Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD

Abstract

ImportanceNonpharmacologic treatments are important for managing chronic pain among persons with opioid use disorder (OUD), for whom opioid and other pharmacologic therapies may be particularly harmful. Racial and ethnic minority individuals with chronic pain and OUD are vulnerable to suboptimal pain management due to systemic inequities and structural racism, highlighting the need to understand their receipt of guideline-recommended nonpharmacologic pain therapies, including physical therapy (PT) and chiropractic care.ObjectiveTo assess differences across racial and ethnic groups in receipt of PT or chiropractic care for chronic low back pain (CLBP) among persons with comorbid OUD.Design, Setting, and ParticipantsThis retrospective cohort study used a 20% random sample of national Medicare administrative data from January 1, 2016, to December 31, 2018, to identify fee-for-service community-dwelling beneficiaries with a new episode of CLBP and comorbid OUD. Data were analyzed from March 1, 2022, to July 30, 2023.ExposuresRace and ethnicity as a social construct, categorized as American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, Hispanic, non-Hispanic White, and unknown or other.Main Outcomes and MeasuresThe main outcomes were receipt of PT or chiropractic care within 3 months of CLBP diagnosis. The time (in days) to receiving these treatments was also assessed.ResultsAmong 69 362 Medicare beneficiaries analyzed, the median age was 60.0 years (IQR, 51.5-68.7 years) and 42 042 (60.6%) were female. A total of 745 beneficiaries (1.1%) were American Indian or Alaska Native; 444 (0.6%), Asian or Pacific Islander; 9822 (14.2%), Black or African American; 4124 (5.9%), Hispanic; 53 377 (77.0%); non-Hispanic White; and 850 (1.2%), other or unknown race. Of all beneficiaries, 7104 (10.2%) received any PT or chiropractic care 3 months after a new CLBP episode. After adjustment, Black or African American (adjusted odds ratio, 0.46; 95% CI, 0.39-0.55) and Hispanic (adjusted odds ratio, 0.54; 95% CI, 0.43-0.67) persons had lower odds of receiving chiropractic care within 3 months of CLBP diagnosis compared with non-Hispanic White persons. Median time to chiropractic care was longest for American Indian or Alaska Native (median, 8.5 days [IQR, 0-44.0 days]) and Black or African American (median, 7.0 days [IQR, 0-42.0 days]) persons and shortest for Asian or Pacific Islander persons (median, 0 days [IQR, 0-6.0 days]). No significant racial and ethnic differences were observed for PT.Conclusions and RelevanceIn this retrospective cohort study of Medicare beneficiaries with comorbid CLBP and OUD, receipt of PT and chiropractic care was low overall and lower across most racial and ethnic minority groups compared with non-Hispanic White persons. The findings underscore the need to address inequities in guideline-concordant pain management, particularly among Black or African American and Hispanic persons with OUD.

Unraveling the Tapestry of Pain: A Comprehensive Review of Ethnic Variations, Cultural Influences, and Physiological Mechanisms in Pain Management and Perception

“…Radicular pain arises from irritation or compression of a nerve root in the spinal cord, often caused by conditions like herniated discs or spinal stenosis [12]. It can cause sharp and shooting pain that travels along the nerve pathway and may be accompanied by numbness, tingling, or weakness in muscles [13].…”

“…Neuropathic pain arises from damage or dysfunction of the nervous system [14]. It can be caused by conditions such as advanced diabetes, uncontrolled autoimmune diseases, various vasculitides, postherpetic neuralgia, and mechanical compression [6,12,15]. Neuropathic pain is characterized by unusual sensations like shooting or burning pain, tingling, numbness, or heightened sensitivity [16].…”

Implementation of eLearning solutions for patients with chronic pain conditions

“… 2 From a clinical perspective, patients experiencing chronic pain are best served with multidisciplinary expertise, including those specializing in psychology, neurology, internal medicine, rheumatology, physical therapy, and others. 3 Access to multidisciplinary care is limited, and disparities exist in the management of chronic pain based on patient geographic location, 4 race/ethnicity, 5 and cultural aspects of pain. 6 Within our current structures, healthcare providers report that the needs of patients with chronic pain can be highly burdensome due to the multifactorial medical, social, and mental health aspects that need to be addressed.…”