Low back pain is one of the most common reasons patients seek medical care. Low back pain can have a big impact on patients’ quality of life and functioning. Patients and providers are becoming more frustrated with common low back pain treatments like steroid injections and the long-term use of opioid medications, which have been shown to have limited long-term impact on patients’ pain and day-to-day functioning and can have safety risks.
The State of Oregon is in the process of changing what low back pain treatments they will pay for. This started to affect those insured by Medicaid in July 2016 and will be completely implemented by January 2018. These changes will end payments for treatments like chronic opioid therapy and injections. It will also increase the use of nondrug treatments, such as cognitive behavioral therapy, supervised exercise therapy, intensive interdisciplinary rehabilitation, physical/occupational therapy, and complementary medical approaches (acupuncture, osteopathic/chiropractic manipulation, yoga, and massage). While experts agree that opioid use must be reduced, Oregon is the first state to try such strong measures to promote nondrug treatments and prevent the use of chronic opioid treatment for low back pain.
This study will evaluate physicians’ opioid prescribing practices and other outcomes patients value as Oregon Medicaid reimbursement changes for low back pain treatment creates the opportunity for a “natural experiment.” The project team will compare outcomes among patients with low back pain in Oregon who will have access to these expanded nondrug treatments to matched patients seen in comparable clinics in California where services for low back pain are restricted to more conventional care. The project team will compare patients’ pain severity, pain-related functioning, and satisfaction with care. While the project team thinks the Oregon Medicaid change will result in many positive changes, limiting the use of opioids and pain-reducing procedures like injections may motivate some individuals to use illegal substances.
As such, the team will also compare the reported use of illegal and other recreational drugs. Finally, the study will look at overall changes in the healthcare services for pain, including new starts of chronic opioid treatment used by patients served in clinics with “enhanced” services (Oregon) compared to those in “conventional” service clinics (California). Patients with low back pain who get their care in community health clinics in Oregon and California will participate in this study. Participating patients will be asked to complete a short online survey every three months. The project team will also interview some patients and healthcare providers to get more in-depth information about their experiences with these changes in healthcare services.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.