Evidence map›Paper›PMID 38951321›Full record

ArticleJournal of general internal medicine2025

Outcomes After a Statewide Policy to Improve Evidence-Based Treatment of Back Pain Among Medicaid Enrollees in Oregon.

Esther K Choo, Christina J Charlesworth, Catherine J Livingston, Daniel M Hartung, Sanae El Ibrahimi, Liliya Kraynov, K John McConnell

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Joint call to action paper-Pain disparities special issues: Why this, why now? A unified call at a critical time.Health psychology : official journal of the Division of Health Psychology, American Psychological Association · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Esther K ChooCenter for Policy & Research in Emergency Medicine (CPR-EM), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA. echoMD@gmail.com.ORCID 0000-0001-8847-5745
Christina J CharlesworthCenter for Health Systems Effectiveness (CHSE), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Catherine J LivingstonDepartment of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
Daniel M HartungCollege of Pharmacy, Oregon State University, Portland, OR, USA.
Sanae El IbrahimiDivision of Research and Evaluation, Comagine Health, Portland, OR, USA.
Liliya KraynovValleyWise Health, Phoenix, AZ, USA.
K John McConnellCenter for Health Systems Effectiveness (CHSE), Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.

Funding

Implementation, Outcomes, and Cost of a Novel Medicaid Policy to Reduce Opioids for Back PainR01DA044284 · NIDA · OREGON HEALTH & SCIENCE UNIVERSITY · PI CHOO, ESTHER K · 2018 to 2022
$3.2M
Evaluating health disparities among likely transgender persons in OregonR01MD011212 · NIMHD · OREGON HEALTH & SCIENCE UNIVERSITY · PI MCCONNELL, KENNETH JOHN · 2016 to 2019
$2.5M
NIDA NIH HHS 1R01DA044284NIDA NIH HHS R01 DA044284NIMHD NIH HHS R01 MD011212NIMH NIH HHS 1R01MD011212
6 · The paper itself

Abstract

backgroundA novel Oregon Medicaid policy guiding back pain management combined opioid restrictions with emphasis on non-opioid and non-pharmacologic therapies.

objectiveTo examine the effect of the policy on prescribing, health outcomes, and health service utilization.

designUsing Medicaid enrollment, medical and prescription claims, prescription drug monitoring program, and vital statistics files, we analyzed the policy's association with selected outcomes using interrupted time series models. SUBJECTS: Adult Medicaid patients with back pain enrolled between 2014 and 2018.

interventionThe Oregon Medicaid back pain policy. MAIN MEASURES: Opioid and non-opioid medication prescribing, procedural care, substance use and mental health conditions, and outpatient and inpatient healthcare utilization. KEY

resultsThe policy was associated with decreases in the percentage of Medicaid enrollees with back pain receiving any opioids (- 2.68 percentage points [95% CI - 3.14, - 2.23] level, - 1.01 pp [95% CI - 1.1, - 0.92] slope), days of short-acting opioid use (- 0.4 days [95% CI - 0.53, - 0.26] slope), receipt of more than 7 days of short-acting opioids (- 2.36 pp [95% CI - 2.76, - 1.95] level, - 0.91 pp [95% CI - 1, - 0.83] slope), chronic opioid use (- 1.27 pp [95% CI - 1.59, - 0.94] level, - 0.46 [95% CI - 0.53, - 0.39 slope), and spinal surgeries and procedures. Among secondary outcomes, we found no increase in opioid overdose and a small, statistically significant trend decrease in opioid use disorders. There were small increases in non-opioid substance use and mental health diagnoses and visits but no increase in self-harm.

conclusionsA state Medicaid policy emphasizing evidence-based back pain management was associated with decreases in opioid prescribing, spinal surgeries, and opioid use disorder trends, but also short-term increases in mental health encounters and an increase in non-opioid substance use disorder trends. Such policies may help reinforce evidence-based care, but must be designed with consideration of potential harms.

Indexed as

Back PainHealth PolicyMedicaidPain ManagementAdultAnalgesics, OpioidFemaleHumansMaleMiddle AgedOregonTreatment OutcomeUnited StatesYoung AdultAnalgesics, Opioidcomplementary therapyMedicaidopioid analgesicspain managementpolicy

Identifiers

PMID38951321
PMCPMC11802945

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.