Chiropractic spinal manipulation reduces opioid risks for sciatica patients

A new study led by researchers at University Hospitals Connor Whole Health found that adults with newly diagnosed sciatica who initially received chiropractic spinal manipulation (CSM) were significantly less likely to experience opioid-related adverse drug events (ORADEs) such as overdose and poisoning over a one-year follow-up compared to those receiving usual medical care. The study highlights the value of CSM as a potential opioid-sparing approach in the management of sciatica, a low back disorder characterized by radiating pain, numbness, or weakness in the leg due to a compressed nerve root.

"In light of the ongoing opioid crisis, these findings underscore the importance of offering evidence-based non-pharmacological alternatives for pain management," said Dr. Françoise Adan, Chief Whole Health and Well-being Officer and Director of UH Connor Whole Health.

Published in PLOS One, this retrospective cohort study used data from the TriNetX Diamond Network, including over 744,000 patients. The researchers found that only 0.09% of patients in the CSM cohort experienced an ORADE within a year, compared to 0.30% in the usual medical care cohort. This translated to a risk ratio of 0.29 (95% CI: 0.25–0.32), meaning CSM recipients were 71% less likely to have an ORADE. Additionally, CSM recipients were also 32% less likely to be prescribed oral opioids.

Although previous studies demonstrated a reduced likelihood of opioid prescription among patients receiving chiropractic care, our study is the first to focus on opioid-related adverse events, adding a layer of clinical relevance to our work."

Robert Trager, DC, lead author of the study

According to Roshini Srinivasan, MD, co-author and resident physician at Duke University Hospital, "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." 

The study excluded patients with prior ORADE and opioid use disorder and used propensity score matching to balance cohorts on key variables such as age, sex, other substance use disorders, medications, and other factors.

The researchers acknowledged the limitations inherent to retrospective studies, such as potential unmeasured confounding and constraints related to using real-world data. However, they emphasized that their findings align with clinical practice guidelines recommending spinal manipulation as part of a multimodal approach to treating sciatica.

The authors call for further research to explore whether the observed reduction in ORADEs is attributable to the CSM intervention itself or could be due to the broader effects of visiting non-pharmacological clinicians such as chiropractors or physical therapists.