Abstract
AIMS: To examine multilevel factors associated with nonpharmacological treatment (NPT) use during opioid tapering among older adults with chronic low back pain (cLBP). METHODS: A cohort study was conducted using 2012-2020 5% national Medicare data. Older adults ≥65 with cLBP who initiated long-term opioid therapy and experienced subsequent tapering were included. The primary outcome was the receipt of NPT within 90 days of tapering. Guided by the social ecological model, predictors were assessed across individual, interpersonal, community, and organizational levels. Multivariable logistic regression was used to evaluate associations with NPT use. RESULTS: A total of 10,811 eligible beneficiaries were identified. NPT use was more likely among Asian and female individuals, while those receiving partial low-income subsidies had lower odds. Residing in counties with more mental health providers and social associations was linked to higher NPT use. Prior NPT use, higher baseline opioid dose, rapid tapering, mental health conditions, substance use disorders, additional pain diagnoses, and higher comorbidity burden were associated with increased odds of NPT use. CONCLUSION: This study identified key factors affecting NPT use during opioid tapering among older adults with cLBP. Findings underscore the importance of targeted clinical and policy strategies to reduce disparities in NPT access.