Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries.
Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries.
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最初选择脊柱推拿疗法治疗慢性腰痛可降低老年医疗保险受益人的长期药物不良事件风险
DOI：
10.1097/brs.0000000000004078
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发表时间：
2021-12-15
期刊：
影响因子：
3
通讯作者：
Haldeman S
中科院分区：
文献类型：
--
作者：
Whedon JM;Kizhakkeveettil A;Toler AW;MacKenzie TA;Lurie JD;Hurwitz EL;Bezdjian S;Bangash M;Uptmor S;Rossi D;Haldeman S
回顾性观察研究阿片类镇痛疗法 (OAT) 和脊柱手法疗法 (SMT) 是治疗慢性腰痛 (cLBP) 的循证策略，但这些疗法的长期安全性尚不确定。本研究的目的是比较 OAT 与 SMT 在患有 cLBP 的老年人中药物不良事件 (ADE) 的风险。我们检查了 5 年期间 65-84 岁按服务收费受益人的 Medicare 索赔数据，他们在 60 个月的研究期内连续参加 Medicare A、B 和 D 部分，以及 2013 年发生过一次 cLBP。我们排除了诊断为癌症或接受临终关怀的患者。所有纳入的患者均接受 SMT 或 OAT 的 cLBP 长期治疗。我们收集了仅接受 SMT 或 OAT 的患者队列，以及从 OAT 过渡到 SMT 或从 SMT 过渡到 OAT 的患者队列。我们使用泊松回归来估计最初选择 OAT 与 SMT 的患者中门诊 ADE 的调整后发生率比率。在控制患者特征、健康状况和倾向评分的情况下，初始选择 OAT 的 ADE 调整率比初始选择 SMT 高 42 倍以上（比率 42.85，95% CI 34.16–53.76，p <.0001）。在接受 cLBP 长期护理的老年医疗保险受益人中，最初选择 OAT 的患者的 ADE 调整率明显高于最初选择 SMT 的患者。 2 在开始使用阿片类镇痛疗法治疗慢性腰痛的老年医疗保险受益人中，调整后的门诊不良药物事件发生率比最初选择脊柱手法治疗的受益人高出 42 倍以上（发生率比 42.85，95% CI 34.16–53.76，p <.0001）。
Retrospective observational study Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain. The objective of this study was to compare OAT vs. SMT with regard to risk of adverse drug events (ADEs) among older adults with cLBP. We examined Medicare claims data spanning a five-year period on fee-for-service beneficiaries aged 65–84 years, continuously enrolled under Medicare Parts A, B, and D for a 60-month study period, and with an episode of cLBP in 2013. We excluded patients with a diagnosis of cancer or use of hospice care. All included patients received long term management of cLBP with SMT or OAT. We assembled cohorts of patients who received SMT or OAT only, and cohorts of patients who crossed over from OAT to SMT or from SMT to OAT. We used Poisson regression to estimate the adjusted incidence rate ratio for outpatient ADE among patients who initially chose OAT as compared to SMT. With controlling for patient characteristics, health status, and propensity score, the adjusted rate of ADE was more than 42 times higher for initial choice of OAT vs. initial choice of SMT (rate ratio 42.85, 95% CI 34.16–53.76, p <.0001). Among older Medicare beneficiaries who received long-term care for cLBP the adjusted rate of ADE for patients who initially chose OAT was substantially higher than those who initially chose SMT. 2 Among older Medicare beneficiaries who initiated long-term care of chronic low back pain with opioid analgesic therapy, the adjusted rate of outpatient adverse drug events was more than 42 times higher as compared to those who initially chose spinal manipulative therapy (rate ratio 42.85, 95% CI 34.16–53.76, p <.0001).