Written by Kevin Liu
Spoon Feed
Chiropractic care in opioid-naive veterans with low back pain significantly reduced the likelihood of opioid prescriptions within one year.
Chiropractic adjustments lower back pain and opioid use
Veterans are disproportionately affected by high rates of chronic low back pain (LBP) and LBP-associated opioid prescriptions. This large, national VA study used a cross-sectional design with a 1-year longitudinal follow-up to analyze the health records from 128,377 opioid-naive veterans with incident LBP.
Adjusting for confounders using propensity-score matching, those receiving chiropractic care (at least 2 LBP visits) were 23% less likely to fill an opioid prescription within a year (HR 0.77; 95%CI 0.71–0.83). While this study is limited to the veteran population, it demonstrated a decrease in opioid prescription use of 3.8% (13.0% for chiropractic care users vs. 16.8% for non-users).
How does this change my practice?
This study is similar to another this month assessing the long term effectiveness of non-surgical interventions for lower back pain. While it is important to acknowledge that the use of early chiropractic referrals in veterans reduced opioid usage, chiropractic care provides only small, clinically modest reductions in pain for patients with LBP, and its effects are not superior to recommended first-line options such as exercise or behavioral therapy. For patients with the option of trying multiple modalities to treat their back pain, I would suggest exercise or behavioral therapy first and offer chiropractic services as an adjunct.
Source
The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care. J Gen Intern Med. 2025 May 20. doi: 10.1007/s11606-025-09556-w. Epub ahead of print. PMID: 40394439
