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

https://doi.org/10.1016/j.apmr.2020.04.002Get rights and content

Abstract

Objective

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

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.

Section snippets

Data source and cohort development

Using claims data from the Marketscana research databases (2009-2016), we identified a sample of opioid-naïve patients with a primary, outpatient neck pain diagnosis between 2010 and 2014 (fig 1). The Marketscan research databases contain fully adjudicated medical and prescription drug claims from large, self-insured employers. These employers subcontract administration of their preferred provider organization (PPO), point of service plan, health maintenance organization (HMO), high-deductible

Results

A total 427,966 individuals met all inclusion criteria and had a new-onset, neck pain diagnosis during the study period (see fig 1). Table 1 indicates that over 40% of the study sample saw a chiropractor for their initial neck pain visit (n=178,705), with the next most frequent initial provider being a PCP (n=121,817). PWNP who saw PCPs were significantly younger than the PWNP who saw clinician specialists (see supplemental appendix S2, supplemental table S3). Table 1 reports the share of

Discussion

We examined whether the initial provider for new-onset neck pain was associated with opioid use in the year following diagnosis. We found that more than 49% of PWNP who used opioids during the study period used opioids within 3 days of their diagnosis. Further, we also found that PWNP who received their initial diagnosis from conservative therapists had lower odds of short- and long-term opioid use compared to PNWP who were initially diagnosed by PCPs. Conversely, PWNP who received their

Conclusions

Our study found that the type of initial provider for neck pain was associated with subsequent opioid use. The initial clinical contact for a patient seeking care for neck pain may be an important opportunity to influence subsequent opioid use. Clinician leaders concerned with short-term opioid prescribing may wish to consider developing policies to help emergency department clinicians and specialists determine when patients might benefit from alternatives to opioids. Understanding more about

Suppliers

  • a.

    Marketscan Research Databases; IBM Corp.

  • b.

    Elixhauser Comorbidity Index software; Healthcare Cost and Utilization Project (HCUP).

  • c.

    Stata, version 14.2; StataCorp.

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  • Cited by (5)

    • Association Between Chiropractic Utilization and Opioid Prescriptions Among People With Back or Neck Pain: Evaluation of the Medical Expenditure Panel Survey

      2022, Journal of Manipulative and Physiological Therapeutics
      Citation Excerpt :

      A 2020 retrospective cohort study of health claims data from 3 states found chiropractic recipients (who also saw primary care providers for spinal pain) had half the risk of filling an opioid prescription than nonchiropractic recipients.20 Another 2020 retrospective cohort study of commercial insurance enrollees found patients with outpatient neck pain who initially saw a chiropractor had 0.16 times the odds of an opioid prescription fill within 1 year compared to those who initially saw a primary care provider (95% CI, 0.14-0.18).21 Our study results are also similar to the meta-analysis findings reported in 2019 by Corcoran et al (OR, 0.36; 95% CI, 0.3-0.43).5

    Disclosures: none.

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