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Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain

      Abstract

      Objective

      To determine whether the initial care provider for neck pain was associated with opioid use for individuals with neck pain.

      Design

      Retrospective cohort study.

      Setting

      Marketscan research databases.

      Participants

      Patients (N=427,966) with new-onset neck pain from 2010-2014.

      Main Outcome Measures

      Opioid use was defined using retail pharmacy fills. We performed logistic regression analysis to assess the association between initial provider and opioid use. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using bootstrapping logistic models. We performed propensity score matching as a robustness check on our findings.

      Results

      Compared to patients with neck pain who saw a primary health care provider, patients with neck pain who initially saw a conservative therapist were 72%-91% less likely to fill an opioid prescription in the first 30 days, and between 41%-87% less likely to continue filling prescriptions for 1 year. People with neck pain who initially saw emergency medicine physicians had the highest odds of opioid use during the first 30 days (OR, 3.58; 95% CI, 3.47-3.69; P<.001).

      Conclusions

      A patient’s initial clinical contact for neck pain may be an important opportunity to influence subsequent opioid use. Understanding more about the roles that conservative therapists play in the treatment of neck pain may be key in unlocking new ways to lessen the burden of opioid use in the United States.

      Keywords

      List of abbreviations:

      CI (confidence interval), HMO (health maintenance organization), ICD (International Classification of Diseases), OR (odds ratio), PCP (primary care provider), PPO (preferred provider organization), PWNP (people with neck pain)
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      References

        • Cohen S.P.
        Epidemiology, diagnosis, and treatment of neck pain.
        Mayo Clin Proc. 2015; 90: 284-299
        • Murray C.J.
        • Atkinson C.
        • Bhalla K.
        • et al.
        The state of US health, 1990-2010: burden of diseases, injuries, and risk factors.
        JAMA. 2013; 310: 591-608
        • Dieleman J.L.
        • Baral R.
        • Birger M.
        • et al.
        US spending on personal health care and public health, 1996-2013.
        JAMA. 2016; 316: 2627-2646
        • Davis M.A.
        • Onega T.
        • Weeks W.B.
        • Lurie J.D.
        Where the United States spends its spine dollars.
        Spine. 2012; 37: 1693-1701
        • Weeks W.B.
        • Goertz C.M.
        • Long C.R.
        • Meeker W.C.
        • Marchiori D.M.
        Association among opioid use, treatment preferences, and perceptions of physician treatment recommendations in patients with neck and back pain.
        J Manipulative Physiol Ther. 2018; 41: 175-180
        • Fischbein R.
        • Mccormick K.
        • Selius B.A.
        • et al.
        The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network.
        Prim Health Care Res Dev. 2014; 16: 461-469
        • Vowles K.E.
        • McEntee M.L.
        • Julnes P.S.
        • Frohe T.
        • Ney J.P.
        • van der Goes D.N.
        Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis.
        Pain. 2015; 156: 569-576
        • Dowell D.
        • Haegerich T.M.
        • Chou R.
        CDC guideline for prescribing opioids for chronic pain—United States, 2016.
        JAMA. 2016; 315: 1624-1645
        • Qaseem A.
        • Wilt T.J.
        • McLean R.M.
        • Forciea M.A.
        Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians.
        Ann Intern Med. 2017; 166: 514-530
        • Centers for Disease Control and Prevention
        Opioid overdose drug overdose deaths.
        (Available at:)
        • Fritz J.M.
        • Kim J.
        • Dorius J.
        Importance of the type of provider seen to begin health care for a new episode low back pain: associations with future utilization and costs.
        J Eval Clin Pract. 2015; 22: 247-252
        • Frogner B.K.
        • Harwood K.
        • Andrilla C.H.
        • Schwartz M.
        • Pines J.M.
        Physical therapy as the first point of care to treat low back pain: an instrumental variables approach to estimate impact on opioid prescription, health care utilization, and costs.
        Health Serv Res. 2018; 53: 4629-4646
        • Horn M.E.
        • George S.Z.
        • Fritz J.M.
        Influence of initial provider on health care utilization in patients seeking care for neck pain.
        Mayo Clin Proc Innov Qual Outcomes. 2017; 1: 226-233
        • Sun E.
        • Moshfegh J.
        • Rishel C.A.
        • Cook C.E.
        • Goode A.P.
        • George S.Z.
        Association of early physical therapy with long-term opioid use among opioid-naive patients with musculoskeletal pain.
        JAMA Netw Open. 2018; 1e185909
        • Feudtner C.
        • Hexem K.R.
        • Shabbout M.
        • Feinstein J.A.
        • Sochalski J.
        • Silber J.H.
        Prediction of pediatric death in the year after hospitalization: a population-level retrospective cohort study.
        J Palliat Med. 2009; 12: 160-169
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Ensrud K.E.
        • Lui L.Y.
        • Langsetmo L.
        • et al.
        Effects of mobility and multimorbidity on inpatient and postacute health care utilization.
        J Gerontol A Biol Sci Med Sci. 2017; 73: 1343-1349
        • Chu Y.T.
        • Ng Y.Y.
        • Wu S.C.
        Comparison of different comorbidity measures for use with administrative data in predicting short- and long-term mortality.
        BMC Health Serv Res. 2010; 10: 140
        • Baldwin L.M.
        • Klabunde C.N.
        • Green P.
        • Barlow W.
        • Wright G.
        In search of the perfect comorbidity measure for use with administrative claims data.
        Med Care. 2006; 44: 745-753
        • Schneeweiss S.
        • Avorn J.
        A review of uses of health care utilization databases for epidemiologic research on therapeutics.
        J Clin Epidemiol. 2005; 58: 323-337
        • McKenizie D.A.
        The validity of Medicaid pharmacy claims for estimating drug use among elderly nursing home residents: the Oregon experience.
        J Clin Epidemiol. 2000; 53: 1248-1257
        • Kazis L.E.
        • Ameli O.
        • Rothendler J.
        • et al.
        Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use.
        BMJ Open. 2019; 9e028633
        • Korff M.V.
        • Kolodny A.
        • Deyo R.A.
        • Chou R.
        Long-term opioid therapy reconsidered.
        Ann Intern Med. 2011; 155: 325-328
        • Chou R.
        • Turner J.A.
        • Devine E.B.
        • et al.
        The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop.
        Ann Intern Med. 2015; 162: 276-286
        • SAS Support
        Jackknife and bootstrap analyses.
        (Available at:)
        http://support.sas.com/kb/24/982.html
        Date accessed: November 6, 2018
        • Louis C.J.
        • Clark J.R.
        • Hillemeier M.M.
        • Camacho F.
        • Yao N.
        • Anderson R.T.
        The effects of hospital characteristics on delays in breast cancer diagnosis in Appalachian communities: a population-based study.
        J Rural Health. 2017; 34: s91-s103
        • Barnett M.L.
        • Olenski A.R.
        • Jena A.B.
        Opioid prescribing by emergency physicians and risk of long-term use.
        N Engl J Med. 2017; 376: 1895-1896
        • Hoppe J.A.
        • Nelson L.S.
        • Perrone J.
        • et al.
        Opioid prescribing in a cross section of US emergency departments.
        Ann Emerg Med. 2015; 66: 253-259
        • Portal D.A.
        • Healy M.E.
        • Satz W.A.
        • Mcnamara R.M.
        Impact of an opioid prescribing guideline in the acute care setting.
        J Emerg Med. 2016; 50: 21-27
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Kaiser Family Foundation
        Health insurance coverage of the total population.
        (Available at:)