• James M Whedon, Anupama Kizhakkeveettil, Andrew Wj Toler, Serena Bezdjian, Daniel Rossi, Sarah Uptmor, Todd A MacKenzie, Jon D Lurie, Eric L Hurwitz, Ian Coulter, and Scott Haldeman.
• Southern California University of Health Sciences, Whittier, CA.
• Spine. 2022 Feb 15; 47 (4): E142E148E142-E148.

Study DesignWe combined elements of cohort and crossover-cohort design.ObjectiveThe objective of this study was to compare longterm outcomes for spinal manipulative therapy (SMT) and opioid analgesic therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).Summary Of Background DataCurrent evidence-based guidelines for clinical management of cLBP include both OAT and SMT. For long-term care of older adults, the efficiency and value of continuing either OAT or SMT are uncertain.MethodsWe examined Medicare claims data spanning a five-year period. We included older Medicare beneficiaries with an episode of cLBP beginning in 2013. All patients were continuously enrolled under Medicare Parts A, B, and D. We analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.ResultsSMT was associated with lower rates of escalation of care as compared to OAT. The adjusted rate of escalated care encounters was approximately 2.5 times higher for initial choice of OAT vs. initial choice of SMT (with weighted propensity scoring: rate ratio 2.67, 95% confidence interval 2.64-2.69, P < .0001).ConclusionAmong older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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