PT First for Low Back Pain

By: Dr. Laura Wenger, PT, OCS, FAAOMPT

You’ve heard the news: our country has an opioid epidemic. This history of this epidemic is not a pretty one, and it is one that our country is attempting to take steps toward fixing. From policy-makers trying to affect change via rules and regulations for prescribing providers to trying to get physical therapists included on national loan repayment programs for underserved and rural communities in our country, there are a lot of people putting their heads together to try and figure out how to solve this national problem. One such group of people is the American Physical Therapy Association, or APTA, that recently co-sponsored a very large study to assess the effects of which provider someone sees first for low back pain on the use of opioids both in the short- and long-term.

When I say very large, I mean it: the study analyzed more than 200,000 insurance claims from adults with a new onset of low back pain.(1) The researchers were looking to see if the type of provider seen at the initial visit (specifically primary care physicians versus PTs, chiropractors, or acupuncturists) affected the patient’s use of opioids either short-term (filled their prescription within 30 days of the initial visit) or long-term (filled their prescription within 60 days of the initial visit and continued taking opioids over the next 4-12 months).(1) Here are the key take-aways from the results of the study:(1)

  • Of all of the patients looked at, about 18% filled an opioid prescription within 3 days of their initial visit, and 22% filled a prescription within 30 days of their initial visit. 1.2% of the entire group studied fit the criteria for long-term use.
  • Looking at the patients with short-term opioid use, those who saw a PT first had 85% less chance of filling an opioid prescription within the first 30 days of their visit versus patients who saw a primary care physician first.
  • Furthermore, the patients who saw a PT first for their back pain had 73% decreased odds of long-term opioid use versus patients who saw a primary care physician first.
As PTs, we have many tools- including manual therapy- to treat low back pain

This study provides strong evidence for patients who are experiencing a new onset of low back pain to come to PT first.(1) After all, we are the musculoskeletal specialists, and low back pain a condition we treat frequently. Ultimately, if you come to PT first to get a thorough evaluation and treatment for your low back pain, your likelihood of taking opioids is significantly decreased. If you are experiencing low back pain and not sure where to go, make sure you give our office a call so we can get you in to see one of our specialized physical therapists for a timely evaluation and get you on the road to feeling better without delay.

1. Kazis LE, Ameli O, et al. Observation retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open. 2019;9:e028633. doi:10.1136/bmjopen-2018-028633