, Geriatrics, Lumbar Spine - Manipulation/Mobilization and the 2022 Archive.
adverse drug reactions

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