Chiropractic Therapy Linked to Lower Risk of Opioid Use Disorder in Low Back Pain Patients

A comprehensive multi-center study conducted by University Hospitals Connor Whole Health reveals that adults experiencing newly diagnosed low back pain, whether with or without sciatica, who initially received chiropractic spinal manipulative therapy (SMT) were significantly less likely to develop opioid use disorder (OUD) over a two-year period compared to those who were prescribed ibuprofen. The findings highlight the potential of chiropractic care as an effective nonpharmacological alternative in managing low back pain and mitigating risks associated with opioid dependency.

The research, published in Health Science Reports, analyzed data from over 49,000 matched patients across the United States between 2015 and 2025, sourced from the TriNetX Research Network. Results showed only 0.24% of patients undergoing SMT developed OUD within two years, a stark contrast to the 1.51% incidence among those treated with ibuprofen. This corresponds to an 80% reduction in the risk of developing opioid use disorder among chiropractic care recipients.

Further, patients who received SMT were 77% less likely to engage in long-term opioid use and 31% less likely to receive any opioid prescriptions initially. Lead author Robert Trager, DC, emphasizing the significance of these findings, stated that this is the first study to directly link spinal manipulative therapy with a lower incidence of opioid use disorder, highlighting its benefits as a front-line treatment option.

The study population focused on opioid-naive adults aged 18 and older with recent low back pain episodes, excluding individuals with prior OUD, opioid prescriptions, or serious underlying conditions like cancer or fractures. Participants were grouped based on initial treatment: chiropractic SMT versus outpatient ibuprofen prescriptions. Propensity score matching was employed to balance the groups regarding demographics and risk factors such as mood disorders and substance use history.

Dr. Kristi Artz, Vice President of UH Connor Whole Health, remarked on the importance of exploring non-drug-based treatments to address pain while reducing opioid dependency. Co-author Dr. Roshini Srinivasan from Duke University added that these findings reinforce the growing evidence supporting chiropractic care’s role in addressing pain amid the opioid crisis.

While observational limitations exist, including potential residual confounding and reliance on real-world electronic records, the results align with guidelines from the American College of Physicians and CDC advocating for primary use of nonpharmacologic therapies for low back pain. The authors call for further research to understand whether benefits stem directly from SMT or from broader aspects like patient-provider interactions in non-medication settings.

Overall, this study underscores the promising role of chiropractic care in reducing opioid use and highlights an important step toward safer pain management strategies.