Patients with neck pain who initially consult a nonpharmacologic provider may have reduced exposure to opioids in the following year and fewer injections and advanced imaging, according to a study published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes.

Opioid exposure outcomes were retrospectively analyzed in patients who consulted with a healthcare provider (ie, primary care provider, physical therapist, chiropractor, or specialist) for neck pain between January 2012 and June 2013 (n=1702). Comorbidities that might have had an impact on neck pain prognosis or health care were considered in the analysis, and healthcare utilization in the year following the initial consultation for neck pain was assessed.

Patients who consulted with a chiropractor or physical therapist had a lower odds of receiving an opioid prescription vs those who consulted with a primary care provider (adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76 and aOR, 0.59; 95% CI, 0.44-0.78, respectively). The odds of receiving advanced imaging and injections were also lower in patients consulting a chiropractor vs a primary care provider (aOR, 0.43; 95% CI, 0.15-0.76 and aOR, 0.34; 95% CI, 0.19-0.56). Consulting with a specialist or physical therapist was found to increase the likelihood of a patient getting advanced imaging (aOR, 2.96; 95% CI, 2.01-4.38 and aOR, 1.57; 95% CI, 1.01-2.46). Receiving initial care from a specialist alone was found to increase the odds of patients receiving injections (aOR, 3.21; 95% CI, 2.31-4.47).

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Study limitations include the lack of data on the severity of neck pain and the inclusion of study participants who were insured by 1 payer in a single geographic area.

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“[O]ur results suggest that adopting such a strategy [of initiating care with a nonpharmacological provider for a new episode of neck pain] aligns well with recent [Centers for Disease Control and Prevention] and [American College of Physicians] recommendations and has the potential to decrease the management burden of neck pain by [primary care providers].” 

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Horn ME, George SZ , Fritz JM. Influence of initial provider on health care utilization in patients seeking care for neck pain. Mayo Clin Proc Innov Qual Outcomes. 2017;1(3):226-233.