John C. Licciardone, DO, MS, MBA
Corresponding Author: John C. Licciardone, DO, MS, MBA; University of North Texas Health Science Center. Email: john.licciardone@unthsc.edu
Section: Original Research
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Introduction: This study was conducted to determine if limited access to health care during the COVID-19 pandemic impacted utilization of recommended non-pharmacological treatments, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids by persons with chronic low back pain and affected clinical outcomes relating to pain intensity and disability. Methods: Participants within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation were eligible if they provided encounter data in the three months immediately before and after the national emergency proclamation date (NEPD). Results: The mean age of the 528 study participants was 53.9 yr and 74.1% were women. Utilization of exercise therapy, massage therapy, and spinal manipulation decreased during the pandemic. Increasing age was associated with decreased utilization of all non-pharmacological treatments except exercise therapy, and with increased opioid use during the pandemic. African-American participants reported decreased utilization of yoga and spinal manipulation during the pandemic. Overall, mean change scores for pain intensity and disability before and after the NEPD were not significant. However, African-American participants consistently reported worse pain intensity and disability outcomes during the pandemic. Marginally worse outcomes were observed less consistently for pain intensity with increasing age and for disability among women. Discussion: Social distancing during the pandemic impacted the uptake of recommended non-pharmacological treatments for chronic low back pain that require visiting community-based facilities or interacting closely with providers. Conclusions: The pandemic threatens to exacerbate the impact of chronic low back pain, particularly among African-American patients and the older population, by impeding access to guideline-informed noninvasive treatments.