The association of a military health facility’s availability of non-pharmacologic therapies for new-onset back pain on opioid prescription and temporary duty limitation in U.S soldiers returning from deployment: an observational retrospective study

Abstract Background Back pain (BP) is common and often leads to disability. Treatment with opioids (which has been decreasing in frequency) is problematic. Nonpharmacologic treatments (NPTs) are recommended but of uncertain value. To better evaluate the value of offering NPTs for BP, we examined the association of NPT availability at military treatment facilities (MTFs) and providers’ use rate of NPT with opioid fills and functional limitation (temporary duty limitation) outcomes among US Army Soldiers who returned from a deployment. Methods This study is centered in the United States Military Health System (MHS). Our sample consisted of male ( n = 141,012) and female ( n = 20,920) soldiers with a new diagnosis of BP post-deployment. We used a retrospective, observational study design applied to longitudinal healthcare records of patients with new onset of BP during the time window of October 1, 2010 to September 30, 2016 and examined outcomes for the one-year period beginning the 91st day after a patient’s initial BP diagnosis. BP patients were positive for an opioid outcome if they filled any opioid prescription during a one-year follow-up period. The patients were identified as having a functional limitation if they had a clinician-assigned “temporary duty limitation” during this period. For each MTF and fiscal year, two key facility-level variables measured: (a) physical therapy full-time equivalents (FTEs) per 100,000 persons served, and (b) Doctor of Chiropractic FTEs per 100,000 persons served. Results Indicators for being treated at facilities with higher levels of NPT availability had lower odds ratios for opioid prescription fills and functional limitations. Compared with BP patients treated in facilities in the low quartile of annual PT availability, BP patients treated in very-high-availability facilities had an odds ratio of 0.75 (95% CI 0.72,0.78) for functional limitations and an odds ratio of 0.81 (CI 0.78,0.83) for the likelihood of post-90-day opioid fill. Conclusions For soldiers with new onset BP after returning from military deployment, increased NPT availability at their military treatment facilities were associated with positive health and functioning outcomes.