RT Journal Article
SR Electronic
T1 Health Care Utilization and Pain Outcomes Following Early Imaging for Low Back Pain in Older Adults
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 773
OP 780
DO 10.3122/jabfm.2019.06.190103
VO 32
IS 6
A1 Adam C. Powell
A1 Teresa L. Rogstad
A1 Sarah W. Elliott
A1 Stephen E. Price
A1 James W. Long
A1 Uday U. Deshmukh
A1 M. Hassan Murad
A1 Mark W. Steffen
YR 2019
UL http://www.jabfm.org/content/32/6/773.abstract
AB Background: Professional societies have provided inconsistent guidance regarding whether older patients should receive early imaging for low back pain, in the absence of clinical indications. The study assesses the implications of early imaging by evaluating its association with downstream utilization in an elderly population.Methods: Patients were included if they had a Medicare Advantage plan, had claims-based evidence of low back pain in 2014, and lacked conditions justifying early imaging. The outcomes examined were short-term, nonchronic, and chronic opioid use, steroid injections, and spinal surgery in the following 730 days, and persistent low back pain at 180 to 365 days. Morphine dose equivalents of opioid use was used as a measure of intensity. Logistic and γ regressions were used to assess the association between imaging in the first 6 weeks and the outcomes.Results: Among the 57,293 patients meeting inclusion criteria, the mean age was 71.2, and 26,606 (46.4%) received early imaging. Early imaging was associated with increased adjusted odds of short-term (odds ratio [OR], 1.21; 95% CI, 1.15 to 1.28), nonchronic (OR, 1.78; 95% CI, 1.69 to 1.88), and chronic (OR, 1.13; 95% CI, 1.07 to 1.18) opioid use, as well as steroid injections (OR, 2.55; 95% CI, 2.28 to 2.85) and spinal surgery (OR, 3.40; 95% CI, 2.97 to 3.90). Patients that received early imaging were more likely to experience persistent pain (OR, 1.09; 95% CI, 1.05 to 1.14) and used significantly more morphine dose equivalents if they had nonchronic opioid use.Conclusions: Early imaging for low back pain in older individuals was common, and was associated with greater utilization of downstream services and persistent pain.