Lower back pain is a scourge, with many sufferers turning to opioids in an attempt to manage their symptoms. Promoting chiropractic care might reduce short and long-term use of opioid medications.
Lower back pain is arguably the most burdensome public health problem on a global scale, COVID-19 aside. In terms of years lived with disability and prevalence among adult populations, lower back pain is a perennial top contender in almost any study of global burdens of disease.
Opioid use, abuse, and the damage done to individuals, families, and the societal ramifications of these medications are likewise well documented.
So it is welcome to see that chiropractic care, and other conservative treatments for lower back pain, are associated with less reliance on opioid medications, which do not have a particularly great track record in resolving spinal pain complaints and are not recommended as first-line interventions for acute or chronic lower back pain.
From Reuters Health in 2019:
Patients with spinal pain who visit a chiropractor may receive treatments such as spinal manipulation, massage, acupuncture, exercises and education as appropriate,” said lead author Kelsey Corcoran of Yale School of Medicine in New Haven, Connecticut. These therapies may lead to decreased pain, improved range of motion and increased function, Corcoran said by email. If a patient’s pain is well controlled by the treatment they received from a chiropractor, they may subsequently need less pain medications or even none at all.
Addressing Biases
Of course, you might say, “You’re a chiropractor so obviously you’re going to tout these studies” and you’d be correct. Also, there is selection bias involved, people who self-select conservative care like chiropractic or physical therapy over medical care may be doing so with the explicit intention of avoiding the use of medications.
However, these studies were not just done by chiropractors, and they haven’t only been published in niche journals catering to the chiropractic or manual therapy professions. It is true that these types of studies tend to be retrospective and observational, and cannot imply causation, but evidence will continue to accumulate and it will be interesting to see what future work on this topic elucidates.
Final Thoughts
I’ve written on this subject several times before, but when it comes to addressing your pain, you have options. One of those options is to see a chiropractor. Unfortunately, chiropractic care is a mixed bag ranging from evidence-based multimodal care to, ugh, pretty much any of the trash you will see if you type chiropractic into YouTube.
In my personal opinion, and knowing the majority of lower back pain has a favorable natural history, I’m inclined to recommend conservative treatments such as yoga, walking, chiropractic care, PT, or a general exercise program over medical care and definitely before considering opioids, advanced imaging, injections, or surgery.
Thank you for reading and let me know what you think or share your experiences in the comments.
Works Consulted:
Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi:10.21037/atm.2020.02.175
Whedon, James M et al. “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain medicine (Malden, Mass.) vol. 21,12 (2020): 3567–3573. doi:10.1093/pm/pnaa014
Whedon, James M et al. “Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 24,6 (2018): 552–556. doi:10.1089/acm.2017.0131
Kazis, Lewis E et al. “Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use.” BMJ open vol. 9,9 e028633. 20 Sep. 2019, doi:10.1136/bmjopen-2018–028633
