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Beliefs and Attitudes About Opioid Prescribing in Patients With Low Back Pain: A Survey of Osteopathic Physicians
Pham, B. [1]
Tzau, A. [2]
Lee, A. S. [4]
DeStefano, L. A. [3]
Popovich, J. M. [5]

Journal: Journal of Osteopathic Medicine Date: 2022/12, 122(12):Pages: A60-A61. doi: Subito , type of study: cross sectional study

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2022-2000/html)

Keywords:

attitude [117]
cross sectional study [597]
drugs [17]
low back pain [413]
opioids [32]
osteopathic physicians [163]
prescription [14]
USA [1086]

Abstract:

Statement of Significance: The American Osteopathic Association guidelines state that Osteopathic Manipulative Treatment (OMT), effectively reduces pain and improves functional status in patients with chronic nonspecific Low Back Pain (LBP) [1], which is further corroborated by a recent review and meta-analysis [2]. These findings are significant for the health of patients with LBP and warrant further investigation into osteopathic physicians’ perspectives on the use of opiates in their management of patients with LBP. Research Methods: Osteopathic physicians were recruited to participate in this study. Participants completed an online questionnaire that included: 1) Demographic information, 2) Health Care Providers’ Pain and Impairment Relationship Scale (HC-PAIRS), 3) Pain Attitudes and Beliefs Scale for Physical Therapists (PABS-PT), and 4) Opioid Therapy Provider Survey (OTS). The HC-PAIRS was used to measure physicians’ attitudes and beliefs regarding the relationship between LBP and impairment. The PABS-PT was used to differentiate between biomedical and biopsychosocial treatment orientations for patients with LBP. The OTS is a ten-item survey that was used to assess providers’ practice behaviors and confidence in managing their patients with opioid therapy with each question labeled from OTS1 through OTS10. The responses to the OTS were scored on a 5-point Likert scale where 1 = “Completely Disagree” and 5 = “Completely Agree”. Comparisons between multiple physician groups were conducted using the non-parametric independent samples Kruskal-Wallis test and comparisons between two physician groups were conducted using the non-parametric Mann-Whitney U test. Data are reported as median [range]. Statistical analyses were conducted using SPSS Statistics (Ver. 28.0. Armonk, NY) and statistical significance was set at p≤0.05. This study has osteopathic significance because understanding osteopathic physicians’ beliefs and attitudes on opiate usage in the management of patients with LBP may provide clarity and direction as to why patients treated with OMT have significant reductions in medication and opioid drug use. Data Analysis/Results: A total of 35 osteopathic physicians (n=10 women, n= 1 unspecified, n= 24 men) with an average of 17.2 ± 10.4 years post/after residency participated in this study and represented the following specialties: ONMM, n=9; PM&R, n=13; Family Medicine, n=12; Pediatrics, n=1. Of the 35 physicians, 32 (91.4%) reported using OMM in their practice for a total of 86% [range 5-100%] of the time. Overall (n=35 physicians), the scores for the HC-PAIRS, PABS-PT-Biomedical, PABS-PT-Biopsychosocial, and OTS were 51 [34-75], 34 [19-43], 34 [24-44], 30 [14-41], respectively. There were no significant differences among the different specialties (Pediatrics was excluded from this comparison due to the small sample size) in any of the aforementioned questionnaire scores (all p>0.05). However, when comparing physicians who almost exclusively use OMM in their practice (defined as greater than 90% of the time, n=13) to physicians who use OMM less often (defined as 90% or less, n=19) there were significant differences in questionnaire responses. Specifically, there were significant differences between physicians who exclusively practice OMM compared to those who use OMM less often in OST1) “I am willing to prescribe opioids with support from a pain clinic” (1[1-4] vs. 3 [1-5], p=0.05), OST5) “I would likely prescribe opioids when other treatments are ineffective” (1[1-5] vs. 2 [1-4], p=0.04), and HC-PAIRS (56 [43-75] vs. 50 [34-67], p=0.02). Conclusion: In conclusion, our hypothesis that osteopathic physicians who use OMM to treat their patients with LBP will have a unique perspective on the use of opioid drugs was supported by our findings in Osteopathic physicians who practice OMM for more than 90% of their practice. In the HC-PAIRS survey, physicians who practice OMM >90% of their practice scored an average of 56 in comparison to physicians who practice OMM less often of their practice which scored an average of 50. This higher score in physicians who practice OMM >90% of their practice suggest greater adherence with the notion that LBP necessitates the avoidance of activities and justifies disability; however, while this 6-point difference was statistically significant, it may not constitute clinically meaningful differences between groups. [3] Additionally, the difference in scores for questions OST1 and OST5 between physicians who used OMM in >90% of their practice and physicians whose practice was 90% OMM or less may indicate why patients with chronic LBP who are treated with OMM, by an osteopathic physician, have been shown to utilize less opiates than their non-OMM counterparts [4]. Further investigation is required to fully understand why the practice patterns of physicians who practice OMM result in significantly less opiate drug usage in this patient population.

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