The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care.

Abstract

Key nonpharmacologic therapies, including those routinely provided by chiropractors, are recommended first-line treatments for low back pain (LBP). Little is known on whether such care provided in the Veterans Health Administration (VA) has a downstream effect on the use of other healthcare services, including opioid prescriptions. To evaluate the impact of chiropractic care on receipt of opioid prescriptions within 365 days of an incident primary care provider (PCP) visit for LBP among opioid-naïve VA patients. Cross-sectional analysis with longitudinal follow-up. Patients had an LBP visit with a VA PCP between 10/1/2015 and 9/30/2020, without any VA LBP visit in the preceding 18 months, and then 2 subsequent VA LBP visits in the following 12 months. VA electronic health record data including outpatient visits, prescriptions, and comorbid diagnoses. A total of 128,377 patients met study criteria. The hazard ratio for opioid prescription in a propensity-matched sample was 0.77 (95% CI 0.71-0.83), indicating a significantly lower risk for receipt of an opioid prescription among chiropractic care users in the 365-day follow-up adjusting for potential confounders. The cumulative incidence of opioid prescriptions was 13.0% for chiropractic care users and 16.8% for non-users and the number needed to treat was 27. The results of this study show that nonpharmacologic chiropractic care can be an important component of opioid sparing strategies for VHA patients with LBP.