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Pain and Spine Medicine

Underutilization in Guideline-Concordant Care in Chronic Low Back Pain Patients Facing Socioeconomic Hardship in the Chicagoland Area.

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • Boss Povieng, MD

    Interventional Pain Physician
    Insight Medical Center Chicago
    Chicago, Illinois

    • Poster Presenter(s)

  • Alvyn Hernandez Reyes, Other

    4th year medical student
    Rush Medical College of Rush University Medical Center
    Chicago, Illinois

    • Co-Author(s)

  • Weibin Shi, MD, PhD

    Associate Clinical Professor
    Penn State Hershey Medical Center
    Hershey, Pennsylvania

  • HW

    Hong Wu, MD

    Professor
    Rush University Medical Center
    Oak Brook, Illinois

Disclosure(s):
Boss Povieng, MD: No financial relationships to disclose
Alvyn Hernandez Reyes, Other: No financial relationships to disclose
Weibin Shi, MD, PhD: No financial relationships to disclose
Hong Wu, MD: No financial relationships to disclose
Background and/or Objectives: Approximately 19.4% of the general population suffers from chronic low back pain (CLBP), making it the leading cause of disability and a major healthcare cost in the U.S. Socioeconomic status (SES) significantly influences health outcomes, with lower SES individuals experiencing greater pain and disability due to limited access to care and systemic disparities. This study assessed the use of non-opioid treatments among CLBP patients facing socioeconomic hardship and adherence to evidence-based guidelines.

Design: Retrospective case-control study.

Setting : Tertiary Academic Healthcare System.

Participants : 4,193 subjects with CLBP and 4,193 age-, sex-, race-, and region-matched subjects with non-chronic low back pain (NCLBP).

Interventions: This observation study evaluated the frequency of prescribed treatments, including physical therapy (PT), non-steroidal anti-inflammatory drugs (NSAIDs), and opioid medications, categorized into five hardship index groups (HIGs) based on socioeconomic factors.

Main Outcome Measures: Primary outcome measures involved treatment utilization patterns (i.e., prescription of opioid and non-opioid medications as well as non-pharmaceutical interventions) and socioeconomic hardship.

Results: Opioid prescription rates significantly increased with rising levels of socioeconomic hardship, demonstrating a positive correlation with HIGs. Patients in HIG 5 (highest hardship) were 1.64 times more likely to receive morphine than those in HIG 1 (lowest hardship) (95% CI: 1.02-2.63). This trend was observed across all HIGs, with opioid prescriptions increasing as hardship levels rose. In contrast, adherence to non-invasive treatments like PT declined, with each HIG increase reducing expected treatments by a factor of 1.07 (95% CI: 1.04-1.09).

Conclusions: The underutilization of guideline-concordant non-opioid treatments, particularly physical therapy, coupled with higher opioid prescription rates among patients facing socioeconomic hardship, highlights significant disparities in pain management. As hardship increased, the likelihood of receiving physical therapy significantly decreased (Tukey–Kramer adjusted p < 0.0001), while opioid prescriptions became more prevalent. Addressing these gaps through improved adherence to evidence-based guidelines is essential to enhancing outcomes and reducing disparities in CLBP management.