New research links chiropractic care to significantly lower rates of opioid use disorder in back pain patients

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New research links chiropractic care to significantly lower rates of opioid use disorder in back pain patients

A significant new study has found that people with low back pain who begin care with spinal manipulative therapy are far less likely to develop opioid use disorder than those who start with medication. These findings carry real weight for anyone navigating back pain treatment decisions.

The research, published in Health Science Reports in 2025, analysed medical data from around 50,000 adults across the United States who had been newly diagnosed with low back pain, with or without sciatica. All participants were opioid-naïve at the outset — meaning no prior history of opioid use disorder — giving the study a clean baseline to work from.

What the study found

Researchers divided participants into two groups: those who received spinal manipulative therapy (SMT), and those prescribed ibuprofen  (a common non-opioid anti-inflammatory). Patients were then followed for up to two years to track opioid-related outcomes.

The results were striking. Only 0.24% of patients in the SMT group were diagnosed with opioid use disorder within two years, compared to 1.51% of those in the ibuprofen group. This represents an approximately 80% lower relative risk. SMT recipients were also 77% less likely to develop long-term opioid use, and 31% less likely to receive any opioid prescription at all during the follow-up period.

“What this research highlights is that the pathway a patient starts on matters — not just for their immediate pain relief, but potentially for their longer-term relationship with medication. In practice, I regularly see patients who were initially prescribed medication for back pain and found themselves on a trajectory they hadn’t anticipated. These findings are consistent with what many of us observe clinically.” said commentator Dr Matthew Alch (Chiropractor), Sydney Spinal Care

Why this matters in the context of opioid use

Low back pain is one of the most common reasons people seek medical care globally, and has historically been a leading driver of opioid prescriptions. While opioids can offer short-term relief, their use carries well-documented risks — including dependence, reduced effectiveness over time, and the potential for misuse.

Public health guidance in recent years has increasingly pointed toward non-pharmacological approaches as a first-line option for uncomplicated back pain. This study adds meaningful data to that conversation, suggesting that the choice of initial treatment may have consequences that extend well beyond the first appointment.

Important caveats to keep in mind

The study is observational, which means patients were not randomly assigned to each treatment group. As the researchers themselves note, people who seek chiropractic care may differ in meaningful ways from those who begin with medication — in their health behaviours, pain thresholds, or attitudes toward drug-based treatment. These differences could influence the results independently of the treatment itself.

The comparator group also received ibuprofen, not opioids directly, so the study is measuring differences in treatment pathways rather than a head-to-head comparison with opioid therapy. The findings are best understood as a strong signal that warrants further investigation — particularly through randomised controlled trials — rather than definitive proof of causation.

“As clinicians, we’ve long advocated for starting with conservative care for back pain where appropriate. What’s valuable about research like this is that it moves the conversation beyond anecdote and starts building an evidence base. That’s good for patients, and it’s good for the profession.” said Dr Matthew Alch (Chiropractor), Sydney Spinal Care

What this means for patients

For anyone currently managing back pain or considering their treatment options, the core message is straightforward: how you start your care may matter more than previously understood. Seeking assessment from a qualified chiropractor or spinal care practitioner early — before reaching for long-term medication — is increasingly supported by both clinical guidelines and emerging research.

Further studies, particularly randomised trials, will be needed to clarify the extent to which spinal manipulative therapy directly drives these outcomes. But for now, the evidence continues to point in a consistent direction.

Author contributions: Dr. Matthew Alch (Chiropractor) has been practising with Sydney Spinal Care since late 2002. Matthew graduated from Macquarie University with a Bachelor of Chiropractic Science and a Masters of Chiropractic. He is a member of The Chiropractors Association of Australia and is registered with the Australian Health Practitioner Regulation Agency.