Differences in the use of pharmacologic and nonpharmacologic treatments among patients with chronic low back pain between 2017 and 2021: A cross-sectional study of commercial claims.

A large study examining over 1.7 million patients with chronic low back pain found significant differences in how people access different types of treatments based on their income, education, age, and sex. Researchers analyzed insurance claims from 2017 to 2021 to understand who receives medications like opioids and muscle relaxants versus nonpharmacologic treatments like physical therapy and acupuncture.

The study revealed that patients with higher incomes and more education were more likely to use nonpharmacologic treatments and less likely to fill multiple prescriptions for pain medications. Age and sex were also important factors in predicting what types of care patients received, while the relationship with race and ethnicity showed less consistent patterns.

What this means for patients: If you're dealing with chronic low back pain, this research highlights that your access to different treatment options may depend on factors beyond just your medical needs. People with lower incomes or less education may face barriers to accessing treatments like acupuncture and physical therapy, potentially leading them to rely more heavily on prescription medications including opioids. This suggests there may be inequities in how chronic pain care is distributed.

For those considering acupuncture for chronic low back pain, this study reinforces that it's recognized as a legitimate treatment option within the healthcare system, though access may vary based on socioeconomic factors. Understanding these disparities can help you advocate for comprehensive pain management that includes nonpharmacologic options. To pursue acupuncture treatment, seek a licensed acupuncturist (L.Ac.) or a practitioner certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

This cross-sectional analysis of 1,770,498 patients with chronic low back pain (cLBP) from Optum's Clinformatics Database (2017-2021) examined utilization patterns of pharmacologic and nonpharmacologic treatments across demographic and socioeconomic groups. The study assessed receipt of opioids, muscle relaxants, physical therapy, and acupuncture, stratified by race/ethnicity, sex, age, income, and educational attainment.

Key findings indicate that higher socioeconomic status (income and education) correlated with increased nonpharmacologic treatment utilization and reduced prescription fills. Adjusted analyses identified sex and age as primary predictors of cLBP care patterns, while race/ethnicity showed inconsistent associations. The results demonstrate systematic disparities in pain care access, with lower-income and less-educated patients experiencing greater barriers to evidence-based nonpharmacologic interventions.

Clinical takeaway: Acupuncturists should recognize that socioeconomic factors significantly influence patient access to integrative pain management. Practitioners may need to address financial barriers and advocate for insurance coverage to ensure equitable access to acupuncture services for cLBP patients across all demographic groups.