Management of low back pain among Medicaid beneficiaries: modalities, patterns, and perspectives across states.

Introduction: Low back pain is the leading cause of disability worldwide and Medicaid beneficiaries are disproportionally impacted. No studies have comprehensively examined patterns of treatment among Medicaid beneficiaries with low back pain. Methods: We quantitatively described modalities of treatment and low-value care received following a low back pain diagnosis among Medicaid beneficiaries across the United States. We then qualitatively explored factors that influence treatment patterns by interviewing chronic pain experts. Results: On average, 39.6% of patients received a prescription opioid in the 12 months following diagnosis and 41.2% received conservative therapies-noninvasive, nonpharmacological methods including physical, manual, or psychological therapies. Prescription nonopioid analgesic medications were the most common modality received first (57.8%) and across the 12 months following diagnosis (74.1%). On average, 8.9% of patients received high-dose, long-term opioid therapy (>120 morphine milligram equivalents/d for ≥90 days) and 31.7% received early imaging; both indicators for low-value care. Chronic pain experts highlighted challenges related to Medicaid coverage for conservative therapies, limited access to pain specialists, and social and economic factors influencing treatment access and utilization. Conclusion: Barriers, including Medicaid coverage limitations, provider access challenges, and economic factors, likely impact patterns of low back pain treatment among individuals enrolled in Medicaid.