Chiropractic Care and Opioid Use for Spine Pain

Chiropractic care and opioid use have become important topics in the management of noncancer spine pain. Healthcare systems continue to seek effective nonpharmacologic approaches to pain. Researchers have therefore examined whether chiropractic care affects prescription opioid use.

A 2025 systematic review and meta-analysis provides a comprehensive look at this question. The review found lower odds of prescription opioid use among adults with noncancer spine pain who received chiropractic care. However, the authors rated the evidence for this outcome as very low certainty.

Key takeaway: Research shows an association between chiropractic care and lower opioid use in adults with noncancer spine pain. The evidence does not prove that chiropractic care alone causes lower opioid use. Better randomized trials are still needed.

What did the latest research on chiropractic care and opioid use find?

The key evidence comes from a 2025 systematic review and meta-analysis published in Pain Reports. Peter C. Emary and colleagues conducted the review.

The researchers searched six major databases. Their search covered literature through March 20, 2025.

The review included 2 randomized controlled trials with 838 participants. It also included 18 cohort studies with 6,035,220 participants.

The researchers examined prescription opioid initiation and continued use. They focused on adults with noncancer spine pain.

The pooled observational evidence showed lower odds of receiving prescription opioids among chiropractic patients. The odds ratio was 0.36. The 95% confidence interval ranged from 0.25 to 0.52.

The researchers also estimated an absolute risk reduction of about 15%.

Those numbers need context. An odds ratio of 0.36 describes an association. It does not mean chiropractic care prevents 64% of opioid prescriptions.

The authors rated the certainty of this evidence as very low. Several factors contributed to that rating.

Does the timing of chiropractic care matter?

The review also examined when patients received chiropractic care.

Fourteen cohort studies examined this issue. Patients who received chiropractic care within the first 30 days had lower odds of receiving prescription opioids.

The pooled odds ratio for earlier care was 0.33. The 95% confidence interval ranged from 0.22 to 0.51.

Later chiropractic care produced a smaller association. The pooled odds ratio was 0.73. The 95% confidence interval ranged from 0.53 to 0.99.

The review authors identified this difference as a credible subgroup effect. However, both findings still came from evidence with very low certainty.

This finding does not mean every patient should receive chiropractic care within 30 days. Instead, it raises an important research question.

Could earlier access to appropriate conservative care influence later pain-management decisions?

Current evidence cannot answer that question with certainty.

What does the research show about long-term opioid use?

The review also examined long-term opioid use.

Six cohort studies included about 2.6 million participants. These studies suggested lower odds of long-term opioid initiation among patients who received chiropractic care.

The pooled odds ratio was 0.27. The 95% confidence interval ranged from 0.15 to 0.47.

The researchers estimated an absolute risk reduction of about 3%.

These findings suggest a meaningful association. However, the evidence again received a very low certainty rating.

The observational design creates important limitations. Researchers cannot completely eliminate differences between patients who choose or receive chiropractic care and those who do not.

Why does evidence certainty matter?

Large studies can produce impressive numbers. Those numbers do not automatically prove causation.

Most of the opioid evidence comes from observational cohort studies. Such studies can identify associations. They cannot always establish cause and effect.

Patients who receive chiropractic care may differ from other patients in several ways. They may have different healthcare preferences. They may have different access to care. Their baseline health may also differ.

Other factors may include pain severity, socioeconomic status, referral patterns, and expectations about treatment.

Researchers can adjust for measured factors. However, statistical adjustment cannot remove every possible source of confounding.

That limitation matters when interpreting this research. It explains why the authors called for better randomized controlled trials.

How does this research fit with earlier studies?

The 2025 review builds on earlier research. It does not replace that research.

A 2020 systematic review examined six observational studies. It found lower odds of prescription opioid use among chiropractic patients.

The pooled odds ratio was 0.36. The 95% confidence interval ranged from 0.30 to 0.43.

That review searched the literature through April 2018. It also did not formally assess evidence certainty with GRADE.

Another 2020 study examined 101,221 adults with spinal pain. Whedon and colleagues found lower opioid prescribing among patients who saw a chiropractor.

The association appeared stronger among patients who saw a chiropractor within 30 days of diagnosis.

These earlier findings generally agree with the newer systematic review. The newer review adds more evidence. It also separates randomized trials from observational studies.

Importantly, it evaluates risk of bias and evidence certainty. That gives clinicians more context when interpreting the results.

What about older adults?

Older adults deserve special attention in discussions about opioid-sparing care.

Age, comorbidities, and polypharmacy can complicate pain management. Medication-related risks can also increase with age.

A 2022 retrospective observational study examined 55,949 Medicare beneficiaries with spinal pain. Of those patients, 9,356 received chiropractic care.

Researchers used Cox proportional hazards modeling. They also used inverse probability weighting.

The analysis found a lower risk of filling an opioid prescription among chiropractic patients. The hazard ratio was 0.44. The 95% confidence interval ranged from 0.40 to 0.49.

That result represents an association. The study did not establish a causal treatment effect.

What does Veterans Health Administration research show?

Recent research also provides evidence from the Veterans Health Administration.

A 2025 study examined 128,377 opioid-naive veterans with low back pain. The researchers evaluated patients after an incident primary-care visit.

They then compared healthcare utilization between chiropractic care users and non-users.

The researchers used propensity matching to reduce differences between the groups.

Chiropractic care was associated with a lower risk of receiving an opioid prescription during the following 365 days.

The hazard ratio was 0.77. The 95% confidence interval ranged from 0.71 to 0.83.

The cumulative incidence of opioid prescriptions was 13.0% among chiropractic users. It was 16.8% among non-users.

The researchers reported a number needed to treat of 27.

This study adds another useful population to the evidence base. It remains an observational study, however. Therefore, the findings show association rather than proof of causation.

Why is nonpharmacologic care important in spine pain?

The opioid question fits within a broader change in pain management.

The CDC’s 2022 clinical practice guideline recommends nonopioid therapies for many patients with subacute and chronic pain. It also recommends maximizing appropriate nonpharmacologic and nonopioid therapies before starting opioids.

The guideline identifies several nonpharmacologic options for low back pain. These include exercise, psychological therapies, spinal manipulation, massage, mindfulness-based approaches, yoga, acupuncture, and multidisciplinary rehabilitation.

The appropriate approach depends on the patient’s clinical situation.

This guidance does not mean opioids have no role in pain management. Some patients may require opioid therapy for specific clinical circumstances.

Examples can include severe acute pain, serious injury, and certain postoperative situations.

Clinicians should individualize treatment decisions. They should consider diagnosis, pain severity, risks, benefits, patient preferences, and other appropriate medical care.

What does this mean for chiropractors?

The research offers several practical points for chiropractors.

Recognize the potential value of early conservative care. The research suggests that earlier chiropractic care may correlate with lower opioid use.
Avoid overstating causality. Most of the evidence comes from observational studies. Use terms such as “associated with” when describing those findings.
Use chiropractic care within a broader treatment plan. Appropriate care may include examination, diagnosis, clinical reasoning, patient education, exercise, and rehabilitation.
Coordinate with other healthcare professionals. Medication management may fall within the scope of other licensed professionals. Follow applicable laws and professional requirements.
Document clinical reasoning. Good documentation should explain examination findings, diagnosis, treatment rationale, response to care, and referrals when appropriate.

What should patients understand about chiropractic care and opioids?

The research does not show that chiropractic care will prevent opioid use in every patient.

It also does not show that chiropractic treatment can replace medically necessary medication in every situation.

A more accurate message is straightforward. Chiropractic care represents one nonpharmacologic option for appropriate patients with spine-related musculoskeletal pain.

Research has also found an association between chiropractic care and lower opioid prescribing or use.

The latest systematic review strengthens that evidence base. It also highlights important limitations.

Patients and clinicians should therefore consider chiropractic care as part of an individualized treatment plan.

What are the limitations of the current evidence?

Several limitations deserve attention.

Most opioid evidence comes from observational studies.
Observational studies can have residual confounding.
Patient selection can affect study results.
Studies use different definitions of chiropractic exposure.
Studies also use different opioid outcomes.
Healthcare systems differ across populations and countries.
Insurance arrangements can influence access to care.
Prescribing practices can differ between healthcare settings.
The evidence does not identify one chiropractic technique as responsible for the association.
The 2025 review rated the opioid evidence as very low certainty.
Researchers need more rigorous randomized controlled trials.

What is the bottom line?

The current research shows a consistent signal.

Adults with noncancer spine pain who receive chiropractic care tend to have lower rates of prescription opioid use than comparable patients who do not receive chiropractic care.

The 2025 systematic review strengthens this observation. It combined randomized and observational evidence from more than six million participants.

The review also found a stronger association when patients received chiropractic care earlier.

However, the evidence for opioid outcomes remains very low certainty.

Therefore, the evidence does not prove that chiropractic care causes lower opioid use.

The most defensible conclusion is more measured. Chiropractic care may be associated with lower opioid use among adults with noncancer spine pain.

Future randomized trials can help determine whether chiropractic care itself produces this effect.

Watch the ChiroSecure Research Update

Video overview

This ChiroSecure Research Update examines chiropractic care and prescription opioid use.

The presentation reviews research involving adults with noncancer spine pain. It discusses lower opioid use among chiropractic patients and considers the limitations of the evidence.

The latest systematic review provides important context. The authors rated the opioid evidence as very low certainty.

Important: The findings should not be interpreted as proof that chiropractic care prevents opioid use.

References and Further Reading

Emary PC, Corcoran KL, Coleman BC, et al. Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis. Pain Reports. 2025;11(1):e1374. doi:10.1097/PR9.0000000000001374.
Whedon JM, Toler AWJ, Kazal LA, et al. Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain. Pain Medicine. 2020;21(12):3567–3573. doi:10.1093/pm/pnaa014.
Whedon JM, Uptmor S, Toler AWJ, et al. Association between chiropractic care and use of prescription opioids among older Medicare beneficiaries with spinal pain: a retrospective observational study. Chiropractic & Manual Therapies. 2022;30:5. doi:10.1186/s12998-022-00415-7.
Lisi AJ, Bastian LA, Brandt CA, et al. The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care. Journal of General Internal Medicine. 2025;40:3973–3981. doi:10.1007/s11606-025-09556-w.
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recommendations and Reports. 2022;71(3).

Educational disclaimer: This article is provided for educational purposes. It is not a substitute for individualized clinical evaluation, diagnosis, treatment, medication management, or consultation with an appropriately licensed healthcare professional.

Opioid prescribing and tapering decisions should involve clinicians authorized to manage those medications. Such decisions should reflect the individual patient’s clinical circumstances.

Conclusion

Research continues to examine chiropractic care as part of nonpharmacologic management for noncancer spine pain.

Multiple observational studies show an association between chiropractic care and lower opioid use. This pattern appears in several populations.

These populations include general spine-pain patients, older Medicare beneficiaries, and Veterans Health Administration patients.

Still, the evidence has important limitations. The latest systematic review rates the opioid evidence as very low certainty.

For chiropractors and other healthcare professionals, the most defensible conclusion is clear.

Appropriate chiropractic care may form part of an opioid-sparing, patient-centered approach to noncancer spine pain. More rigorous research must confirm the causal effect.

For additional ChiroSecure research updates on pain, spine care, and opioid utilization, explore the related resources below.

Interested in staying current with chiropractic research? Continue exploring the ChiroSecure Research Update library for evidence reviews and clinically relevant research summaries.

Chiropractic Care and Opioid Use for Noncancer Spine Pain