Megan E Vanneman1,2,3, Mary Jo Larson4, Cheng Chen5, Rachel Sayko Adams4, Thomas V Williams6, Esther Meerwijk5, Alex H S Harris5,7. 1. Informatics, Decision-Enhancement, and Analytic Sciences Center. 2. Department of Internal Medicine, Division of Epidemiology. 3. Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT. 4. Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. 5. Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA. 6. Health Care Division, NORC at the University of Chicago, Bethesda, MD. 7. Department of Surgery, Stanford University School of Medicine, Stanford, CA.
Abstract
BACKGROUND: In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use. OBJECTIVES: To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA for LBP, either alone or as adjuncts to opioid medications, and to understand associations between veterans' clinical and demographic characteristics and type of treatment. RESEARCH DESIGN: This retrospective cohort study examined use of opioids and 21 specific NPT modalities used by veterans. SUBJECTS: VHA-enrolled Iraq and Afghanistan veterans who utilized care in ("linked" to) 130 VHA facilities within 12 months after their separation from the Army between fiscal years 2008-2011, and who were diagnosed with LBP within 12 months after linkage (n=49,885). MEASURES: Measures included per patient: days' supply of opioids, number of visits for NPT modalities, and pain scores within one year after a LBP diagnosis. RESULTS: Thirty-four percent of veterans filled a prescription for opioids, 35% utilized at least 1 NPT modality, and 15% used both within the same year. Most patients with LBP receiving NPT, on average, had moderate pain (36%), followed by low pain (27%), severe pain (15%), and no pain (11%). Eleven percent had no pain scores recorded. CONCLUSIONS: About 65% of VHA patients with a LBP diagnosis did not receive NPT, and about 43% of NPT users also were prescribed an opioid. Understanding utilization patterns and their relationship with patient characteristics can guide pain management decisions and future study.
BACKGROUND: In the Veterans Health Administration (VHA) there is growing interest in the use of nonpharmacologic treatment (NPT) for low back pain (LBP) as pain intensity and interference do not decrease with opioid use. OBJECTIVES: To describe overall and facility-level variation in the extent to which specific NPT modalities are used in VHA for LBP, either alone or as adjuncts to opioid medications, and to understand associations between veterans' clinical and demographic characteristics and type of treatment. RESEARCH DESIGN: This retrospective cohort study examined use of opioids and 21 specific NPT modalities used by veterans. SUBJECTS: VHA-enrolled Iraq and Afghanistan veterans who utilized care in ("linked" to) 130 VHA facilities within 12 months after their separation from the Army between fiscal years 2008-2011, and who were diagnosed with LBP within 12 months after linkage (n=49,885). MEASURES: Measures included per patient: days' supply of opioids, number of visits for NPT modalities, and pain scores within one year after a LBP diagnosis. RESULTS: Thirty-four percent of veterans filled a prescription for opioids, 35% utilized at least 1 NPT modality, and 15% used both within the same year. Most patients with LBP receiving NPT, on average, had moderate pain (36%), followed by low pain (27%), severe pain (15%), and no pain (11%). Eleven percent had no pain scores recorded. CONCLUSIONS: About 65% of VHA patients with a LBP diagnosis did not receive NPT, and about 43% of NPT users also were prescribed an opioid. Understanding utilization patterns and their relationship with patient characteristics can guide pain management decisions and future study.
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