• Whedon JM
• Uptmor S
• Toler AWJ
• Bezdjian S
• Mackenzie TA
• Kazal LA Jr

• Affiliation / Arizona Personal Injury Centers
• Affiliation / Dartmouth College. Geisel School of Medicine
• Affiliation / Southern California University of Health Sciences
• Affiliation(G) / United States / Arizona / Phoenix
• Affiliation(G) / United States / California / Whittier
• Affiliation(G) / United States / New Hampshire / Hanover
• Aged
• Analgesics, Opioid
• Chiropractic / United States
• Manipulation, Spinal
• Medicare
• Musculoskeletal Pain
• Open Access Document

Background: The burden of spinal pain can be aggravated by the hazards of opioid analgesics, which are still widely prescribed for spinal pain despite evidence-based clinical guidelines that identify non-pharmacological therapies as the preferred first-line approach. Previous studies have found that chiropractic care is associated with decreased use of opioids, but have not focused on older Medicare beneficiaries, a vulnerable population with high rates of co-morbidity and polypharmacy. The purpose of this investigation was to evaluate the association between chiropractic utilization and use of prescription opioids among older adults with spinal pain.

Methods: We conducted a retrospective observational study in which we examined a nationally representative multi-year sample of Medicare claims data, 2012–2016. The study sample included 55,949 Medicare beneficiaries diagnosed with spinal pain, of whom 9,356 were recipients of chiropractic care and 46,593 were non-recipients. We measured the adjusted risk of filling a prescription for an opioid analgesic for up to 365 days following diagnosis of spinal pain. Using Cox proportional hazards modeling and inverse weighted propensity scoring to account for selection bias, we compared recipients of both primary care and chiropractic to recipients of primary care alone regarding the risk of filling a prescription.

Results: The adjusted risk of filling an opioid prescription within 365 days of initial visit was 56% lower among recipients of chiropractic care as compared to non-recipients (hazard ratio 0.44; 95% confidence interval 0.40–0.49).

Conclusions: Among older Medicare beneficiaries with spinal pain, use of chiropractic care is associated with significantly lower risk of filling an opioid prescription.

Author keywords: Opioids - Analgesics - Chiropractic - Spinal pain - Medicare - Spinal manipulation - Aged

Author affiliations: JMW, AWJT, SB: Southern California University of Health Sciences, Whittier, CA, USA; SU: Arizona Personal Injury Centers, Phoenix, AZ, USA; TAM, LAK: Geisel School of Medicine at Dartmouth, Hanover, NH, USA

Corresponding author: James M. Whedon: jameswhedon@scuhs.edu

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.  Online access only. PubMed Record