Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis

Pain Medicine September 2019

Kelsey L. Corcoran, DC, Lori A. Bastian, MD, Craig G. Gunderson, MD, Catherine Steffens, Alexandria Brackett, MA, Anthony J. Lisi, DC. From Yale School of Medicine.

In the midst of a national crisis surrounding opioid abuse and overdose deaths, healthcare professionals are urgently seeking alternatives to traditional pain management methods. A recent systematic review and meta-analysis sought to uncover whether chiropractic care could serve as a viable solution, specifically investigating its association with reduced opioid use among individuals suffering from non-cancer pain.

The study, which included data from over 62,000 patients across six distinct research endeavors, aimed to discern if chiropractic interventions could offer a promising pathway towards mitigating reliance on opioids for pain management.

The findings of the review shed light on several critical points, illuminating the potential role of chiropractic care in combating the opioid crisis:

  • Opioid Crisis in Context: Against the backdrop of a staggering opioid crisis, where an average of 115 Americans succumbed to opioid overdoses daily in 2017, the need for effective alternatives to these potent painkillers is more pressing than ever. The correlation between opioid-related deaths and prescribing patterns underscores the urgency of exploring non-pharmacological avenues for pain management.
  • Guidelines and Recommendations: Current clinical guidelines emphasize the prioritization of non-pharmacological treatments for various pain conditions, positioning chiropractic care as a frontline intervention for individuals grappling with low back pain, neck pain, and osteoarthritis.
  • Chiropractic Interventions: Chiropractors offer a spectrum of non-pharmacological treatments endorsed by clinical practice guidelines, including spinal manipulation, patient education, exercise regimens, acupuncture, and massage therapy. These modalities align closely with the recommended strategies for managing spinal pain and hold promise as alternatives to opioid prescriptions.
  • Mitigating Opioid Dependency: Multimodal chiropractic care represents a potential avenue for averting the need for opioid prescriptions, particularly given the adverse outcomes associated with prolonged opioid use for chronic pain management. By offering holistic treatments that address the root causes of pain, chiropractors may play a pivotal role in reducing reliance on opioids.
  • Economic and Social Costs: The burden of back pain extends far beyond individual suffering, imposing substantial economic costs and contributing to widespread disability. With an estimated annual cost exceeding $100 billion in the United States alone, the imperative to explore effective pain management strategies is clear.
  • Prevalence of Chiropractic Care: Chiropractors primarily focus on managing spinal conditions, making them a natural point of access for individuals seeking relief from back pain and related ailments. Their prominence in the healthcare landscape underscores the significance of investigating the relationship between chiropractic care and opioid use.
  • Negative Association Identified: Crucially, the meta-analysis revealed a consistent inverse association between chiropractic care utilization and opioid prescriptions among patients with spinal pain. Across all included studies, chiropractic users demonstrated lower rates of opioid receipt compared to non-users, highlighting the potential of chiropractic interventions as a means of curbing opioid dependency.
  • Implications for Healthcare Policy: The findings of this review underscore the need for further investigation into the role of chiropractic care in opioid reduction strategies. By enhancing access to chiropractic services and integrating them into comprehensive pain management protocols, healthcare systems may mitigate the reliance on opioids and improve patient outcomes.
  • Key Insights: Notably, chiropractic users exhibited significantly lower odds of receiving opioid prescriptions, with a 64% reduction compared to non-users. This inverse association underscores the potential of chiropractic care as a viable alternative to traditional pharmacological interventions for pain management.
  • Future Directions: As the body of evidence supporting the link between chiropractic care and reduced opioid use continues to grow, there is a compelling need for further research to elucidate the mechanisms underlying this relationship. By fostering a deeper understanding of the interplay between chiropractic interventions and opioid prescribing patterns, clinicians and policymakers can make informed decisions that prioritize patient well-being and public health.

In conclusion, the systematic review and meta-analysis provide compelling evidence of the inverse association between chiropractic care utilization and opioid prescriptions among individuals suffering from spinal pain. As healthcare systems grapple with the challenges posed by the opioid crisis, integrating chiropractic interventions into comprehensive pain management strategies holds promise for reducing opioid dependency and improving patient outcomes.