Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes
Impact of COVID-19 on utilization of nonpharmacological and pharmacological treatments for chronic low back pain and clinical outcomes
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DOI：
10.1515/jom-2020-0334
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发表时间：
2021-07-01
影响因子：
1.5
通讯作者：
Licciardone, John C.
中科院分区：
文献类型：
--
作者：
Licciardone, John C.
内容：的新型冠状病毒2019 2019冠状病毒病（COVID-19）大流行影响了整个美国的医疗保健服务，包括慢性疼痛患者的医疗保健服务。目的：测量COVID-19大流行期间慢性腰痛患者使用非药物和药物治疗的变化以及相关结果。方法：在流行病学、临床和干预性研究与创新疼痛登记研究（PRECISION Pain Research Registry）中进行了一项前后研究，使用了宣布与COVID-19相关的国家紧急状态之前3个月和之后3-6个月的数据。21-79岁的慢性腰痛患者被纳入研究，并在相关季度会议上提供自我报告的数据。测量了运动疗法、瑜伽、按摩疗法、脊柱推拿、针灸、认知行为疗法、非甾体类药物和阿片类药物治疗腰痛的使用情况。主要结局是分别用数字评定量表和罗兰莫里斯残疾问卷测量腰痛强度和背部相关功能。次要结果包括与健康相关的生活质量量表与患者报告的结果测量信息系统，包括身体功能，焦虑，抑郁，低能量/疲劳，睡眠障碍，参与社会角色和活动，疼痛干扰activity.Results：共476名参与者被纳入本研究。基线时参与者的平均年龄为54.0岁（标准差，+/- 13.2岁;范围，22-81岁）。研究中有349名（73.3%）女性参与者和127名（26.7%）男性参与者。大流行期间，运动疗法（比值比[OR]，0.37; 95%置信区间[CI]，0.23-0.57）、按摩疗法（OR，0.46; 95% CI，0.25-0.83）和脊柱推拿（OR，0.53; 95% CI，0.29-0.93）的使用减少。还观察到NSAID使用减少（OR，0.67; 95% CI，0.45-0.99）。参与者报告在大流行期间腰痛强度有显著改善，但无临床意义（平均改善，0.19; 95%CI，0.03-0.34; Cohen's d，0.11）。然而，白色受试者报告腰痛强度显著改善（平均改善，0.28; 95% CI，0.10-0.46），而黑人受试者没有（平均改善，-0.13; 95% CI，-0.46至0.19;相互作用p =0.03）。总体而言，疼痛对活动的干扰有显著的临床相关改善（平均改善，1.11; 95% CI，0.20-2.02; Cohen d，0.20）。在大流行期间使用非甾体抗炎药与腰痛强度的边际增加有关。结论：总体而言，慢性腰痛治疗的利用率下降，在大流行的前6个月期间，对疼痛和功能结果没有产生不利影响。然而，黑人受试者的疼痛结果明显比白色受试者差。
Context: The novel coronavirus 2019 (COVID-19) pandemic has impacted the delivery of health care services throughout the United States, including those for patients with chronic pain.Objectives: To measure changes in patients' utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic.Methods: A pre-post study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data in the 3 months before and 3-6 months after the declaration of a national emergency related to COVID-19. Participants 21-79 years old with chronic low back pain were included in the study and provided self reported data at relevant quarterly encounters. Use of exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy, nonsteroidal antiinflammatory drugs, and opioids for low back pain was measured. The primary outcomes were low back pain intensity and back related functioning measured with a numerical rating scale and the Roland Morris Disability Questionnaire, respectively. Secondary outcomes included health related quality of life scales measured with the Patient Reported Outcomes Measurement Information System, including scales for physical function, anxiety, depression, low energy/fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities.Results: A total of 476 participants were included in this study. The mean age of participants at baseline was 54.0 years (standard deviation, +/- 13.2 years; range, 22-81 years). There were 349 (73.3%) female participants and 127 (26.7%) male participants in the study. Utilization of exercise therapy (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23-0.57), massage therapy (OR, 0.46; 95% CI, 0.25-0.83), and spinal manipulation (OR, 0.53; 95% CI, 0.29-0.93) decreased during the pandemic. A reduction in NSAID use was also observed (OR, 0.67; 95% CI, 0.45-0.99). Participants reported a significant, but not clinically relevant, improvement in low back pain intensity during the pandemic (mean improvement, 0.19; 95% CI, 0.03-0.34; Cohen's d, 0.11). However, White participants reported a significant improvement in low back pain intensity (mean improvement, 0.28; 95% CI, 0.10-0.46), whereas Black participants did not (mean improvement, -0.13; 95% CI, -0.46 to 0.19; p for interaction=0.03). Overall, there was a significant and clinically relevant improvement in pain interference with activities (mean improvement, 1.11; 95% CI, 0.20-2.02; Cohen's d, 0.20). The use of NSAIDs during the pandemic was associated with marginal increases in low back pain intensity.Conclusions: Overall, decreased utilization of treatments for chronic low back pain did not adversely impact pain and functioning outcomes during the first 6 months of the pandemic. However, Black participants experienced significantly worse pain outcomes than their White counterparts.