Physical therapy, acupuncture and chiropractic care are consistently corresponding with lower opioid prescription use in workers compensation, according to a Workers Compensation Insurance Rating Bureau study released Thursday.

The Oakland, California-based bureau examined physical medicine, which includes physical therapy, chiropractic care and acupuncture, and its impact on opioid use and lost time on the Golden State’s workers compensation system. Since 2014, when the state’s fee schedule increased reimbursements for this type of treatment, average medical payments for physical medicine have continued to rise, contributing to a growing proportion of the total medical paid per claim as well as of the medical paid for physician services per claim.

Physical medicine payments per workers compensation claim have increased about 8% annually, with utilization increasing at about the same rate, and utilization of opioids and other pain medications decreased by 86% between 2013 and 2018 for claims involving physical medicine, according to the study. 

Soft tissue injury claims involving PT during the first 30 days of the initial medical visit were less likely to involve opioid use within one year of the injury, compared to similar claims without early PT. The impact of early PT on initiation of opioid use varies over time; particularly, between 2015 and 2017, soft tissue claims involving early PT were significantly less likely to involve opioid use.

Workers who received physical therapy as well as an opioid within the first year of injury also received 23% lower doses of prescribed opioids compared with workers with similar claims who did not receive PT, said the study. In addition, workers who began PT shortly after their injury were 12% less likely to have a lost-time component compared to workers with similar injuries who did not receive PT.

Workers who sustained soft tissue injuries in the transportation and warehousing sector were most likely to use physical medicine, according to the study, and only about 2% of workers comp claims reached the 24-visit physical medicine cap within 12 months following the injury.