Opioid-related deaths in the United States remain stubbornly high, even as clinicians look for safer ways to manage pain. Against this backdrop, a growing body of research is examining whether non-drug therapies can curb the need for prescription opioids. A recent study in BMJ Open offers fresh evidence: adults with newly diagnosed sciatica who started care with chiropractic spinal manipulation were about three times less likely to receive the opioid tramadol over the following 12 months than patients who entered the medical system through conventional routes. The findings add weight to the argument that early, hands-on care could reshape treatment pathways in an era still grappling with opioid misuse.
Early Chiropractic Care, Fewer Opioids
Researchers reviewed electronic health record data on 2,315 U.S. adults who presented for their first episode of sciatica. After adjusting for age, sex, comorbidities, and baseline pain scores, they found that just 1.3% of those who began treatment with chiropractic spinal manipulation received a prescription for tramadol within a year. In contrast, 4.0% of those who started with usual medical care were prescribed opioids. That difference (an odds ratio of 0.32) was statistically significant, with a p-value of less than 0.001. Importantly, the association held even after researchers adjusted for potential confounding factors using propensity score matching, suggesting a durable signal worth further exploration.
A Similar Pattern in Larger Cohorts
In January 2025, a separate retrospective cohort study in PLOS ONE analyzed insurance claims data from 744,942 adults with sciatica. After matching 372,471 chiropractic patients to an equal number of controls, researchers reported:
- Opioid-related adverse drug events (ORADEs) occurred in 0.09 % of the chiropractic group versus 0.30 % of usual-care patients—an adjusted risk ratio of 0.29.
- Prescription fills for any oral opioid were 32 % lower in the chiropractic cohort.
The authors concluded that initial exposure to spinal manipulation “may influence downstream opioid use,” reinforcing guideline recommendations to consider manual therapy in sciatica management.
Context: Non-Drug Care Moves Upstream
The CDC’s 2022 opioid-prescribing guideline urges clinicians to prioritize non-pharmacologic approaches for acute musculoskeletal pain. Professional societies, including the American College of Physicians, recommend spinal manipulation, exercise, and other conservative options before resorting to opioids. Against that policy backdrop, the BMJ Open and PLOS ONE findings land at a timely moment: they suggest that when non-drug care is offered first, fewer opioid prescriptions follow.
A January 2025 news synthesis in News-Medical highlighted the same takeaway, quoting study co-author Dr. Robert Trager: “Early access to chiropractic care could meaningfully reduce opioid exposure in routine practice.” ReachMD’s clinical-news service reached a similar conclusion, noting that spinal manipulation may “shift the trajectory of medication use” for sciatica.
What scientists still need to know
- Causation vs. correlation. While large, well-matched cohorts strengthen confidence, randomized trials would clarify whether spinal manipulation itself—rather than patient preference or health-system factors—drives the opioid-sparing effect.
- Comparative effectiveness. Future studies could benchmark chiropractic care against physical therapy, acupuncture, or combined multimodal programs.
- Long-term outcomes. Beyond the first year, do early chiropractic patients experience less chronic pain, better function, or lower health-care costs?
These questions underscore a broader research agenda: identifying which nonpharmacologic strategies best reduce reliance on opioids without sacrificing pain relief or quality of life.
Conclusion
The newest evidence, from both a focused BMJ Open analysis and a nationwide PLOS ONE cohort, points in the same direction: patients with sciatica who begin with chiropractic spinal manipulation are markedly less likely to receive opioid prescriptions and opioid-related adverse-event diagnoses during the crucial first year of care. While causality has yet to be proved, the consistency of the association bolsters calls to elevate non-drug options in frontline pain management. For clinicians and health-system leaders confronting the persistent opioid crisis, these findings add another data-driven nudge toward safer, guideline-aligned pathways.
Sources
Discover What Grows Wealth with Minimum Effort & Minimum Risk
