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.

Differences in pain care utilization for chronic low back pain (cLBP) across groups are well-documented, but studies have largely focused on pharmacologic treatments and the role of demographic characteristics. Differences in the use of nonpharmacologic treatments are less clear, as is the extent to which socioeconomic characteristics predict use of cLBP care. Using insurance claims from Optum's de-identified Clinformatics® Data Mart Database, this study investigated the receipt of pharmacologic treatments, including opioids and muscle relaxants, and nonpharmacologic treatments, including physical therapy and acupuncture, disaggregating by race/ethnicity, sex, age, income, and educational attainment. The sample included 1,770,498 patients diagnosed with cLBP between 2017 and 2021. Higher incomes and more educational attainment were generally associated with an increased likelihood of using nonpharmacologic treatments and fewer prescription fills. Adjusted analyses indicated that sex and age were key predictors of cLBP care; race/ethnicity findings were less consistent. These results indicate that demographic and socioeconomic groups face differential barriers in access to pharmacologic and nonpharmacologic treatments, suggesting potential disparities in cLBP care. PERSPECTIVE: This study documents differences in chronic low back pain (cLBP) care, finding that higher incomes and educational attainment are associated with less use of pharmacologic treatments like opioids and greater use of nonpharmacologic treatments such as physical therapy. Race/ethnicity, sex, and age also predict cLBP care.