PainRelief.com Interview with:
Patience Moyo, Ph.D
Assistant Professor of Health Services, Policy and Practice
Center for Gerontology and Healthcare Research
Department of Health Services, Policy, and Practice
Brown University School of Public Health
PainRelief.com: What is the background for this study?
Response: Clinical practice guidelines recommend nonpharmacologic treatments as first-line therapies for managing chronic pain. However, little is known about the use of guideline-recommended pain therapies and whether use varies in demographic subgroups. Individuals with co-occurring chronic pain and opioid use disorder deserve particular consideration because of their increased risk of harm from opioids and other pharmacologic therapies combined with their susceptibility to social and structural barriers to accessing health care.
We sought to understand whether the well-established racial and ethnic inequities in pain management extend to individuals with opioid use disorder and to nonpharmacologic pain treatments, specifically physical therapy and chiropractic care.
PainRelief.com: What are the main findings?
Response: In this cohort study of 69,362 Medicare beneficiaries with chronic low back pain and opioid use disorder, only 10.2% of beneficiaries received physical therapy or chiropractic care within 3 months of being diagnosed with chronic low back pain. Black or African American and Hispanic persons had 54% and 46% lower odds, respectively, of chiropractic care compared with non-Hispanic White persons. In addition, it took longer for American Indian or Alaska Native persons (median: 8.5 days, IQR: 0-44.0 days) and Black or African American persons (median: 7.0 days, IQR: 0-42.0 days) to receive chiropractic care. While for Asian or Pacific Islander persons this time was much shorter (median: 0 days, IQR: 0-6.0 days). These differences across race and ethnicity were not observed for physical therapy.
PainRelief.com: What should readers take away from your report?
Response: Receipt of physical therapy and chiropractic care was low overall among Medicare beneficiaries with chronic pain and opioid use disorder, with racial and ethnic inequities in utilization and time to chiropractic care. These findings underscore the need for equitable and multimodal pain management for people with opioid use disorder for whom barriers to accessing pain care are compounded by the intersectional nature of racism and opioid-related stigma.
PainRelief.com: What recommendations do you have for future research as a result of this study?
Response: It is critical to understand provider and patient drivers of unequal access to pain care in individuals with opioid use disorders. Hence exploring practitioner referral practices as well as cultural influences on patient preferences on receipt of nonpharmacologic treatments should be prioritized. It is also important to examine the role that insurance coverage policies play in the use of nonpharmacologic pain therapies.
PainRelief.com: Is there anything else you would like to add? Any disclosures?
Response: While this study highlights racial and ethnic disparities in treatments of chronic pain in individuals with opioid use disorder, it is important to note some of the study’s limitations including the use of administrative claims data and inability to capture patient preferences, referrals, and other nonpharmacologic treatment modalities that are not covered by Medicare. This study was funded by the COBRE on Addiction and Disease Risk Exacerbation from the National Institute of General Medical Sciences.
Bhondoekhan F, Marshall BDL, Shireman TI, Trivedi AN, Merlin JS, Moyo P. Racial and Ethnic Differences in Receipt of Nonpharmacologic Care for Chronic Low Back Pain Among Medicare Beneficiaries With OUD. JAMA Netw Open. 2023;6(9):e2333251. doi:10.1001/jamanetworkopen.2023.33251
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