A new study has found that adults with newly diagnosed sciatica who received chiropractic spinal manipulation (CSM) were significantly less likely to experience opioid-related adverse drug events (ORADEs), such as overdose or poisoning, within a year compared to those who received usual medical care.
The findings highlight CSM as a potential opioid-sparing approach for managing sciatica, a condition that causes radiating leg pain due to a compressed nerve root in the lower back.
The study, led by researchers at University Hospitals Connor Whole Health and published in PLOS One, adds to growing evidence supporting non-pharmacological treatments for pain relief.
Chiropractic Treatment and Opioid Risks
Sciatica is often treated with a combination of medications, physical therapy, and in some cases, spinal injections or surgery. However, many patients receive opioid prescriptions for pain management, which carries risks of dependency and overdose. With the ongoing opioid crisis, there is an urgent need for safer alternatives.
Dr. Françoise Adan, Chief Whole Health and Well-being Officer at UH Connor Whole Health, emphasized the importance of these findings:
“In light of the ongoing opioid crisis, these findings underscore the importance of offering evidence-based non-pharmacological alternatives for pain management.”
Study Findings
The study analyzed data from the TriNetX Diamond Network, which includes records from over 744,000 patients. Researchers compared patients who received CSM to those who underwent standard medical treatment.
- Only 0.09% of patients in the CSM group experienced an opioid-related adverse event within a year.
- In contrast, 0.30% of patients in the usual medical care group had an ORADE.
- This represents a 71% lower risk of opioid-related complications in the CSM group (risk ratio: 0.29, 95% CI: 0.25–0.32).
- Patients receiving CSM were also 32% less likely to be prescribed oral opioids compared to those receiving standard care.
Lead author Robert Trager, DC, noted that while previous studies showed chiropractic care reduces the likelihood of opioid prescriptions, this study is the first to focus on opioid-related adverse events.
Co-author Dr. Roshini Srinivasan, a resident physician at Duke University Hospital, stressed the broader significance of the findings:
“This work underscores that chiropractic spinal manipulation is not only an effective analgesic and rehabilitative modality—but perhaps more importantly, may be a life-saving one.”
Study Strengths and Limitations
The research team excluded patients with a history of opioid use disorder or previous opioid-related adverse events. They also used propensity score matching to balance factors such as age, sex, substance use disorders, medications, and other key variables, making the comparisons between groups as fair as possible.
However, as a retrospective cohort study, the research has limitations. The authors acknowledge the possibility of unmeasured confounding factors and the constraints of using real-world data.
They also suggest that further research is needed to determine whether the observed reduction in opioid risks is due directly to CSM or if it reflects broader effects of receiving non-pharmacological care from chiropractors or physical therapists.
Implications for Pain Management
These findings support clinical guidelines that recommend spinal manipulation as part of a multimodal approach to treating sciatica and other musculoskeletal conditions.
Given the growing concerns about opioid misuse, expanding access to evidence-based, non-drug treatments like chiropractic care could play a role in reducing opioid dependency and its associated risks.
The researchers hope that future studies will further explore the long-term impact of CSM and its potential as a safer alternative to opioid-based pain management strategies.
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The research findings can be found in PLOS ONE.
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