A recent study for Medicaid patients shows associations between referrals for Physical Therapy for low back pain affects patient perceptions and reduce odds of later opioid use – even when patients don’t follow up on the referral.

Researchers divided patients into two groups – those who went on to participate in physical therapy after an initial consultation, and those who did not participate.  They also compared those groups to a third group that did not receive a referral for physical therapy for their lower back pain.

The findings included:

• Younger patients tended to receive a PT consultation, and a prescription for NSAIDs or muscle relaxers.
• Patients less likely to receive a consultation for their back pain were associated with tobacco use, chronic pain and depression.
• The odds of a patient receiving a consult were decreased 25 times if the patient received specialty care or advanced imaging.
• Odds of a patient receiving a consult were increased 1.8 times if the patient also received NSAID prescription.

Opioid prescriptions were the most commonly used interventions during the year after the initial LBP visit. While the strongest predictor of a later opioid prescription was associated with whether an opioid prescription occurred at baseline, patients who received a physical therapy consult were 35% less likely to receive an opioid prescription, regardless of whether they participated in physical therapy after the consult.

Researchers concluded that “Patients with a consult to [physical therapy] represent a unique and important subset as the consult may represent a reflection of a provider’s values and subsequent communication with the patient,” they write. “Recommending [physical therapy] provides reassurance to patients that their LBP is best managed with physical activity and is in line with advice to stay active. This in itself has potential to change cost and health care use.”