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    1 Comment for this article
    Another way of reducing opioid use
    Frederick Rivara, MD, MPH | University of Washingtonn
    While data on use of PT for treatment of musculoskeletal pain is well know, this study shows that getting patients to PT early can also result in reduction in long-term opioid use. Getting PT appointments in most places is pretty easy and as shown by this study, earlier rather than later is better.
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Original Investigation
    December 14, 2018

    Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain

    Author Affiliations
    • 1Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California
    • 2Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
    • 3Center for Health Policy, Stanford University School of Medicine, Stanford, California
    • 4Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
    • 5Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
    JAMA Netw Open. 2018;1(8):e185909. doi:10.1001/jamanetworkopen.2018.5909
    Key Points español 中文 (chinese)

    Question  Is early physical therapy associated with long-term opioid use by patients with musculoskeletal pain?

    Findings  In this cross-sectional analysis of 88 985 patients with shoulder, neck, knee, or low back pain, early physical therapy was associated with an approximately 10% statistically significant reduction in subsequent opioid use.

    Meaning  By serving as an alternative or adjunct to short-term opioid use for patients with musculoskeletal pain, early physical therapy may play a role in reducing the risk of long-term opioid use.


    Importance  Nonpharmacologic methods of reducing the risk of new chronic opioid use among patients with musculoskeletal pain are important given the burden of the opioid epidemic in the United States.

    Objective  To determine the association between early physical therapy and subsequent opioid use in patients with new musculoskeletal pain diagnosis.

    Design, Setting, and Participants  This cross-sectional analysis of health care insurance claims data between January 1, 2007, and December 31, 2015, included privately insured patients who presented with musculoskeletal pain to an outpatient physician office or an emergency department at various US facilities from January 1, 2008, to December 31, 2014. The sample comprised 88 985 opioid-naive patients aged 18 to 64 years with a new diagnosis of musculoskeletal shoulder, neck, knee, or low back pain. The data set (obtained from the IBM MarketScan Commercial database) included person-level International Classification of Diseases, Ninth Revision or Tenth Revision diagnosis codes, Current Procedural Terminology codes, and date of service as well as pharmaceutical information (National Drug Code, generic name, dose, and number of days supplied). Early physical therapy was defined as at least 1 session received within 90 days of the index date, the earliest date a relevant diagnosis was provided. Data analysis was conducted from March 1, 2018, to May 18, 2018.

    Main Outcomes and Measures  Opioid use between 91 and 365 days after the index date.

    Results  Of the 88 985 patients included, 51 351 (57.7%) were male and 37 634 (42.3%) were female with a mean (SD) age of 46 (11.0) years. Among these patients, 26 096 (29.3%) received early physical therapy. After adjusting for potential confounders, early physical therapy was associated with a statistically significant reduction in the incidence of any opioid use between 91 and 365 days after the index date for patients with shoulder pain (odds ratio [OR], 0.85; 95% CI, 0.77-0.95; P = .003), neck pain (OR, 0.92; 95% CI, 0.85-0.99; P = .03), knee pain (OR, 0.84; 95% CI, 0.77-0.91; P < .001), and low back pain (OR, 0.93; 95% CI, 0.88-0.98; P = .004). For patients who did use opioids, early physical therapy was associated with an approximately 10% statistically significant reduction in the amount of opioid use, measured in oral morphine milligram equivalents, for shoulder pain (−9.7%; 95% CI, −18.5% to −0.8%; P = .03), knee pain (−10.3%; 95% CI, −17.8% to −2.7%; P = .007), and low back pain (−5.1%; 95% CI, −10.2% to 0.0%; P = .046), but not for neck pain (−3.8%; 95% CI, −10.8% to 3.3%; P = .30).

    Conclusions and Relevance  Early physical therapy appears to be associated with subsequent reductions in longer-term opioid use and lower-intensity opioid use for all of the musculoskeletal pain regions examined.