Choosing — or starting treatment with — manual therapy over opioid medications for the management of spine or shoulder may result in lower associated downstream costs, according to a study published in Pain Medicine.

Data from patients with spine or shoulder pain (n=1876; age range, 18-65 years) who were seen in a single hospital in the military health system were examined to determine health care utilization costs during the year after the initial consultation, which was one of the study’s outcomes.

Mean healthcare costs were found to be lower in patients receiving manual therapy alone (n=714; $5410; 95% CI, $5109-$5730) vs manual therapy in combination with opioids (n=1162; $10,498; 95% CI, $10,043-$10,973). 

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Patients who received manual therapy before being prescribed opioids (n=453) vs those who received opioids before manual therapy (n=671) had lower mean healthcare costs in the first year after treatment initiation ($10,782; 95% CI, $10,050-$11,567 vs $11,938; 95% CI, $11,272-$12,643, respectively; P =.030). Patients receiving manual therapy vs opioids as an initial treatment had lower mean days’ supply of opioids (34.2 vs 70.9 days, respectively; P <.001) and a lower mean number of unique opioid prescriptions (3.1 vs 6.5, respectively; P <.001).

The observational and retrospective nature of the analysis and the lack of data on preexisting comorbidities are the study’s main limitations.

“Clinicians should consider the implications of first-choice decisions and the timing of care for treatment choices utilized for patients with spine and shoulder disorders,” noted the study authors.

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Rhon DI, Greenlee TA, Fritz JM. The influence of a guideline-concordant stepped care approach on downstream health care utilization in patients with spine and shoulder pain [published online November 8, 2018]. Pain Med. doi: 10.1093/pm/pny212