Chiropractic care associated with reduction in opioid use disorder in patients with low back pain

A new multi‑institutional retrospective cohort study led by University Hospitals Connor Whole Health reports that adults with a new diagnosis of low back pain, with or without sciatica, who initially received spinal manipulative therapy (SMT) from a chiropractor were significantly less likely to be diagnosed with opioid use disorder (OUD) over the following two years than similar patients who were initially prescribed ibuprofen in an outpatient setting.

Study at a glance

• Data source: TriNetX Research Network (U.S. electronic health record data)
• Timeframe: 2015 to 2025
• Population: Opioid‑naive adults age 18+ with a new episode of low back pain, with or without sciatica
• Exclusions: Prior OUD, prior opioid prescriptions, and serious pathologies such as cancer or fractures
• Design: Retrospective cohort study using propensity score matching to balance groups on demographics and key OUD risk factors, including mood disorders and substance use history

Key findings

After matching more than 49,000 patients, researchers reported notable differences in opioid‑related outcomes within a two‑year follow‑up period:

• OUD diagnosis:
  • 0.24% in the SMT cohort
  • 1.51% in the ibuprofen cohort
  • Interpreted by the authors as an ~80% lower risk of OUD among those initially receiving SMT
• Long‑term opioid use: SMT recipients were reported to be 77% less likely to experience long‑term opioid use
• Any opioid prescription: SMT recipients were reported to be 31% less likely to receive any opioid prescription

The lead author, Robert Trager, DC, noted that while earlier research has connected SMT with lower opioid prescribing, this study is presented as one of the first to directly examine OUD as an outcome.

What this could mean for chiropractic practice

For CCA members, the study adds to a growing body of evidence supporting nonpharmacological, guideline‑concordant first‑line care for many patients with low back pain. It also highlights a critical point about care pathways: what patients receive first for a new back‑pain episode may influence downstream opioid exposure and related risks.

Important limitations to keep in mind

As with many observational EHR studies, the authors note limitations that should temper interpretation:

• Association does not prove causation. Residual confounding is possible even after matching.
• EHR data can be incomplete. Diagnosis capture, medication data, and follow‑up may vary across systems.
• The observed differences could reflect factors beyond SMT itself, such as patient preferences, care‑seeking behaviors, access to services, or other aspects of patient‑provider interaction in nonpharmacological care settings.

Where to find the published study

Trager RJ, et al. Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A Retrospective Cohort Study. Health Science Reports (2025). DOI: 10.1002/hsr2.71267