Use of chiropractors and occupational, physical therapy for low back pain uncommon, despite guidelines
While clinical practice guidelines encourage nonpharmacologic treatments as first-line therapy for low back pain, fewer than a third of patients used chiropractic care or occupational or physical therapy for this problem in 2002 to 2018.
Fewer than one-third of adults with low back pain reported using chiropractic care or occupational or physical therapy (OT/PT) between 2016 and 2018, a study found.
Researchers conducted a serial cross-sectional analysis of the National Health Interview Survey from 2002 to 2018 among 146,087 adults reporting low back pain in the previous three months.
The goal of the study was to evaluate the association of survey year with patient reports of using chiropractic care or OT/PT in prior 12 months, as well as trends in use by age, sex, race, and ethnicity. The study authors noted that ACP guidelines on the subject endorsed nonpharmacologic treatments (e.g., massage, therapeutic exercise, spinal manipulation) as evidence-based second-line therapy in 2007 and then as first-line therapy in 2017. CDC guidelines on opioid prescribing in 2016 similarly supported nonpharmacologic treatments. Results of the study were published Oct. 19 in the Journal of General Internal Medicine.
From 2002 to 2018, fewer than one-third of adults with low back pain reported use of either chiropractic care or OT/PT. Rates did not change until 2016 (odds ratio [OR] for 2016–2018 vs. 2002–2015, 1.15; 95% CI, 1.10 to 1.19). Younger adults saw larger increases in use of chiropractic care or OT/PT services than older adults after 2016. Racial and ethnic disparities in chiropractic care or OT/PT use persisted over the study period. For example, compared to non-Hispanic adults, use of chiropractic care or OT/PT use was lower among Hispanic adults (combined OR, 0.62; 95% CI, 0.65 to 0.73). Compared to White adults, Black adults had similar OT/PT use (OR, 0.98; 95% CI, 0.94 to 1.03) but lower chiropractic care use (OR, 0.50; 95% CI, 0.47 to 0.53).
Interpretation of the study's results depends on the optimal rate at which patients with low back pain should pursue chiropractic or OT/PT care, according to the study authors. Those with mild pain that does not limit physical function may manage pain on their own, especially if they stay active and avoid bedrest, they advised.
“While primary care providers ought to describe and recommend nonpharmacologic treatments to patients who are seeking treatment for [low back pain], prescribing a pain medication may be a more familiar or preferred practice,” the authors wrote. “Implementation efforts to expand access to nonpharmacologic treatments should consider the even lower rates of use among racial and ethnic minorities.”