Chiropractic care for back pain tied to lower odds of opioid use

People with chronic back and neck pain who receive chiropractic care may be less likely to use opioid painkillers, a research review suggests.

Researchers examined data from six previously-published smaller studies with a total of more than 62,000 participants with spinal pain. Across all of the studies, 11% to 51% of the patients used chiropractic care.

People who saw a chiropractor were 64% less likely to use opioids than people who didn’t, researchers report in the journal Pain Medicine.

“Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,” said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut.

“These therapies may lead to decreased pain, improved range of motion and increased function,” Corcoran said by email. “If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all.” Chiropractors don’t prescribe opioids. However, all of the studies in the analysis examined whether receipt of chiropractic care was associated with whether patients also received opioid prescriptions from other clinicians.

It’s not clear from this analysis whether people already using opioids to manage pain might be able to cut back or eliminate opioid use after getting chiropractic care.

In four of the six studies, chiropractors were either the first provider patients saw or part of the initial treatment plan for back or neck pain. One limitation of the review is that the included studies didn’t specify what exact type of chiropractic care patients received or the severity or frequency of pain symptoms.

“Patients visiting chiropractors are likely to be different than those visiting MDs in terms of their pain complexity,” said Dan Cherkin, an emeritus senior scientific investigator at Kaiser Permanente Health Research Institute in Seattle, Washington.

“In general, I think that patients wishing to avoid Rx (especially opioid) would do well to seek care from providers who can provide potentially helpful alternatives to opioid treatments - this could include chiropractors, physical therapists, massage therapists, pain psychologists, yoga instructors, and mindfulness-based stress reduction classes, etc.,” Cherkin, who wasn’t involved in the study, said by email.

The challenge is that some of these options aren’t always available or covered by insurance, Cherkin added.

Still, organizations such as the Veterans Health Administration and the American College of Physicians currently recommend that patients try conservative treatments commonly delivered by doctors of chiropractic instead of opioids, said Christine Goertz, a researcher at Duke University in Durham, North Carolina, who wasn’t involved in the study.

“The current study indicates that patients who follow these recommendations are, in fact, less likely to receive an opioid prescription,” Goertz said by email.

“Treatments provided by a doctor of chiropractic, such as spinal manipulation, may decrease pain from muscle strain, inflammation and spasm in the back muscles and/or impact the way that the body perceives pain through either the brain or the spinal cord,” Goertz added. “Patients who find effective ways to treat their pain, such as chiropractic care, may be less likely to turn to opioids.”