Many clinical practice guidelines for management of pain disorders now favor first-line use of nonpharmacological therapies (NPT). However, Medicare coverage of NPT is limited.
Methods:
Using a serial cross-sectional design, we examined temporal trends in the utilization and cost of NPT procedures commonly used to treat pain under Medicare.
Results:
Utilization and costs for physical therapy increased while those for spinal and osteopathic manipulation declined.
Discussion:
Future research on NPT under Medicare should focus on equity of patient access and comparative outcomes.
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References
1.
DahlhamerJ, LucasJ, ZelayaC, et al.Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morb Mortal Wkly Rep, 2018; 67(36):1001–1006.
2.
QaseemA, WiltTJ, McLeanRM, et al.Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med, 2017; 166(7):514–530.
3.
WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization, 2023. Available from: https://www.who.int/publications/i/item/9789240081789) [Last accessed: February27, 2024].
4.
AranaE, KovacsFM. The evidence gap in low back pain management strategies. Lancet, 2021; 398(10306):1130–1131.
5.
DeyoRA, Von KorffM, DuhrkoopD. Opioids for low back pain. Bmj, 2015; 350:g6380; doi: 10.1136/bmj.g6380
6.
HeywardJ, JonesCM, ComptonWM, et al.Coverage of nonpharmacologic treatments for low back pain among US public and private insurers. JAMA Netw Open, 2018; 1(6):e183044.
7.
KarmaliRN, SkinnerAC, TrogdonJG, et al.The association between the supply of select nonpharmacologic providers for pain and use of nonpharmacologic pain management services and initial opioid prescribing patterns for Medicare beneficiaries with persistent musculoskeletal pain. Health Serv Res, 2021; 56(2):275–288.
8.
LiouKT, KorensteinD, MaoJJ. Medicare coverage of acupuncture for chronic low back pain: Does it move the needle on the opioid crisis? J Gen Intern Med, 2021; 36(2):527–529.
9.
NahinRL, RheeA, StussmanB. Use of complementary health approaches overall and for pain management by US adults. JAMA, 2024; 331(7):613–615.
10.
MoyoP, VaillantJ, GirardA, et al.Prevalence of opioid and nonopioid pain management therapies among Medicare beneficiaries with musculoskeletal pain conditions from 2016 to 2019. Drug Alcohol Depend, 2023; 248:109930; doi: 10.1016/j.drugalcdep.2023.109930
WhedonJM, HaldemanS, PetersenCL, et al.Temporal trends and geographic variations in the supply of clinicians who provide spinal manipulation to medicare beneficiaries: A serial cross-sectional study. J Manipulative Physiol Ther, 2021; 44(3):177–185.
14.
StarrEG, SmithJF, HansonRB, et al.Utilization and reimbursement trends of osteopathic manipulative treatment for Medicare patients: 2000—2019. J Osteopath Med, 2023; 123(6):309–315.
WhedonJM, GoertzCM, LurieJD, StasonWB. Beyond spinal manipulation: Should Medicare expand coverage for chiropractic services? A review and commentary on the challenges for policy makers. J Chiropr Humanit, 2013; 20(1):9–18.
17.
LeeB, YangKC, KaminskiP, et al.Substitution of nonpharmacologic therapy with opioid prescribing for pain during the COVID-19 pandemic. JAMA Netw Open, 2021; 4(12):e2138453.
