Robert J Trager 1 2 3, Zachary A Cupler 4, Jordan A Gliedt 5, Ryan A Fischer 6, Roshini Srinivasan 7, Hannah Thorfinnson 8
Affiliations Expand
- PMID: 40978305
- PMCID: PMC12447351
- DOI: 10.1002/hsr2.71267
Abstract
Background and aims: Previous research suggests patients receiving spinal manipulative therapy (SMT) for low back pain (LBP) are less likely to be prescribed opioids. However, the clinical implications of this finding are unclear. We tested the hypothesis that opioid-naïve adults receiving SMT for LBP are less likely to develop opioid use disorder (OUD) compared to matched controls prescribed ibuprofen over 2 years follow-up.
Methods: We queried a United States data resource (TriNetX) for patients age ≥ 18 years with a new episode of LBP with/without sciatica from 2015 to 2023 (allowing for up to 2 years of follow-up to 2025), excluding those with serious pathology, OUD, and opioid prescription. We divided patients into cohorts: (1) SMT and (2) ambulatory ibuprofen prescription, using propensity matching for OUD risk factors. Our primary outcome was the risk ratio (RR) of OUD. We secondarily explored the RR for long-term opioid use, and opioid prescription RR and mean count. Primary analyses conducted in TriNetX and R used logistic regression for matching, standardized mean difference to assess between-cohort balance (threshold of ≤ 0.1), and contingency tables for RRs, using a significance threshold of p < 0.05.
Results: 24,993 patients remained per cohort following matching. Comparing the SMT cohort to ibuprofen cohort, there was a significantly lower incidence and risk of OUD [95% CI] (0.24% vs. 1.51%; RR = 0.20 [0.15, 0.28]; p < 0.001), long-term opioid use (0.42% vs. 1.85%; RR = 0.23 [0.18, 0.28]; p < 0.001), and opioid prescription (30.96% vs. 45.00%; RR = 0.69 [0.67, 0.71; p < 0.001]). SMT recipients also received fewer opioid prescriptions [standard deviation] (1.0 [3.3] vs. 2.1 [5.7]; p < 0.001).
Conclusion: Adults receiving SMT for new LBP had a lower risk of OUD compared to matched controls prescribed ibuprofen. These findings corroborate guidelines recommending first-line SMT for LBP. The role of SMT in mitigating opioid-related harms requires further investigation.
