Evaluation and Treatment Patterns of New Low Back Pain Episodes for Elderly Adults in the United States, 2011-2014

Abstract

Introduction: New low back pain (LBP) is a common outpatient complaint. Little is known about how care is delivered over the course of a year to patients who develop new LBP and whether such care patterns are guideline-concordant.

Methods: This retrospective analysis included Medicare claims of 162,238 opioid-naïve beneficiaries with new LBP from January 1, 2011, through December 31, 2014. Simple rates of modality use [computed tomography and magnetic resonance imaging (advanced imaging), physical therapy (PT), opioid and nonopioid medications] and percentiles (5th percentile, 25th percentile, median, 75th percentile, and 95th percentile) were reported.

Results: Within the first year, 29.4% [95% confidence interval (CI), 29.1-29.8] of patients with ≥2 visits for new LBP received advanced imaging, and 48.4% (95% CI, 47.7-49.0) of these patients received advanced imaging within 6 weeks of the first visit; 17.3% (95% CI, 17.1-17.6) of patients with ≥2 visits received PT; 42.2% (95% CI, 41.8-42.5) of patients with ≥2 visits received non-steroidal anti-inflammatory drugs (NSAIDs), 16.9% (95% CI, 16.6-17.1) received a muscle relaxant, and 26.2% (95% CI, 25.9-26.6) received tramadol; 32.3% (95% CI, 31.9-32.6) of patients with ≥2 visits received opioids; 52.4% (95% CI, 51.7-53.0) of these patients had not received a prescription NSAID, and 82.2% (95% CI, 81.7-82.7) of these patients had not received PT.

Conclusions: Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs.