Journal
JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS
Volume 45, Issue 4, Pages 235-247Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jmpt.2022.06.009
Keywords
Health Services Research; Analgesics; Opioid; Community Health Centers; Chiropractic
Funding
- Canadian Chiropractic Research Foundation
- McMaster University
- NCMIC Foundation
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This study found that noncancer spinal pain patients who received chiropractic care were less likely to be prescribed opioids, with a higher risk reduction for patients who received chiropractic care within 30 days of their index visit. The calendar year of the index visit was also associated with opioid prescription probability.
Objective: The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adult patients with noncancer spinal pain in a Canadian community health center.Methods: In this sequential explanatory mixed methods analysis, we conducted a retrospective study of 945 patient records (January 2014 to December 2020) and completed interviews with 14 patients and 9 general practitioners. We used Cox proportional hazards regression analyses, adjusted for patient demographics, comorbidities, visit frequency, and calendar year to evaluate the association between receipt of chiropractic care and time to first opioid prescription up to 1 year after presentation. Qualitative data were analyzed thematically and integrated with our quantitative findings.Results: There were 24% of patients (227 of 945) with noncancer spinal pain who received a prescription for opioids. The risk of initiating a prescription for opioids at 1 year after presentation was 52% lower in chiropractic recipients vs nonrecipients (hazard ratio [HR], 0.48; 99% confidence interval [CI], 0.29-0.77) and 71% lower in patients who received chiropractic services within 30 days of their index visit (HR, 0.29; 99% CI, 0.13-0.68). Patients whose index visit date was in a more recent calendar year were also less likely to receive opioids (HR, 0.86; 99% CI, 0.76-0.97). Interviews suggested that self-efficacy, access to chiropractic services, opioid stigma, and treatment impact were influencing factors.Conclusion: Patients with noncancer spinal pain who received chiropractic care were less likely to obtain a prescription for opioids than patients who did not receive chiropractic care.
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