- Robert James Trager1,2,3,
- http://orcid.org/0000-0001-5537-9810Zachary A Cupler4,5,
- Roshini Srinivasan1,6,
- Regina M Casselberry7,
- Jaime A Perez7,
- Jeffery A Dusek1,2
- Correspondence to Dr Robert James Trager; Robert.Trager@UHhospitals.org
Objectives Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care.
Design Retrospective cohort study.
Setting US medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023.
Participants Opioid-naive adults aged 18–50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching.
Interventions Patients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care).
Primary and secondary outcome measures Risk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary).
Results After propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts.
Conclusions This study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.
Data availability statementData are available in a public, open access repository. Minimal, de-identified, aggregated datasets that support the findings of this study are openly available in Figshare at: https://doi.org/10.6084/m9.figshare.24539908 (baseline characteristics), https://doi.org/10.6084/m9.figshare.24539917 (cumulative incidence data) and https://doi.org/10.6084/m9.figshare.24539920 (propensity score density data).
http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
https://doi.org/10.1136/bmjopen-2023-078105
https://bmjopen.bmj.com/content/14/5/e078105