Chiropractic linked to reduced opioid and gabapentin use

More than three in four drug overdose deaths involve some type of opioid. Of these, between 85% and 90% of the individuals also had gabapentin, an anticonvulsant drug sometimes prescribed for postoperative pain, in their system.  

Opioids and gabapentin are often prescribed together, but can increase a person’s risk of opioid-related death by almost 60% depending on the dose. Finding ways to decrease the use of each can help reduce these deaths, and new research suggests chiropractic may contribute to this goal. 

Chiropractic reduces opioid use

In September 2023, The Spine Journal published a study involving 128,377 Veterans Health Administration (VA) patients with low back conditions. Of these, 7,327 patients engaged in chiropractic care while the remaining 121,050 did not.  

While chiropractic patients made up a small percentage of the total study subjects, they had a significantly lower risk of filling using an opioid prescription to help deal with their pain. The study’s author, a DC connected with the VA Connecticut Healthcare System, concluded that increasing the use of chiropractic for VA patients with low back issues can be important for slowing opioid use in this demographic.  

Chiropractic also reduces gabapentin prescriptions

In another 2023 study, this one published in July in BMJ Open, researchers with University Hospitals Cleveland Medical Center and Butler VA Health Care System sought to determine whether chiropractic spinal manipulation affected the rate of gabapentin use in patients with radicular low back pain.  

This study involved 1,635 patients engaged with chiropractic spinal manipulative therapy and the same number receiving usual medical care. During the year after initial diagnosis, patients in the chiropractic cohort had significantly fewer gabapentin prescriptions. 

“Limited changes” in opioid, gabapentin and chiropractic trends

Despite the potential for chiropractic to reduce the reliance on potentially deadly pain medications, other research suggests there have been “limited changes” in the use of each in recent years. 

This research was published in the journal Drug and Alcohol Dependence in July 2023 and involved a 20% random sample of Medicare recipients between 2016 and 2019 diagnosed with back or neck pain in the back or neck, fibromyalgia or osteoarthritis/joint pain. During this time, the receipt use of chiropractic remained unchanged, as did the receipt of gabapentin.  

Opioid prescriptions did decrease by slightly more than 10%, with additional reductions in the drugs’ dosage and duration of use. However, the receipt of an opioid prescription was high for certain demographics, such as those under 65, American Indians, African Americans and individuals with opioid use disorder, which were also the same demographics least likely to receive nonpharmacologic therapies. 

Changing the trends

In 2019, the U.S. Department of Health and Human Services Pain Management Best Practices Inter-Agency Task Force published a report with recommendations for managing both chronic and acute pain conditions, while reducing the risk of adverse medication outcomes. One of the restorative therapies recommended was transcutaneous electric nerve stimulation (TENS). 

A 2022 study comparing TENS with opioids found individuals with chronic low back pain had greater pain relief with TENS treatment, with analgesic effects beginning immediately and continuing up to 24 hours after this intervention began. A 2023 study adds that TENS may also help reduce opioid-related constipation. 

Other research suggests using a whole health model for patients with chronic pain who have used opioids long-term can reduce their reliance on these medications while improving patient safety and satisfaction. This model involves healthcare providers partnering with patients to promote self-care and encourage the use of healing modalities. Providing coaching and education services with a whole health model may incite the behavioral changes necessary to improve patient wellness outcomes. 

Final thoughts

The latest research into chiropractic’s effectiveness as an alternative to prescription medication for chronic pain is promising; promoting it as such could potentially help decrease new opioid prescriptions and give patients a viable alternative to pharmacological pain interventions and their inherent health risks.