Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is the research about?

Back pain is one of the most common reasons why patients seek medical care. One in four US adults has back pain that lasts for three months or more. Back pain can reduce quality of life and make it hard to do daily activities like walking, sitting, or climbing stairs. Common treatments include opioid pain medicine and steroid injections. But research shows that these treatments do little to ease patients’ pain over the long term and may be unsafe. Opioid medicine can cause addiction, depression, and even accidental death.

The state of Oregon is working to improve care for patients with back or neck pain who are in its Medicaid program. Starting in July 2016, Oregon added coverage for nondrug treatments for back or neck pain. These treatments include counseling, physical therapy, acupuncture, chiropractic care, yoga, and massage. Oregon also stopped coverage for steroid injections and, in January 2018, stopped paying for long-term opioid medicine to treat back or neck pain. It is the first state to try such strong measures to promote nondrug treatments and stop the use of opioids for back pain.

This study is examining the effects of changes to Oregon’s Medicaid program on care for patients with back pain.

Who can this research help?

States, health insurers, and healthcare systems can learn from Oregon’s efforts to prevent the use of long-term opioid medicines for back pain

What is the research team doing?

The research team is comparing Medicaid patients with back or neck pain in Oregon who have access to nondrug treatments to similar patients in California, where care includes opioid medicines and steroid injections with limited access to some nondrug treatments. The team wants to know how the changes to Oregon’s Medicaid program affect

  • Prescriptions for opioid medicines
  • Healthcare services patients use to ease pain
  • Patients’ reported pain levels
  • Patients’ reported pain-related functioning
  • Patients’ satisfaction with the care they receive
  • Patients’ decisions to use illegal drugs to reduce pain

The research team is using information from three sources:

  • Medicaid claims from patients in Oregon and California and electronic health records from about 50,000 Medicaid patients in these states
  • A survey of about 1,200 patients each in Oregon and California every three months
  • Interviews with patients and healthcare providers

Medicaid patients, caregivers, and doctors are working with the research team to plan the study. The team is also working with representatives from health systems, health departments, and health insurers.

Research methods at a glance

Design Elements Description
Design Observational: case-control study
Population Adults insured by Medicaid who have back or neck pain and receive health care in Oregon and California
  • Treatment for back or neck pain in Oregon
  • Treatment for back or neck pain in California

Primary: prescriptions for opioid medicines; use of pain-related healthcare services such as behavioral counseling, physical therapy, chiropractic care, acupuncture, massage, yoga, and exercise therapy; patient-reported pain severity and functioning; patient satisfaction with health care and results of care; harms related to pain-related healthcare services; use of illegal or recreational drugs

Secondary: patients’, healthcare providers’, and healthcare administrators’ experiences with the changes in healthcare services

Timeframe 1-year follow-up for primary outcome

Project Information

Lynn DeBar, PhD, MPH
Kaiser Foundation Research Institute, a Division of Kaiser Foundation Hospitals
A Naturalistic Experiment Evaluating the Impact of Medicaid Treatment Reimbursement Changes on Opioid Prescribing and Patient Outcomes Among Patients with Low Back Pain

Key Dates

August 2017
December 2023

Study Registration Information

^ This project was originally based in California.


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Last updated: March 21, 2024