Yoga and physical therapy effective in treating co-occurring sleep disturbance, back pain
Opioids were prescribed to about one-fourth of patients overall, including one-third of those with two or more LBP visits. In contrast, LBP guidelines suggest that other pain relievers - including nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen - should be tried before opioids.
Physical therapy was prescribed to only 11 percent of patients overall and 17 percent of those with two or more visits. Evidence suggests that early use of physical therapy can avoid the use of opioids in patients with LBP.
Most patients treated with opioids had not received a prescription NSAID or physical therapy. Chronic opioid use developed in about one percent of patients overall, and nearly two percent of those with two or more visits.
Low back pain is a common reason for healthcare visits - in a given year, about ten percent of people will develop a new episode of LBP. Studies examining trends in LBP treatment found increasing use of opioids, and decreased use of NSAIDs, up to 2010. The new analysis focused on more recent patterns in evaluation and treatment of LBP in Medicaid patients, including data on repeated visits over one year.
"Many patients who develop new LBP receive guideline non-concordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs," Dr. Ly writes. At least in the first half of the past decade, one-third of patients making two or more LBP visits received opioids - often without having tried other recommended treatments.
Dr. Ly calls for future studies examining barriers to guideline-recommended treatments for LBP in older adults - particularly physical therapy and NSAIDS. He also points out that pain management can be challenging in older adults, highlighting the need for studies to compare the safety and effectiveness of medication options. Source:
Wolters Kluwer Health Journal reference:
Ly, D. P (2020) Evaluation and Treatment Patterns of New Low Back Pain Episodes for Elderly Adults in the United States, 2011–2014. Medical Care . doi.org/10.1097/MLR. 1244 .
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