Primary care providers may be more likely to prescribe opioids for neck pain, study finds

October 24, 2017 – DCRI researchers found that patients who initiated care with chiropractors and physical therapists were less likely to receive opioid therapy.

Patients with neck pain who are treated initially by a non-pharmacological care providers may be less likely to receive opioid treatment and advanced imaging, according to a new study by DCRI researchers.

The study, led by Maggie Horn, DPT, MPH, PhD, was published online in Proceedings: Innovations, Quality, and Outcomes, a journal of the Mayo Clinic.

“We really wanted to look at pathways of care— where patients enter the heathcare system, and what does that looks like in terms of downstream healthcare utilization and associated costs,” Horn said.

Neck pain is a widespread problem; approximately half of all people will a serious episode of neck pain at some point in their lives. However, there is little agreement among care providers where a patient should initially seek treatment for neck pain. Many recommendations for treating neck pain are extrapolated from recommendations for treating back pain, and it is unclear how these affect outcomes for neck pain patients.

In this study, Horn and her colleagues conducted a retrospective cohort study of 1,702 patients who consulted a primary care provider, physical therapist, chiropractor, or a specialist for a new case of neck pain between January 1, 2012 and June 30, 2013. This dataset came from the University of Utah Health Plans, which insured all of the patients included in the study.

The most common initial provider type was a primary care provider (750 patients, 44.07 percent), followed by chiropractor (382, 22.44 percent), physical therapist (293, 17.22 percent) and specialist (277, 16.27 percent). Patients seeking care from a chiropractor or physical therapist had the lowest prevalence of chronic or generalized pain (2.36 percent and 19.80 percent, respectively); substance abuse, (4.19 percent and 12.29 percent); depression (16.49 percent and 29.01 percent); anxiety (15.97 percent and 25.94 percent) and tobacco use (6.02 percent and 12.29 percent). In contrast, specialists had the highest prevalence of patients with any comorbidity, with the exception of low back pain, where chiropractors had the highest prevalence (76.44 percent).

The median duration of an episode of care in the sample was 42 days, with patients seeking care from a primary care provider having the shortest median episode of care (1 day) followed by physical therapist (51 days), specialist (91 days) and chiropractor (120 days). Very few patients (19, 1.12 percent) underwent surgery for their neck pain.

Patients who initially received care from a chiropractor physical therapy were less likely to receive opioid therapy within one year of their initial visit. Patients who first saw a chiropractor were also less likely to received advanced imaging and injections. Initiating care with a specialist or physical therapist increased the odds of advanced imaging; but only initiating care with a specialist increased the odds of injections.

These findings, Horn said, suggest that initiating care with a non-pharmacological provider for neck pain may be one way to decrease opioid exposure.

“I think this an opportunity to start a conversation about how we direct patients within the healthcare system,” she said. “We should be thinking more carefully about how we can use alternative providers for people with neck pain.”

In addition to Horn, the study’s authors included the DCRI’s Steven Z. George, PT, PhD, and the University of Utah’s Julie M. Fritz, PT, PhD.