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Bohm MK, Siwakoti L, Nahin RL. Treatment Among Commercial and Medicaid-insured Adults with Incident Chronic Pain Episodes. THE JOURNAL OF PAIN 2024:104667. [PMID: 39271034 DOI: 10.1016/j.jpain.2024.104667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/20/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024]
Abstract
Analyses of healthcare data can reveal utilization of treatment options that comprise a multidisciplinary approach to chronic pain management. This retrospective cohort study aimed to characterize treatments among commercially vs. Medicaid-insured adults with incident episodes of chronic pain. We used MarketScan® data to identify patients with diagnoses for conditions associated with chronic pain, assess procedure codes that align with broad categories of treatment options, and compare receipt of treatments by insurance type. Among enrollees aged ≥18 years, 4,254,818 adults with commercial insurance and 583,369 with Medicaid met continuous enrollment criteria and had no chronic pain episodes in 2017. Among patients with incident chronic pain episodes during 2018-2020, we determined the proportions receiving different categories of treatment options during the year following diagnosis. Cohen's h determined meaningful differences by insurance. Study cohorts included 1,095,358 commercial (mean [SD] age, 47.3 [13.3] years; 54.3% women) and 176,607 Medicaid adults (38.1 [12.7] years; 70.6% women) with incident chronic pain episodes during 2018-2020. More commercial than Medicaid patients received restorative therapies such as physical therapy (38.6% vs. 19.2%), complementary or integrative care such as chiropractic treatment (31.1% vs.9.0%), and two or more different types of nonmedication treatment procedures (34.1% vs.16.3%). Median days to treatments were shorter for commercial patients. Disparities in the provision, patterns and timing of treatments by insurance suggest differential access to the full range of treatment options early during the course of care and identify opportunities to align coverage and reimbursement policies with current practice guidelines. PERSPECTIVE: This analysis of medical claims for patients with incident chronic pain episodes found disparities in the provision, patterns and timing of treatments by insurance type. These results suggest differential access to evidence-based treatment options early during care and identify opportunities to align coverage and reimbursement policies with current practice guidelines.
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Affiliation(s)
- Michele K Bohm
- Office of Policy, Performance, and Evaluation, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H 21-11, Atlanta, Georgia 30329, USA.
| | - Lila Siwakoti
- Global Health Center, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS H 21-09, Atlanta, Georgia, 30329, USA.
| | - Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892-5475, USA.
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Wilson MV, Braithwaite FA, Arnold JB, Crouch SM, Moore E, Heil A, Cooper K, Stanton TR. The effectiveness of peer support interventions for community-dwelling adults with chronic musculoskeletal pain: a systematic review and meta-analysis of randomised trials. Pain 2024:00006396-990000000-00636. [PMID: 38916521 DOI: 10.1097/j.pain.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/20/2024] [Indexed: 06/26/2024]
Abstract
ABSTRACT This systematic review and meta-analysis critically examined the evidence for peer support interventions to reduce pain and improve health outcomes in community-dwelling adults with chronic musculoskeletal pain (PROSPERO CRD42022356850). A systematic search (inception-January 2023) of electronic databases and grey literature was undertaken to identify relevant randomised controlled trials, with risk of bias and GRADE assessments performed on included studies. Meta-analyses used a generic, inverse-variance, random-effects model, calculating mean difference (MD) or standardised mean difference (SMD). Of 16,445 records identified, 29 records reporting on 24 studies (n = 6202 participants) were included. All evidence had unclear/high risk of bias and low-very low certainty. Peer support interventions resulted in small improvements in pain (medium-term: MD -3.48, 95% CI -6.61, -0.35; long-term: MD -1.97, 95% CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95% CI 0.16, 0.36; long-term: SMD 0.21, 95% CI 0.07, 0.36), and function (long-term: SMD -0.10, 95% CI -0.19, -0.00) relative to usual care and greater self-efficacy (medium-term: SMD 0.36, 95% CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar improvement as active (health professional led) interventions bar long-term self-efficacy (MD -0.41, 95% CI -0.77, -0.05), which favoured active interventions. No point estimates reached minimal clinically important difference thresholds. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence. Despite low-very low evidence certainty, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes, suggesting that peer support may be useful as an adjunct to other treatments for musculoskeletal pain.
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Affiliation(s)
- Monique V Wilson
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Felicity A Braithwaite
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Sophie M Crouch
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Kaurna Country, Adelaide, Australia
| | - Emily Moore
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
| | - Alrun Heil
- Department of Health Sciences, Bern University of Applied Sciences (BFH), Bern, Switzerland
| | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
- The Scottish Centre for Evidence-based, Multi-professional Practice: A JBI Centre of Excellence, Robert Gordon University, Aberdeen, Scotland
| | - Tasha R Stanton
- Innovation, IMPlementation And Clinical Translation (IIMPACT) in Health, University of South Australia, Kaurna Country, Adelaide, Australia
- Persistent Pain Research Group, Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
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Moyo P, Merlin JS, George M, Shireman TI, Marshall BD. Association of Opioid Use Disorder Diagnosis With Use of Physical Therapy and Chiropractic Care Among Chronic Low Back Pain Patients: A Group-Based Trajectory Analysis. THE JOURNAL OF PAIN 2024; 25:742-754. [PMID: 37820847 PMCID: PMC10922407 DOI: 10.1016/j.jpain.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Nonpharmacologic approaches are recommended as first-line treatment for chronic pain, and their importance is heightened among individuals with co-occurring opioid use disorder (OUD), in whom opioid therapies may be particularly detrimental. Our objectives were to assess the receipt and trajectories of nonpharmacologic pain treatment and determine the association of OUD diagnosis with these trajectories. This retrospective cohort study used Medicare claims data from 2016 to 2018 and applied group-based trajectory models to identify distinct patterns of physical therapy (PT) or chiropractic care treatment over the 12 months following a new episode of chronic low back pain. We used logistic regression models to estimate the association of co-occurring OUD with group membership in PT and chiropractic trajectories. Our sample comprised 607,729 beneficiaries at least 18 years of age, of whom 11.4% had a diagnosis of OUD. The 12-month prevalence of PT and chiropractic treatment receipt was 24.7% and 27.1%, respectively, and lower among Medicare beneficiaries with co-occurring OUD (PT: 14.6%; chiropractic: 6.8%). The final models identified 3 distinct trajectories each for PT (no/little use [76.6% of sample], delayed and increasing use [8.2%], and early and declining use [15.2%]); and chiropractic (no/little use [75.0% of sample], early and declining use [17.3%], and early and sustained use [7.7%]). People with OUD were more likely to belong in trajectories with little/no PT or chiropractic care as compared to other trajectories. The findings indicate that people with co-occurring chronic pain and OUD often do not receive early or any nonpharmacologic pain therapies as recommended by practice guidelines. PERSPECTIVE: PT and chiropractic care use were low overall and even lower among Medicare beneficiaries with co-occurring OUD compared with those without OUD. As updated guidelines on pain management are promulgated, targeted interventions (eg, insurance policy, provider, and patient education) are needed to ensure equitable access to guideline-recommended pain therapies.
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Affiliation(s)
- Patience Moyo
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Jessica S. Merlin
- Challenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, PA, USA
| | - Miriam George
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Theresa I. Shireman
- Brown University School of Public Health, Department of Health Services, Policy, and Practice, Providence, RI, USA
| | - Brandon D.L. Marshall
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
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Fritz JM, Gibson B, Wetter DW, Del Fiol G, Solis V, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. Implement Sci Commun 2024; 5:3. [PMID: 38183154 PMCID: PMC10768478 DOI: 10.1186/s43058-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. METHODS During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. RESULTS CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. CONCLUSIONS Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04923334 . Registered June 11, 2021.
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Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA.
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Victor Solis
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
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Ringsten M, Jakobsson U. Utilization of Methods for Pain Treatment and Management Among Older Adults with Chronic Pain. Pain Manag Nurs 2023; 24:575-580. [PMID: 37679226 DOI: 10.1016/j.pmn.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Older adults have a high prevalence of chronic pain, which can have a substantial effect on their health and quality of life. Patients' use of effective pain relief methods is a central part of the treatment and management of chronic pain. The utilization of pain relief methods and their perceived effectiveness are important knowledge for treating and managing chronic pain for clinicians and older adults. However, this has been poorly investigated. AIM We aimed to survey the methods used by older people to treat and manage chronic pain as well as their perceived effectiveness. METHODS A total of 2,000 questionnaires were sent to a random sample of people aged 65 years of age or older living in Sweden and 1,141 questionnaires were returned in usable condition. A total of 433 participants reported having chronic pain and completed the Pain Management Inventory to map the use and perceived effectiveness of used treatment and management methods. RESULTS The prevalence of chronic pain was 38% and the most used pain treatment methods were passive approaches, i.e., rest (60%), distractions (53%), non-prescribed medicine (49%), and prescribed medicine (44%). A total of 72% of respondents used either prescribed or non-prescribed medicine. The most used active treatment was physical activity (52%). The perceived effectiveness varied to a large extent for each method, and, on average, no treatment method seemed to be more effective than any other. CONCLUSIONS Knowledge about the actual use of pain treatment methods and the varied perceived effectiveness can guide clinicians in recommending new approaches or alternatives to manage chronic pain in older adults. How used methods are aligned with current clinical recommendations could be further explored in the future.
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Affiliation(s)
- Martin Ringsten
- Department of Health Sciences, Lund University, Lund, Sweden.
| | - Ulf Jakobsson
- Center for Primary Healthcare Research, Department of Clinical Sciences, Lund University, Sweden
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Ballengee LA, King HA, Simon C, Lentz TA, Allen KD, Stanwyck C, Gladney M, George SZ, Hastings SN. Partner engagement for planning and development of non-pharmacological care pathways in the AIM-Back trial. Clin Trials 2023; 20:463-472. [PMID: 37269070 PMCID: PMC10524642 DOI: 10.1177/17407745231178789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Embedded pragmatic clinical trials are increasingly recommended for non-pharmacological pain care research due to their focus on examining intervention effectiveness within real-world settings. Engagement with patients, health care providers, and other partners is essential, yet there is limited guidance for how to use engagement to meaningfully inform the design of interventions to be tested in pain-related pragmatic clinical trials. This manuscript aims to describe the process and impacts of partner input on the design of two interventions (care pathways) for low back pain currently being tested in an embedded pragmatic trial in the Veterans Affairs health care system. METHODS Sequential cohort design for intervention development was followed. Engagement activities were conducted with 25 participants between November 2017 and June 2018. Participants included representatives from multiple groups: clinicians, administrative leadership, patients, and caregivers. RESULTS Partner feedback led to several changes in each of the care pathways to improve patient experience and usability. Major changes to the sequenced care pathway included transitioning from telephone-based delivery to a flexible telehealth model, increased specificity about pain modulation activities, and reduction of physical therapy visits. Major changes to the pain navigator pathway included transitioning from a traditional stepped care model to one that offers care in a feedback loop, increased flexibility regarding pain navigator provider type, and increased specificity for patient discharge criteria. Centering patient experience emerged as a key consideration from all partner groups. CONCLUSION Diverse input is important to consider before implementing new interventions in embedded pragmatic trials. Partner engagement can increase acceptability of new care pathways to patients and providers and enhance uptake of effective interventions by health systems. TRIAL REGISTRATION NCT#04411420. Registered on 2 June 2020.
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Affiliation(s)
- Lindsay A Ballengee
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Corey Simon
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Catherine Stanwyck
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Micaela Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Steven Z George
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Aging, Duke University School of Medicine, Durham, NC, USA
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7
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Fritz JM, Gibson B, Wetter DW, Fiol GD, Solis VH, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. RESEARCH SQUARE 2023:rs.3.rs-3267087. [PMID: 37790359 PMCID: PMC10543377 DOI: 10.21203/rs.3.rs-3267087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes. Results CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial registration Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334.
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Bhondoekhan F, Marshall BDL, Shireman TI, Trivedi AN, Merlin JS, Moyo P. Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD. JAMA Netw Open 2023; 6:e2333251. [PMID: 37698860 PMCID: PMC10498328 DOI: 10.1001/jamanetworkopen.2023.33251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/03/2023] [Indexed: 09/13/2023] Open
Abstract
Importance Nonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care. Objective To assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD. Design, Setting, and Participants This retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023. Exposures Race and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other. Main Outcomes and Measures The main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed. Results Among 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT. Conclusions and Relevance In this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.
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Affiliation(s)
- Fiona Bhondoekhan
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Theresa I. Shireman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Amal N. Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jessica S. Merlin
- CHAllenges in Managing and Preventing Pain Clinical Research Center, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Areias AC, Janela D, Molinos M, Moulder RG, Bento V, Yanamadala V, Cohen SP, Correia FD, Costa F. Managing Musculoskeletal Pain in Older Adults Through a Digital Care Solution: Secondary Analysis of a Prospective Clinical Study. JMIR Rehabil Assist Technol 2023; 10:e49673. [PMID: 37465960 PMCID: PMC10466151 DOI: 10.2196/49673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Aging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). OBJECTIVE This study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. METHODS We conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non-work-related activity impairment. RESULTS Of 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P<.001 and OR 2.40, 95% CI 1.97-2.92; P<.001, respectively) and middle-aged adults (OR 1.22, 95% CI 1.03-1.45; P=.03 and OR 1.38, 95% CI 1.14-1.68; P=.001, respectively). Whereas older patients requested more technical assistance and exhibited a slower learning curve in exercise performance, their engagement was higher, as reflected by higher adherence to both exercise and education pieces. Older patients interacted more with the physical therapist (mean 12.6, SD 18.4 vs mean 10.7, SD 14.7 of young adults) and showed higher satisfaction scores (mean 8.7, SD 1.9). Significant improvements were observed in all clinical outcomes and were similar between groups, including pain response rates (young adults: 949/1516, 62.6%; middle-aged adults: 1848/2834, 65.2%; and older adults: 241/387, 62.3%; P=.17). CONCLUSIONS Older adults showed high adherence, engagement, and satisfaction with the DCP, which were greater than in their younger counterparts, together with significant clinical improvements in all studied outcomes. This suggests DCPs can successfully address and overcome some of the barriers surrounding the participation and adequacy of digital models in the older adult population.
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Affiliation(s)
| | - Dora Janela
- Sword Health, Inc, Draper, UT, United States
| | | | - Robert G Moulder
- Sword Health, Inc, Draper, UT, United States
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | | | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, United States
- Department of Surgery, Frank H Netter School of Medicine, Quinnipiac University, Hamden, CT, United States
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, United States
| | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, United States
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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10
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Wang G, Lu L, Gold LS, Bailey JF. Opioid Initiation Within One Year After Starting a Digital Musculoskeletal (MSK) Program: An Observational, Longitudinal Study with Comparison Group. J Pain Res 2023; 16:2609-2618. [PMID: 37533561 PMCID: PMC10390711 DOI: 10.2147/jpr.s412081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023] Open
Abstract
Background In-person, conservative care may decrease opioid use for chronic musculoskeletal (MSK) pain, but the impact of digitally delivered conservative care on opioid use is unknown. This study examines associations between a digital MSK program and opioid initiation and prescriptions among opioid naive adults with chronic MSK pain. Methods This observational study used commercial medical and pharmacy claims data to compare digital MSK program members to matched physical therapy (PT) patients. Outcomes were any opioid prescriptions and opioid prescriptions per 100 participants within the 12-months after starting a digital MSK program. After propensity-score matching, we conducted multivariate regression models that controlled for demographic, comorbidity, and baseline MSK healthcare use. Results The study included 4195 members and 4195 matched PT patients. For opioid initiation, 7.89% (95% Confidence Interval [CI]: 7.07%, 8.71%) of members had opioid prescriptions within 12 months after starting the digital MSK program versus 13.64% (95% CI: 12.60%, 14.67%) of matched PT patients (p < 0.001). Members had significantly fewer opioid prescriptions (16.73 per 100 participants; 95% CI: 14.11, 19.36) versus PT patients (22.36 per 100 participants; 95% CI: 19.99, 24.73). Members had lower odds (OR: 0.52, 95% CI: 0.45, 0.60) of initiating opioids and significantly fewer prescriptions per 100 participants (beta: -6.40, 95% CI: -9.88, -2.93) versus PT patients after controlling for available confounding factors. Conclusion An MSK program that delivers conservative care digitally may be a promising approach for decreasing opioid initiation among individuals with chronic MSK pain given the limitations of the observational design and matching on only available covariates.
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Affiliation(s)
- Grace Wang
- Clinical Research, Hinge Health, Inc, San Francisco, CA, USA
| | - Louie Lu
- Clinical Research, Hinge Health, Inc, San Francisco, CA, USA
| | - Laura S Gold
- Clinical Learning, Evidence and Research Center, University of Washington, Seattle, WA, USA
| | - Jeannie F Bailey
- Orthopaedic Surgery, University of California, San Francisco, CA, USA
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11
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Cui D, Janela D, Costa F, Molinos M, Areias AC, Moulder RG, Scheer JK, Bento V, Cohen SP, Yanamadala V, Correia FD. Randomized-controlled trial assessing a digital care program versus conventional physiotherapy for chronic low back pain. NPJ Digit Med 2023; 6:121. [PMID: 37420107 DOI: 10.1038/s41746-023-00870-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Low back pain (LBP) is the world's leading cause of years lived with disability. Digital exercise-based interventions have shown great potential in the management of musculoskeletal conditions, promoting access and easing the economic burden. However, evidence of their effectiveness for chronic LBP (CLBP) management compared to in-person physiotherapy has yet to be unequivocally established. This randomized controlled trial (RCT) aims to compare the clinical outcomes of patients with CLBP following a digital intervention versus evidence-based in-person physiotherapy. Our results demonstrate that patient satisfaction and adherence were high and similar between groups, although a significantly lower dropout rate is observed in the digital group (11/70, 15.7% versus 24/70, 34.3% in the conventional group; P = 0.019). Both groups experience significant improvements in disability (primary outcome), with no differences between groups in change from baseline (median difference: -0.55, 95% CI: -2.42 to 5.81, P = 0.412) or program-end scores (-1.05, 95% CI: -4.14 to 6.37; P = 0.671). Likewise, no significant differences between groups are found for secondary outcomes (namely pain, anxiety, depression, and overall productivity impairment). This RCT demonstrates that a remote digital intervention for CLBP can promote the same levels of recovery as evidence-based in-person physiotherapy, being a potential avenue to ease the burden of CLBP.
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Affiliation(s)
- Di Cui
- Physical and Rehabilitation Medicine, Emory University, Atlanta, GA, Georgia
| | | | | | | | | | - Robert G Moulder
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | - Steven P Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Vijay Yanamadala
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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12
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Livingston CJ, Gray M, LaForge K, Choo EK. A cross-sectional survey exploring clinician perceptions of a novel Medicaid back pain policy. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:438-446. [PMID: 36306465 PMCID: PMC11302735 DOI: 10.1515/jcim-2022-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Oregon Medicaid (Oregon Health Plan, or OHP) implemented an innovative policy in 2016 that increased coverage of evidence-based non-pharmacologic therapies (NPT, including physical therapy, massage, chiropractic, and acupuncture) while restricting opioids, epidural steroid injections, and surgeries. The objective of this study was to compare the perspectives of clinicians who see back pain patients and can prescribe pharmacologic therapies and/or refer to NPTs and clinicians who directly provide NPT therapies affected by the policy. METHODS A cross-sectional online survey was administered to Oregon prescribing clinicians and NPT clinicians between December 2019 and February 2020. The survey was completed by 107 prescribing clinicians and 83 NPT clinicians. RESULTS Prescribing clinicians and NPT clinicians had only moderate levels of familiarity with core elements of the policy. Prescribing clinicians had higher levels of frustration caring for OHP patients with back pain than NPT clinicians (83 vs. 34%, p<0.001) and were less confident in their ability to provide effective care (73 vs. 85%, p = .025). Eighty-six percent of prescribing clinicians and 83% of NPT clinicians thought active NPT treatments were effective; 74 and 70% thought passive NPT treatments were effective. Forty percent of prescribing clinicians and 25% of NPT clinicians (p<0.001) thought medically-light therapies were effective, while 29% of prescribing clinicians and 10% of NPT clinicians thought medically-intensive treatments were effective (p=0.001). Prescribing clinicians thought increased access to NPTs improved outcomes, while opinions were less consistent on the impact of restricting opioid prescribing. CONCLUSIONS Prescribing clinicians and NPT clinicians had varying perspectives of a Medicaid coverage policy to increase evidence-based back pain care. Understanding these perspectives is important for contextualizing policy effectiveness.
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Affiliation(s)
- Catherine J. Livingston
- Department of Family Medicine, Oregon Health & Science University, 3930 SE Division Street, Portland, Oregon, 97202, USA
| | | | | | - Esther K. Choo
- Department of Emergency Medicine, Oregon Health & Science University, OR, USA
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13
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Salm DC, Horewicz VV, Tanaka F, Ferreira JK, de Oliveira BH, Maio JMB, Donatello NN, Ludtke DD, Mazzardo-Martins L, Dutra AR, Mack JM, de C H Kunzler D, Cargnin-Ferreira E, Salgado ASI, Bittencourt EB, Bianco G, Piovezan AP, Bobinski F, Moré AOO, Martins DF. Electrical Stimulation of the Auricular Branch Vagus Nerve Using Random and Alternating Frequencies Triggers a Rapid Onset and Pronounced Antihyperalgesia via Peripheral Annexin A1-Formyl Peptide Receptor 2/ALX Pathway in a Mouse Model of Persistent Inflammatory Pain. Mol Neurobiol 2023; 60:2889-2909. [PMID: 36745336 DOI: 10.1007/s12035-023-03237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
This study evaluated the antihyperalgesic and anti-inflammatory effects of percutaneous vagus nerve electrical stimulation (pVNS) by comparing the effects of alternating and random frequencies in an animal model of persistent inflammatory hyperalgesia. The model was induced by Freund's complete adjuvant (CFA) intraplantar (i.pl.) injection. Mice were treated with different protocols of time (10, 20, or 30 min), ear laterality (right, left or both), and frequency (alternating or random). Mechanical hyperalgesia was evaluated, and some groups received i.pl. WRW4 (FPR2/ALX antagonist) to determine the involvement. Edema, paw surface temperature, and spontaneous locomotor activity were evaluated. Interleukin-1β, IL-6, IL-10, and IL4 levels were verified by enzyme-linked immunosorbent assay. AnxA1, FPR2/ALX, neutrophil, M1 and M2 phenotype macrophage, and apoptotic cells markers were identified using western blotting. The antihyperalgesic effect pVNS with alternating and random frequency effect is depending on the type of frequency, time, and ear treated. The pVNS random frequency in the left ear for 10 min had a longer lasting antihyperalgesic effect, superior to classical stimulation using alternating frequency and the FPR2/ALX receptor was involved in this effect. There was a reduction in the levels of pro-inflammatory cytokines and an increase in the immunocontent of AnxA1 and CD86 in mice paw. pVNS with a random frequency in the left ear for 10 min showed to be optimal for inducing an antihyperalgesic effect. Thus, the random frequency was more effective than the alternating frequency. Therefore, pVNS may be an important adjunctive treatment for persistent inflammatory pain.
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Affiliation(s)
- Daiana C Salm
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Verônica V Horewicz
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Fernanda Tanaka
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Júlia K Ferreira
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Bruna H de Oliveira
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Julia Maria Batista Maio
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Nathalia N Donatello
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Daniela D Ludtke
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Leidiane Mazzardo-Martins
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Aline R Dutra
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Josiel M Mack
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Deborah de C H Kunzler
- Department of Physiotherapy, State University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | | | | | | | - Gianluca Bianco
- Research Laboratory of Posturology and Neuromodulation RELPON, Department of Human Neuroscience, Sapienza University, Rome, Italy
- Istituto Di Formazione in Agopuntura E Neuromodulazione IFAN, Rome, Italy
| | - Anna Paula Piovezan
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Franciane Bobinski
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
| | - Ari O O Moré
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil
- Integrative Medicine and Acupuncture Division, University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Daniel F Martins
- Experimental Neuroscience Laboratory (LaNEx), University of South Santa Catarina, Palhoça, Santa Catarina, Brazil.
- Postgraduate Program in Health Sciences, University of South Santa Catarina, Palhoça, Santa Catarina, Brazil.
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14
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Smith T, Mansfield M, Hanson S, Welsh A, Khoury R, Clark A, Dures E, Adams J. Caregiving for older people living with chronic pain: analysis of the English longitudinal study of ageing and health survey for England. Br J Pain 2022; 17:166-181. [PMID: 37057251 PMCID: PMC10088417 DOI: 10.1177/20494637221144250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Chronic pain is a disabling condition. Many people with chronic pain seek informal support for everyday activities of daily living (ADL). However, there remains uncertainty on the type of people with chronic pain who access this support, what types of support they need and who provides such support. The purpose of this analysis was to answer these uncertainties. Methods Data from the Health Survey for England (HSE) and English Longitudinal Study of Ageing (ELSA) were accessed. People who reported chronic pain (moderate or above for minimum of 12 months) were identified. From these cohorts, we determined if individuals self-reported receiving informal care. Data on caregiver profiles and caregiving activities were reported through descriptive statistics. Logistic regression analyses were performed to compare health status outcomes between people with pain who received and who did not receive informal care. Results 2178 people with chronic pain from the ELSA cohort and 571 from the HSE cohort were analysed. People who received care were frequently female, older aged with several medical morbidities including musculoskeletal diseases such as arthritis. People with chronic pain received informal care for several diverse tasks. Most frequently these related to instrumental activities of daily living (IADL) such as shopping and housework. They were most frequently provided by partners or their children. Although they reported greater disability and symptoms ( p < 0.001), people who received care did not report differences in health status, loneliness or wellbeing ( p = 0.27; p = 0.46). Conclusions Whilst it may be possible to characterise people living in chronic pain who receive informal care, there is some uncertainty on the impact of informal caregiving on their health and wellbeing. Consideration should now be made on how best to support both care recipients and informal caregivers, to ensure their health and quality of life is promoted whilst living with chronic pain.
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Affiliation(s)
- Toby Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Mansfield
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Sarah Hanson
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allan Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Emma Dures
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Jo Adams
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School of Health Sciences, University of Southampton, Southampton, UK
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15
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Pritchard KT, Baillargeon J, Lee WC, Raji MA, Kuo YF. Trends in the Use of Opioids vs Nonpharmacologic Treatments in Adults With Pain, 2011-2019. JAMA Netw Open 2022; 5:e2240612. [PMID: 36342717 PMCID: PMC9641539 DOI: 10.1001/jamanetworkopen.2022.40612] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
IMPORTANCE Chronic pain prevalence among US adults increased between 2010 and 2019. Yet little is known about trends in the use of prescription opioids and nonpharmacologic alternatives in treating pain. OBJECTIVES To compare annual trends in the use of prescription opioids, nonpharmacologic alternatives, both treatments, and neither treatment; compare estimates for the annual use of acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy; and estimate the association between calendar year and pain treatment based on the severity of pain interference. DESIGN, SETTING, AND PARTICIPANTS A serial cross-sectional analysis was conducted using the nationally representative Medical Expenditure Panel Survey to estimate the use of outpatient services by cancer-free adults with chronic or surgical pain between calendar years 2011 and 2019. Data analysis was performed from December 29, 2021, to August 5, 2022. EXPOSURES Calendar year (2011-2019) was the primary exposure. MAIN OUTCOMES AND MEASURES The association between calendar year and mutually exclusive pain treatments (opioid vs nonpharmacologic vs both vs neither treatment) was examined. A secondary outcome was the prevalence of nonpharmacologic treatments (acupuncture, chiropractic care, massage therapy, occupational therapy, and physical therapy). All analyses were stratified by pain type. RESULTS Among the unweighted 46 420 respondents, 9643 (20.4% weighted) received surgery and 36 777 (79.6% weighted) did not. Weighted percentages indicated that 41.7% of the respondents were aged 45 to 64 years and 55.0% were women. There were significant trends in the use of pain treatments after adjusting for demographic factors, socioeconomic status, health conditions, and pain severity. For example, exclusive use of nonpharmacologic treatments increased in 2019 for both cohorts (chronic pain: adjusted odds ratio [aOR], 2.72; 95% CI, 2.30-3.21; surgical pain: aOR, 1.53; 95% CI, 1.13-2.08) compared with 2011. The use of neither treatment decreased in 2019 for both cohorts (chronic pain: aOR, 0.43; 95% CI, 0.37-0.49; surgical pain: aOR, 0.59; 95% CI, 0.46-0.75) compared with 2011. Among nonpharmacologic treatments, chiropractors and physical therapists were the most common licensed healthcare professionals. CONCLUSIONS AND RELEVANCE Among cancer-free adults with pain, the annual prevalence of nonpharmacologic pain treatments increased and the prevalent use of neither opioids nor nonpharmacologic therapy decreased for both chronic and surgical pain cohorts. These findings suggest that, although access to outpatient nonpharmacologic treatments is increasing, more severe pain interference may inhibit this access.
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Affiliation(s)
- Kevin T. Pritchard
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Jacques Baillargeon
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston
| | - Wei-Chen Lee
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston
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16
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Job-Related Performance and Quality of Life Benefits in First Responders Given Access to H-Wave ® Device Stimulation: A Retrospective Cohort Study. J Pers Med 2022; 12:jpm12101674. [PMID: 36294813 PMCID: PMC9605355 DOI: 10.3390/jpm12101674] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Current chronic pain treatments primarily target symptoms and are often associated with harmful side-effects and complications, while safer non-invasive electrotherapies like H-Wave® device stimulation (HWDS) have been less explored. The goal of this study is to evaluate first responder-reported effects of HWDS on job-related and quality-of-life measures. This is a retrospective cohort study where first responders were surveyed following voluntary use of HWDS regarding participant experience, frequency of use, job-related performance, and quality-of-life. Responses were analyzed using means comparison tests, while bivariate analysis assessed responses associated with HWDS usage. Overall, 92.9% of first responder HWDS users (26/28) reported a positive experience (p < 0.0001), with 82.1% citing pain reduction (p = 0.0013), while 78.6% indicated it would be beneficial to have future device access (p = 0.0046). Participants using H-Wave® were at least six times more likely to report higher rates of benefit (100% vs. 0%, p = 0.022), including pain reduction (91.3% vs. 8.7%, p = 0.021) and improved range-of-motion (93.3% vs. 69.2%, p = 0.044). Spending more time with family was associated with better job performance following frequent HWDS use (50% vs. 8.3%, p = 0.032). Repetitive first responder H-Wave® use, with minimal side effects and easy utilization, resulted in significant pain reduction, improvements in job performance and range-of-motion, and increased time spent with family, resulting in overall positive experiences and health benefits. Level of Evidence: III.
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17
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Huang Y, Lyu N, Gohil S, Bapat S, Essien EJ, Thornton JD. Intention to get naloxone among patients prescribed opioids for chronic pain. Harm Reduct J 2022; 19:104. [PMID: 36138420 PMCID: PMC9502607 DOI: 10.1186/s12954-022-00687-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prescription opioids have been increasingly prescribed for chronic pain while the opioid-related death rates grow. Naloxone, an opioid antagonist, is increasingly recommended in these patients, yet there is limited research that investigates the intention to get naloxone. This study aimed to investigate intention toward getting naloxone in patients prescribed opioids for chronic pain and to assess the predictive utility of the theory of reasoned action (TRA) constructs in explaining intention to get naloxone. METHODS This was a cross-sectional study of a panel of U.S. adult patients prescribed opioids for chronic pain using a Qualtrics®XM survey. These patients participated in the study during February to March 2020. The online internet survey assessed the main outcome of intention to get naloxone and constructs of TRA (attitudes and subjective norms); additional measures assessed the characteristics of patients' opioid overdose risk factors, knowledge of naloxone, and their demographics. The relationship between TRA constructs, namely, attitudes and subjective norms, and the intention variable was examined using logistic regression analyses with the intention outcome contrasted as follows: high intention (scores ≥ 5) and non-high intention (scores < 5). RESULTS A total of 549 participants completed the survey. Most of them were female (53.01%), White or Caucasian (83.61%), non-Hispanic (87.57%) and had a mean age of 44.16 years (SD = 13.37). Of these, 167 (30.42%) had high intention to get naloxone. The TRA construct of subjective norm was significantly associated with increased likelihood of higher intentions to get naloxone (OR 3.04, 95% CI 2.50-3.70, P < 0.0001). CONCLUSIONS Our study provides empirical support of the TRA in predicting intention to get naloxone among chronic pain patients currently taking opioids. Subjective norms significantly predicted intention to get naloxone in these patients. The interventions targeting important reference groups of these patients would have greater impact on increasing intention to get naloxone in this population. Future studies should test whether theory-based interventions focusing on strengthening subjective norms increase intention to get naloxone in this population.
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Affiliation(s)
- Yinan Huang
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204
| | - Ning Lyu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204
| | - Shrey Gohil
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204
| | - Shweta Bapat
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204
| | - E James Essien
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4349 Martin Luther King Boulevard, Room 9045, Houston, USA, TX, 77204. .,Prescription Drug Misuse Education and Research (PREMIER) Center, College of Pharmacy, University of Houston, Houston, TX, USA.
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18
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Duca LM, Helmick CG, Barbour KE, Nahin RL, Von Korff M, Murphy LB, Theis K, Guglielmo D, Dahlhamer J, Porter L, Falasinnu T, Mackey S. A Review of Potential National Chronic Pain Surveillance Systems in the United States. THE JOURNAL OF PAIN 2022; 23:1492-1509. [PMID: 35421595 PMCID: PMC9464678 DOI: 10.1016/j.jpain.2022.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/05/2022] [Accepted: 02/24/2022] [Indexed: 04/19/2023]
Abstract
Pain has been established as a major public health problem in the United States (U.S.) with 50 million adults experiencing chronic pain and 20 million afflicted with high-impact chronic pain (ie, chronic pain that interferes with life or work activities). High financial and social costs are associated with chronic pain. Over the past 2 decades, pain management has been complicated by the marked increase in opioids prescribed to treat chronic noncancer pain and by the concurrent opioid crisis. Monitoring the prevalence of chronic pain and pain management is especially important because pain management is changing in uncertain ways. We review potential U.S. chronic pain surveillance systems, present potential difficulties of chronic pain surveillance, and explore how to address chronic pain surveillance in the current opioid era. We consider case definitions, severity, anatomic site, and varieties of chronic pain management strategies in reviewing and evaluating national surveys for chronic pain surveillance. Based on the criteria evaluated, the National Health Interview Survey offers the best single source for pain surveillance as the pain-related questions administered are brief, valid, and cover a broad scope of pain-related phenomena. PERSPECTIVE: This review article describes data sources that can be leveraged to conduct national chronic pain surveillance in the United States, explores case defining or pain-related questions administered, and evaluates them against 8 surveillance attributes.
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Affiliation(s)
- Lindsey M Duca
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Charles G Helmick
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Richard L Nahin
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, Maryland
| | - Michael Von Korff
- Kaiser Permanente Washington, Health Research Institute, Seattle, Washington
| | - Louise B Murphy
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristina Theis
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Guglielmo
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - James Dahlhamer
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Linda Porter
- National Institutes of Health, Director of the Office of Pain Policy, Bethesda, Maryland
| | - Titilola Falasinnu
- Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Sean Mackey
- Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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19
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Scott R, Nahin RL, Sussman BJ, Feinberg T. Physician Office Visits That Included Complementary Health Approaches in U.S. Adults: 2005-2015. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:641-650. [PMID: 35559729 PMCID: PMC9467635 DOI: 10.1089/jicm.2021.0331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Introduction: The Institute of Medicine has described the need for comparing models of care delivery involving complementary health approaches and conventional medical practitioners. As a step toward addressing this need, we used a nationally representative 11-year sample of office-based visits to physicians from the National Ambulatory Medical Care Survey (NAMCS), to examine a comprehensive list of factors believed to be associated with visits where complementary health approaches were recommended or provided. Methods: NAMCS is a national health care survey designed to collect data on the provision and use of ambulatory medical care services provided by office-based physicians in the United States. Patient medical records were abstracted from a random sample of office-based physician visits. We examined several visit characteristics, including patient demographics, physician specialty, documented health conditions, and reasons for health visit. We ran chi-square analyses to test bivariate associations between visit factors and whether complementary health approaches were recommended or provided to guide development of logistic regression models. Results: Of the 550,114 office visits abstracted, 4.43% contained a report that complementary health approaches were ordered, supplied, administered, or continued. Among complementary health visits, 87% of patient charts mentioned nonvitamin nonmineral dietary supplements. The prevalence of complementary health visits significantly increased from 2% in 2005 to almost 8% in 2015. Returning patient status, survey year, physician specialty and degree, menopause, cardiovascular, and musculoskeletal diagnoses were significantly associated with complementary health visits, as was seeking preventative care or care for a chronic problem. Conclusion: We present an overview of the first study of office-based physician visits where complementary health approaches were recommended or ordered to their patients. These data confirm the growing popularity of complementary health approaches in the United States, provide a baseline for further studies, and inform subsequent investigations of integrative health care.
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Affiliation(s)
- Remle Scott
- Kelly Government Solutions, Rockville, MD, USA
| | - Richard L. Nahin
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
| | - Barbara J. Sussman
- National Center for Complementary and Integrative Health (NCCIH), National Institutes of Health, Bethesda, MD, USA
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20
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Magel J, Kietrys D, Kruger ES, Fritz JM, Gordon AJ. Physical therapists should play a greater role in managing patients with opioid use and opioid misuse. Subst Abus 2021; 42:255-260. [PMID: 34524070 DOI: 10.1080/08897077.2021.1971818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The U.S. opioid crisis necessitates that health care providers of all types work collaboratively to manage patients taking prescription opioid medications and manage those who may be misusing prescription opioids. Musculoskeletal conditions are the most common diagnoses associated with an opioid prescription. Physical therapists commonly manage patients with musculoskeletal conditions and chronic pain. Some patients who attend physical therapy for pain management take prescription opioid medications for pain and some of these patients may be misusing prescription opioids. Physical therapists who manage patients with musculoskeletal conditions are well-positioned to help address the opioid crisis. Historically, physical therapists have not been adequately engaged in efforts to manage persons with co-occurring musculoskeletal pain and opioid misuse or OUD. The American Physical Therapy Association (APTA) has emphasized physical therapy over the use of prescription opioids for the management of painful conditions. The APTA, however, does not highlight the important role that physical therapists could play in monitoring opioid use among patients receiving treatment for pain, nor the role that physical therapists should play in screening for opioid misuse. Such screening could facilitate referral of patients suspected misuse to an appropriate provider for formal assessment and treatment. This commentary presents simulated musculoskeletal patient presentations depicting 2 common opioid use states; chronic opioid use and opioid misuse. The cases highlight and interactions that physical therapists could have with these patients and actions that the physical therapist could take when working inter-disciplinarily. Recommendations are provided that aim to increase physical therapists' knowledge and skills related to managing patients taking prescription opioid medications for pain.
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Affiliation(s)
- John Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - David Kietrys
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ, USA
| | - Eric S Kruger
- School of Medicine, Department of Orthopaedics and Rehabiliation, Division of Physical Therapy, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
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21
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George SZ, Lentz TA, Goertz CM. Back and neck pain: in support of routine delivery of non-pharmacologic treatments as a way to improve individual and population health. Transl Res 2021; 234:129-140. [PMID: 33901699 PMCID: PMC8340679 DOI: 10.1016/j.trsl.2021.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
Chronic back and neck pain are highly prevalent conditions that are among the largest drivers of physical disability and cost in the world. Recent clinical practice guidelines recommend use of non-pharmacologic treatments to decrease pain and improve physical function for individuals with back and neck pain. However, delivery of these treatments remains a challenge because common care delivery models for back and neck pain incentivize treatments that are not in the best interests of patients, the overall health system, or society. This narrative review focuses on the need to increase use of non-pharmacologic treatment as part of routine care for back and neck pain. First, we present the evidence base and summarize recommendations from clinical practice guidelines regarding non-pharmacologic treatments. Second, we characterize current use patterns for non-pharmacologic treatments and identify potential barriers to their delivery. Addressing these barriers will require coordinated efforts from multiple stakeholders to prioritize evidence-based non-pharmacologic treatment approaches over low value care for back and neck pain. These stakeholders include patients, health care providers, health care organizations, administrators, payers, policymakers and researchers.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Trevor A Lentz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Christine M Goertz
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, North Carolina
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22
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Volinn E, Loeser JD. Upsurges in the joblessness and opioid epidemics in the United States after the COVID-19 epidemic: the plight of the jobless patient in the clinic. Pain 2021; 162:1608-1611. [PMID: 33657577 DOI: 10.1097/j.pain.0000000000002253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ernest Volinn
- Department of Sociology, University of Utah, Salt Lake City, UT, United States
| | - John D Loeser
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
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23
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George SZ, Giczewska A, Alhanti B, Lutz AD, Shanley E, Thigpen CA, Bhavsar NA. Predicting Recurrent Care Seeking of Physical Therapy for Musculoskeletal Pain Conditions. PAIN MEDICINE 2021; 22:1837-1849. [PMID: 33905514 DOI: 10.1093/pm/pnab154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Musculoskeletal pain conditions are a leading cause of pain and disability internationally and a common reason to seek health care. Accurate prediction of recurrence of health care seeking due to musculoskeletal conditions could allow for better tailoring of treatment. The aim of this project was to characterize patterns of recurrent physical therapy seeking for musculoskeletal pain conditions and to develop a preliminary prediction model to identify those at increased risk of recurrent care seeking. DESIGN Retrospective cohort. SETTING Ambulatory care. SUBJECTS Patients (n = 578,461) seeking outpatient physical therapy (United States). METHODS Potential predictor variables were extracted from the electronic medical record, and patients were placed into three different recurrent care categories. Logistic regression models were used to identify individual predictors of recurrent care seeking, and the least absolute shrinkage and selection operator (LASSO) was used to develop multivariate prediction models. RESULTS The accuracy of models for different definitions of recurrent care ranged from 0.59 to 0.64 (c-statistic), and individual predictors were identified from multivariate models. Predictors of increased risk of recurrent care included receiving workers' compensation and Medicare insurance, having comorbid arthritis, being postoperative at the time of the first episode, age range of 44-64 years, and reporting night sweats or night pain. Predictors of decreased risk of recurrent care included lumbar pain, chronic injury, neck pain, pregnancy, age range of 25-44 years, and smoking. CONCLUSION This analysis identified a preliminary predictive model for recurrence of care seeking of physical therapy, but model accuracy needs to improve to better guide clinical decision-making.
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Affiliation(s)
- Steven Z George
- Department of Orthopaedic Surgery.,Duke Clinical Research Institute
| | | | | | - Adam D Lutz
- ATI Physical Therapy, Chicago, Illinois, USA
| | | | | | - Nrupen A Bhavsar
- Division of General Internal Medicine, Duke University, Durham, North Carolina
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24
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Physical therapy and opioid use for musculoskeletal pain management: competitors or companions? Pain Rep 2020; 5:e827. [PMID: 33490834 PMCID: PMC7808685 DOI: 10.1097/pr9.0000000000000827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/29/2022] Open
Abstract
Existing evidence is reviewed and gaps in the literature are identified to better understand how physical therapy has been used to provide exposure to nonpharmacological treatments. Musculoskeletal (MSK) pain conditions are highly prevalent and a leading cause of disability globally. When people with MSK pain seek health care, they often receive treatment not aligned with best practices, including initial management options such as opioids. In recent practice guidelines, nonpharmacological treatments have been emphasized for initial pain management, and physical therapists are providers who routinely deliver nonpharmacological treatments. The purpose of this review is to describe the current and future state for how physical therapy may be used to increase exposure to nonpharmacological treatments for MSK pain conditions. For the current state, we review existing observational evidence investigating early exposure to physical therapy and its influence on subsequent opioid use. For the future state, we propose clinical research questions that could define the role of physical therapy on interdisciplinary teams working towards improving effectiveness of nonpharmacological treatments through more rigorous study designs. These clinical questions are intended to guide health services research and clinical trials when building an evidence base of nonpharmacological care options for MSK pain conditions.
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