Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A...

Area of Science:

• Pain Management
• Integrative Medicine
• Public Health

Background:

• Previous research indicates spinal manipulative therapy (SMT) for low back pain (LBP) may reduce opioid prescription rates.
• The clinical significance of this association regarding opioid use disorder (OUD) development remains unclear.

Purpose of the Study:

• To test the hypothesis that opioid-naïve adults receiving SMT for LBP are less likely to develop OUD compared to matched controls prescribed ibuprofen.
• To investigate the long-term implications of SMT versus ibuprofen for LBP management in relation to opioid use.

Main Methods:

• A retrospective cohort study using the TriNetX United States data resource.
• Propensity score matching was employed to compare patients receiving SMT for new LBP episodes with those prescribed ibuprofen, controlling for OUD risk factors.
• Primary outcome was the risk ratio (RR) for OUD, with secondary outcomes including long-term opioid use and opioid prescription rates over a 2-year follow-up period.

Main Results:

• The study included 24,993 patients per cohort after matching.
• SMT recipients demonstrated a significantly lower risk of OUD (RR=0.20), long-term opioid use (RR=0.23), and any opioid prescription (RR=0.69) compared to the ibuprofen cohort.
• SMT patients received fewer opioid prescriptions on average (1.0 vs. 2.1).

Conclusions:

• Adults treated with SMT for new LBP exhibited a reduced risk of developing OUD compared to those managed with ibuprofen.
• These findings support current guidelines recommending SMT as a first-line treatment for LBP.
• Further research is warranted to explore the role of SMT in mitigating opioid-related harms.