Long-Term Medicare Costs Associated with Opioids vs. SMT for Chronic Low Back Pain in Older Adults
- Dr. Shawn Thistle
The most common condition for which opioid analgesics are prescribed in the United States, and one of the most common reasons for a physician visit in general, is low back pain (LBP).
Nonspecific back pain affects approximately 30% of older adults at any given time. This patient group (65 years of age and over) often experience recurrent episodes of LBP as well. The prevalence of chronic LBP (cLBP) increased between 2000 and 2007 by 64% in the United States and similar increases have been noted globally. Spinal pain is also one of the costliest medical conditions, even though there was a decline in positive clinical outcomes between 1997 and 2006 despite rising costs. We (as taxpayers and/or private consumers of healthcare) are paying way more, for no real benefit or improvement!
A recent study found that 31% of patients with LBP received prescriptions for opioid analgesics within the first 6 months of initial diagnosis, rising to 42% within 3 years. Nevertheless, the long-term effectiveness of opioid therapy for chronic LBP is unknown, whereas the risks of opioid analgesics are widely known and simply devastating on many levels. It has been reported that opioid analgesic therapy (OAT) results in 3.8% of patients developing opioid use disorder and up to 26% of patients developing opioid dependence. Furthermore, almost 70% of US drug overdose deaths in 2018 involved an opioid, resulting in 46,802 deaths from opioid-related overdoses. It is troubling that many patients who end up with negative clinical consequences from opioid medications were first prescribed these drugs for low back pain! Further, among patients with chronic, disabling musculoskeletal disorders, higher dosing of opioids is correlated with greater pain severity and higher levels of disability and depression.
In contrast, nonpharmacological therapies for spinal pain have been shown to be associated with a decreased use of opioids. One such nonpharmacological therapy, spinal manipulative therapy (SMT), has been shown to be an effective treatment for cLBP and current clinical guidelines recommend SMT as a first-line approach to the management of LBP.
Chiropractic management of LBP typically involves SMT, and several studies have evaluated the costs of such care as compared with usual care. However, the results of this research have been mixed. No studies have rigorously compared the long-term costs associated with OAT and SMT. Therefore, the purpose of this study was to compare Medicare expenditures for cLBP among patients aged 65-84 who were recipients of OAT versus SMT, hypothesizing that initiation of treatment with OAT would be associated with higher costs than with SMT.
THIS WEEK'S RESEARCH REVIEW: “Long-Term Medicare Costs Associated with Opioids vs. SMT for Chronic Low Back Pain in Older Adults”
This paper was published in JMPT (2021) and this Review is posted in Recent Reviews, Low Back Pain, Geriatrics, Lumbar Spine - Manipulation/Mobilization and the 2022 Archive.