Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016–2019

Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.5%-6.7%), chiropractic care (11.0%-11.7%), and gabapentinoid (9.6%-8.9%) receipt were limited, whereas prescription opioid use substantially decreased (26.2%-17.8%). Prescription opioid receipt was higher among individuals under age 65, American Indian/Alaskan Native, non-Hispanic Black/African American, and Hispanic individuals, individuals with opioid use disorder, and in Southern states, while the use of nonpharmacologic pain therapies remained low among these subgroups. It is essential to promote equitable access to multimodal and guideline-recommended approaches for aLBP management including nonpharmacologic therapies.