162. Opioid usage patterns, patient characteristics, and the role of chiropractic services in a publicly funded inner city health care facility

Abstract

BACKGROUND CONTEXT Opioid prescription for spinal pain while common, is no longer recommended by recent clinical practice guidelines. Opioid prescription rates in the US and Canada are double those in most European countries. A recent study found chiropractic care provided in Veterans Health Administration facilities resulted in reduced opioid prescriptions. Further research on populations with access to chiropractic care and opioid medication is warranted. PURPOSE To determine if chiropractic management of financially disadvantaged individuals, using opioid medications and diagnosed with spine or extremity conditions, reduced pain, and impacted opioid prescription frequency, or dosage. STUDY DESIGN/SETTING Retrospective analysis of prospectively collected quality assurance data. Data were collected in a publicly funded multidisciplinary health care facility (2011-2017) that includes primary care, a chiropractic program and an on-site pharmacy dispensary. The health care facility is exclusively utilized by a financially disadvantaged inner city population. PATIENT SAMPLE The typical opioid-using chiropractic program patient (N=64) had chronic lumbar region pain (>3 months) was female (59.4%) self-identified as Caucasian (50%), was 49.6 (SD = 13.6) years of age, and had an average BMI of 31.5 (SD 8.4) which is classified as obese. The majority were referred by their primary care physician who managed their prescriptions (66.7%). OUTCOME MEASURES Included: (1) numeric rating scale (NRS) for pain for each region (cervical, thoracic, lumbar, sacro-iliac and extremity); (2) number of chiropractic program patients prescribed opioids by the health care facility at baseline, visit 5 and discharge; and (3) dosage via the number of tablets per 24-hour period from T3 prescriptions filled at the health care facility. METHODS For each NRS region, percent change and a one-way analysis of variance (ANOVA) were calculated. The minimally clinically important difference (MCID) was defined as −20%. The ANOVA was a 1 Region x 3 Time Point (baseline, 5th visit, discharge) model. Posthoc paired Student's t-tests were applied to dissect significant main effects. Percent change scores were calculated for both the number of people prescribed opioids within the clinic (n=38), and dosage via number of tablets per 24-hours for T3 the most common opioid prescribed (n=21). RESULTS Percent change in pain by region after chiropractic management were as follows: cervical (−30.8%), thoracic (−37.2%), lumbar (−40.5%), sacral (−43.9%) and extremity pain (−43.0%). For each region, main effects were found for pain level between baseline measures, visit 5, and discharge (p CONCLUSIONS Financially disadvantaged patients with an opioid relationship who underwent chiropractic management for spine and extremity conditions in a publicly funded health care facility responded to treatment evidenced through reduction in pain beyond a MCID. Opioid usage decreased over a brief trial of care in both percentage of users and dosage. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.