Patients With OUD Less Likely to Initiate and Attend Physical Therapy for Low Back Pain

A female massage therapist standing behind a male patient and massaging his back with both hands.
Researchers evaluated the relationship between OUD history and physical therapy initiation for low back pain.

Patients with a history of opioid use disorder (OUD) are less likely to initiate physical therapy following a visit with their healthcare provider for new low back pain, according to the results of a study published in the Journal of Addiction Medicine.

Although studies have shown that people with an OUD are less likely to receive outpatient care, recommended healthcare screenings, and preventive care compared with people without OUD, the extent to which patients with a history of OUD initiate physical therapy for low back pain after seeing a healthcare provider has not yet been determined.

To evaluate the association between a history of OUD and initiation of physical therapy for low back pain, data from 2720 participants (55.9% women; mean age, 47.2±15.9; 50% with OUD) were analyzed after propensity matching. Consultation for the care of a new episode of low back pain was defined as a consultation with a healthcare provider with no claims related to low back pain for at least 180 days prior to the visit.  OUD history was defined by the presence of an International Classification of Disease, Ninth Revision (ICD-9) code indicating opioid dependence, abuse, or poisoning in the 180 days before the visit. Initiation of physical therapy was considered if it occurred 60 days or less after the visit.

People with OUD were significantly less likely to attend physical therapy for low back pain after their visit compared with people without an OUD (P =.01).

The results of this study are consistent with previous studies showing a difference in outpatient care among these groups. Whether this difference is due to a significant difference in healthcare provider referrals, or if the patients were less likely to act on a referral, could not be determined. These findings may be useful to healthcare providers when considering the treatment of patients with OUD who are presenting with low back pain.

Limitations to this study include the use of propensity matching, the lack of data regarding pain intensity or patient outcomes related to cognition around pain, and patient income or socioeconomic status.

“Future research is needed to understand the provider and patient factors that influence whether a patient with a history of an OUD attends treatment for musculoskeletal conditions including [low back pain],” the researchers concluded. “Future research should also prospectively examine the impact of [physical therapy] for [low back pain] in patients with a history of an OUD.”


Magel JS, Gordon AJ, Fritz JM, Kim J. The influence of an opioid use disorder on initiating physical therapy for low back pain: a retrospective cohort. Published online October 16, 2020. J Addict Med. doi:10.1097/ADM.0000000000000751