Study finds lower opioid risk among back pain patients receiving spinal manipulation
A recent study has found that patients with low back pain who received spinal manipulative therapy were less likely to use opioids or develop opioid use disorder compared to those treated with ibuprofen, a common non-opioid pain reliever.
The findings come at a time when health systems worldwide continue to grapple with the long-term impacts of opioid use, including dependence and overdose risk, and are increasingly exploring non-drug approaches to managing common conditions such as back pain.
Research examines treatment pathways and opioid outcomes
The study, published in Health Science Reports in 2025, analysed data from approximately 50,000 adults with newly diagnosed low back pain, with or without sciatica.
Using a retrospective cohort design, researchers reviewed existing health records from a large database. Patients included in the study had no prior history of opioid use disorder at the time of diagnosis.
Participants were divided into two groups based on their initial treatment approach:
- Those who received spinal manipulative therapy (SMT), commonly provided by chiropractors
- Those who were prescribed Ibuprofen — a non-opioid anti-inflammatory medication — was used as a comparator, meaning the study examined different treatment pathways rather than opioid versus non-opioid therapy directly.
Patients were followed for up to two years to assess differences in opioid-related outcomes.
Lower rates of opioid use observed
According to the findings, patients who underwent spinal manipulative therapy were less likely to be prescribed opioids during the follow-up period.
They were also less likely to develop opioid use disorder and less likely to continue using opioids over the long term compared to those in the medication group.
Specifically, 0.24% of patients receiving spinal manipulative therapy were diagnosed with opioid use disorder within two years, compared to 1.51% of those prescribed ibuprofen — an approximate 80% lower relative risk.
“What this study highlights is that the initial treatment approach for low back pain may be associated with different opioid-related outcomes over time. While we can’t draw firm conclusions from observational data alone, the findings are consistent with what many clinicians observe — that patients who engage with non-pharmacological care early may be less likely to move toward opioid-based management.” said Dr. Alissar Ayouby (Chiropractor).
These differences suggest that the type of care patients receive early in their treatment may be associated with their likelihood of being exposed to opioid medications later on.
Context of the opioid epidemic
Low back pain is one of the most common reasons for healthcare visits globally and has historically been a frequent trigger for opioid prescriptions.
While opioids can provide short-term pain relief, their use has been linked to a range of risks, particularly when used over longer periods. Public health efforts in recent years have focused on reducing unnecessary opioid prescribing and promoting alternative treatment pathways.
“Many patients are increasingly looking for ways to manage pain without relying heavily on medication, particularly given the wider concerns around opioid use. There’s a growing awareness that non-drug approaches can play a role, depending on the individual case,” Dr. Ayouby (Chiropractor) said.
In this context, research that examines how initial care decisions influence medication use is increasingly relevant.
Findings show association, not causation
Researchers emphasised that the study identifies an association, rather than a direct causal relationship.
Because the study is observational, patients were not randomly assigned to treatments. This means other factors may have influenced the results.
For example, individuals who seek chiropractic care may have different health preferences, expectations, or baseline risk profiles compared to those who begin treatment with medication.
As a result, while the findings are notable, they should be interpreted with appropriate caution.
Broader implications for care
The study contributes to a growing body of research exploring the role of conservative, non-pharmacological approaches in managing musculoskeletal conditions.
Many clinical guidelines already recommend starting with non-drug treatments — such as manual therapy, exercise, and education — for low back pain, particularly in the absence of serious underlying conditions.
The findings may support ongoing discussions about how early treatment pathways could influence longer-term outcomes, including medication use.
Ongoing research needed
Further research, particularly randomised controlled trials, is needed to better understand whether spinal manipulative therapy directly contributes to reduced opioid use, or whether the observed differences are driven by other factors.
Takeaway
The study suggests that patients with low back pain who begin care with spinal manipulative therapy may have lower rates of opioid use and related risks compared to those initially prescribed ibuprofen.
However, as the findings are based on observational data, more research is needed to confirm the nature of this relationship and its implications for clinical practice.
Article contribution and clinical commentary provided by Dr. Alissar Ayouby (Chiropractor), chiropractor based in Sydney, with an interest in evidence-based care for back pain and musculoskeletal conditions.
