In what the Associated Press describes as "a groundbreaking guideline," the Ohio agency that oversees that state's workers' compensation program has rejected spinal fusion surgery and opioid prescriptions as an early response to back pain. Instead, the state now requires that all workers with work-related back injuries undergo at least 60 days of nonsurgical care, including physical therapy, while avoiding opioids, before pursuing other treatments.

According to an AP article published in The New York Times, Ohio isn't the first state to restrict payments for surgery, but its approach includes a new twist: including a warning on the use of opioids. The Ohio rule stipulates that the 60 days of "alternative" treatment must be accomplished while avoiding opioid use if possible, an approach that NYT says is "more aggressive than other states that also decline to pay right away for the surgery."

In the report, the Ohio Bureau of Workers' Compensation defended the move by citing research showing that spinal fusion surgery is "often ineffective," can lead to complications, and may result in increased opioid use postsurgery. The policy went into effect on January 1.