Acupuncture Versus Analgesic Pharmacotherapy: Comparison of Efficiency in the Management of Low Back Pain Among Medicare Fee-for-Service Beneficiaries

Study Design: Retrospective cohort design Objective: The purpose of this study was to compare initial care with acupuncture versus analgesic pharmacotherapy regarding escalation of care. Summary of Background Data: Usual medical care for chronic low back pain (cLBP) tends to be inefficient because health care resources are often overutilized, unnecessarily escalating the course of care. In 2020, Medicare initiated coverage of acupuncture for treatment of cLBP. The efficiency of acupuncture for the management of cLBP among Medicare beneficiaries is unknown. Methods: We examined Medicare claims data for 2020-2023. We compared rates of escalation of care between two cohorts of patients seen for cLBP, assembled according to initial treatment. The ACU cohort received acupuncture; the MED cohort saw a primary care physician and filled a prescription for analgesic medication from the same physician within 7 days, with no acupuncture. We measured rates of secondary care encounters indicative of escalation of care at 6 months. We modeled the odds of care escalations for ACU versus MED using logistic regression, adjusting for patient characteristics. We subanalyzed by chronicity and by the specialty of the initial primary care physician. Results: For any escalation, risk was higher for ACU versus MED among chronic cases but lower among the primary care specialties. The risk was lower for emergency department visits, imaging, and use of opioids. For hospitalization, the risk was lower among acute cases. For interventional pain management, risk was lower for family medicine, but higher among chronic cases. For medical specialist encounters, risk was higher among both acute and chronic cases, but lower for family medicine and internal medicine. Conclusions: The comparative risk of escalation of care favored acupuncture over pharmacotherapy for emergency department visits, imaging, and use of opioid analgesics. The acupuncture group had higher rates of medical specialist encounters and of interventional pain management among chronic cases. Level of evidence: Level III.