New low back pain
(LBP) is a common outpatient complaint. Little is known about how care is delivered over the course of a year to patients who develop new LBP and whether such care patterns are guideline-concordant.
This retrospective analysis included Medicare claims of 162,238 opioid-naïve beneficiaries with new LBP from January 1, 2011, through December 31, 2014. Simple rates of modality use [computed tomography and magnetic resonance imaging (advanced imaging
), physical therapy
(PT), opioid and nonopioid medications] and percentiles (5th percentile, 25th percentile, median, 75th percentile, and 95th percentile) were reported.
Within the first year, 29.4% [95% confidence interval (CI), 29.1–29.8] of patients with ≥2 visits for new LBP received advanced imaging
, and 48.4% (95% CI, 47.7–49.0) of these patients received advanced imaging
within 6 weeks of the first visit; 17.3% (95% CI, 17.1–17.6) of patients with ≥2 visits received PT; 42.2% (95% CI, 41.8–42.5) of patients with ≥2 visits received non–steroidal anti-inflammatory drugs (NSAIDs), 16.9% (95% CI, 16.6–17.1) received a muscle relaxant, and 26.2% (95% CI, 25.9–26.6) received tramadol; 32.3% (95% CI, 31.9–32.6) of patients with ≥2 visits received opioids
; 52.4% (95% CI, 51.7–53.0) of these patients had not received a prescription NSAID, and 82.2% (95% CI, 81.7–82.7) of these patients had not received PT.
Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging
before other modalities like PT and prescription NSAIDs.