Chiropractic care for low back pain may decrease later opioid prescriptions
U.S. veterans who visited a primary care clinician for low back pain were less likely to be prescribed opioids in the next year if they received chiropractic care, a recent study found.
Patients with low back pain may be less likely to be prescribed opioids in the future if they receive chiropractic care, according to a recent study.
Researchers used data from the Veterans Health Administration (VA) to assess the effect of chiropractic care on receipt of opioid prescriptions within 365 days of a visit to a primary care clinician for low back pain. Opioid-naive patients who were seen for low back pain between Oct. 1, 2015, and Sept. 30, 2020, who did not have a visit for low back pain in the previous 18 months, and who had two subsequent visits for low back pain in the following 12 months were included. The primary outcome measures were outpatient visits, prescriptions, and comorbid diagnoses. The results of the study, which was funded by the VA and by the Interinstitutional Network for Chiropractic Research through a grant from the Palmer College Foundation, were published May 20 by the Journal of General Internal Medicine.
Overall, 128,377 patients were included in the study. A total of 7,327 (5.71%) were considered chiropractic users because they had an index visit to a primary care physician and at least two subsequent visits for low back pain in a chiropractic clinic within 365 days, while 121,050 (94.29%) were defined as nonusers, with an index visit to a primary care clinician and at least two subsequent visits for low back pain to any clinics other than chiropractic. Chiropractic users were significantly younger than nonusers (41.5 vs. 46.9 years) and were more likely to be women (15.6% vs. 12.9%), White (61.8% vs. 58.2%), and never married (20.4% vs. 17.4%). In a propensity score-matched sample that included 6,477 chiropractic care users and 19,431 nonusers, the hazard ratio for opioid prescription was 0.77 (95% CI, 0.71 to 0.83) over 365 days for the former group, after adjustment for potential confounders. The cumulative incidence of opioid prescriptions was 13.0% and 16.8%, respectively, with a number needed to treat of 27.
Limitations include that the study only assessed care provided in the VA system and did not evaluate patients' or clinicians' preferences regarding opioids and chiropractic care. The researchers concluded that initiation of opioid prescriptions after visits to a primary care clinician for incident low back pain was less common in U.S. veterans who received subsequent chiropractic care than in those who did not. “Our results add to the existing literature showing an inverse relationship between receipt of chiropractic care and receipt of opioid prescriptions among patients with [low back pain] in private sector and VA populations,” they wrote. They called for further evaluation of the effect of use of chiropractic care on other health care services, as well as economic analyses.