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. 2025 Dec;40(16):3973-3981.
doi: 10.1007/s11606-025-09556-w. Epub 2025 May 20.

The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care

Anthony J Lisi  1   2 , Lori A Bastian  3   4 , Cynthia A Brandt  3   4 , Brian C Coleman  3   4 , Brenda Fenton  3 , Joseph T King Jr  3   4   5 , Joseph L Goulet  3   4
Affiliations

The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care

Anthony J Lisi et al. J Gen Intern Med. 2025 Dec.

Abstract

Background: Key nonpharmacologic therapies, including those routinely provided by chiropractors, are recommended first-line treatments for low back pain (LBP). Little is known on whether such care provided in the Veterans Health Administration (VA) has a downstream effect on the use of other healthcare services, including opioid prescriptions.

Objective: To evaluate the impact of chiropractic care on receipt of opioid prescriptions within 365 days of an incident primary care provider (PCP) visit for LBP among opioid-naïve VA patients.

Design: Cross-sectional analysis with longitudinal follow-up.

Participants: Patients had an LBP visit with a VA PCP between 10/1/2015 and 9/30/2020, without any VA LBP visit in the preceding 18 months, and then 2 subsequent VA LBP visits in the following 12 months.

Main measures: VA electronic health record data including outpatient visits, prescriptions, and comorbid diagnoses.

Key results: A total of 128,377 patients met study criteria. The hazard ratio for opioid prescription in a propensity-matched sample was 0.77 (95% CI 0.71-0.83), indicating a significantly lower risk for receipt of an opioid prescription among chiropractic care users in the 365-day follow-up adjusting for potential confounders. The cumulative incidence of opioid prescriptions was 13.0% for chiropractic care users and 16.8% for non-users and the number needed to treat was 27.

Conclusions: The results of this study show that nonpharmacologic chiropractic care can be an important component of opioid sparing strategies for VHA patients with LBP.

Keywords: Veterans health; analgesics, opioid; chiropractic; low back pain; primary healthcare.

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Conflict of interest statement

Declarations:. Conflict of Interest:: The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for veteran inclusion for the examination of opioids in veterans in the year following a Primary Care encounter for incident LBP (total period: 10/1/2015–9/30/2021).
Figure 2
Figure 2
Kaplan–Meier estimates of time to opioid prescription for veterans with low back pain in entire and propensity score-matched sample. A Cumulative incidence of opioid prescription within 365 days of incident LBP visit (entire sample N = 128,377). B Cumulative incidence of opioid prescription within 365 days of incident LBP visit (matched sample N = 25,908).
See this image and copyright information in PMC

References

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