New research indicates chiropractic significantly lowers opioid use and should be primary low back pain treatment 

What follows is a summary of a National Institutes of Health (NIH) article recently published comparing chiropractic to physical therapy on several different levels, focusing on opioid use and low back pain.

The initial study was published primarily with Doctors of Physical Therapy (DPTs), and subsequent articles were co-authored by three doctors of chiropractic who are also professors at medical and chiropractic schools, a medical doctor who specializes in neurosurgery and a doctor of osteopathic medicine with specialties in radiology and neuroradiology and on staff at a teaching hospital.  

What do the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Library of Medicine have in common? They both continually suggest physical therapy as one of the main treatments for low back pain despite the evidence in the literature showing otherwise.  

While this form of rehabilitation may be beneficial for easing pain in the lower back, a newly published article suggests chiropractic care may eclipse its results by as much as 313%. This puts chiropractic care in a much more favorable position to be considered the primary treatment for pain in this area solely based on outcome studies in the literature. 

Chiropractic vs. physical therapy and opioid use

One comparison discussed involved each modality’s effect on opioid use. Patients’ reliance on opioid-based pain medications is a common measure of whether non-pharmacological treatment options work. While chiropractic has been connected with a 55% reduction in opioid use, and 56% with an older population (cohort: 6868). The authors also report that physical therapy is not associated with any opioid reduction and is the cause for opioid use increases of 90% with physical therapy care (cohort:4827.   

This article further noted that opiate usage also increases by an additional 5% (to 95%) when physical therapy treatment is long-term. Standard physical therapy protocols also lead to an increase in spinal injections by upward of 53%, and specialty medical care and patient hospitalizations increase upward of 50%.  

Other research

Other pieces of research have found similar results. One study involved 40,929 subjects from Arkansas with low back pain. It found early chiropractic care may disrupt opioid usage both short– and long–term (which was quantified as by sby sage after one year), while physical therapy had no effect on patient opioid use. 

Costs of low back pain treatment

Article authors further share that costs associated with the opioid epidemic are around $1.5 trillion per year, with more than half of people taking this category of drugs reportedly having back pain. However, if these patients were first treated by a doctor of chiropractic, annual opioid prescription costs would be reduced by at least $550 billion. 

Other studies have found cost savings in chiropractic versus physical therapy. One piece of research was published in Healthcare in February 2020 and found the average cost of chiropractic to be $48.56 per visit lower than costs associated with physical therapy. Thus, this treatment option is more cost-effective for individuals experiencing low back pain for a minimum of three weeks over six months. 

A comparison of patient disability

Low back pain is the leading cause of disability globally according to the World Health Organization (WHO), making it a “major public health issue.” Some people can’t work at all because of their pain. Others continue to work but suffer from a loss of productivity, negatively impacting them, their families and society as a whole. 

When comparing chiropractic with physical therapy, the authors of the newly published article reported that chiropractic reduces secondary disability for back-related conditions by 313% when compared to physical therapy. It reduces primary disability by 239%. 

Patient satisfaction rate

The article adds that 96% of patients report chiropractic care helps, effectively representing a high satisfaction rate. This was a four-year study and a cohort of 8,023,162 chiropractic patients nationwide.  

Where do we go from here?

In the 2024 article, the authors stress the goal is not to discredit the value of physical therapy or medical treatments as each modality has its place, and collaboration among healthcare professionals is better for patients. However, when the reason for seeking care is pain in the lower back, outcomes studies must be the arbiter for an effective care path. As shown above, chiropractic is the best “first option” to help eradicate opioid use and reverse the trend of the low back pain epidemic worldwide.  

According to the article’s lead author, Mark Studin, DC, “Finally the research has shown what chiropractic has been saying for years. However, we need to get the entire medical community to put aside preconceived notions of care and allow care paths to follow the evidence. It is also past time that doctors of chiropractic increased their credentials through post-doctoral education to better diagnose and triage patients and be a part of the entire healthcare community.”  

Evidence such as that presented in the article reinforces the value that chiropractic provides compared to the current preferred physical therapy treatment. It is more effective for reducing opioid use, it’s more cost-effective, it reduces disability hundreds of times over and it also has a slightly higher patient satisfaction rate. 

For all these reasons, the authors suggest that patients may benefit from obtaining chiropractic care for low back pain before seeking other treatment options. The hope is that someday, health organizations will look at the evidence available on this topic and modify their recommendations to make chiropractic the primary treatment choice. 

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Gloria N. Hall is the editor-in-chief of Chiropractic Economics.