MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

This systematic review was aimed at investigating the current evidence to determine whether there is an association between chiropractic use and opioid receipt.

Controlled studies, cohort studies, and case-control studies including adults with noncancer pain were eligible for inclusion. Studies reporting opioid receipt for both subjects who used chiropractic care and nonusers were included. Data extraction and risk of bias assessment were completed independently by pairs of reviewers. Meta-analysis was performed and presented as an odds ratio with 95% confidence interval.

In all, 874 articles were identified. After detailed selection, 26 articles were reviewed in full, and 6 met the inclusion criteria. Five studies focused on back pain and one on neck pain. The prevalence of chiropractic care among patients with spinal pain varied between 11.3% and 51.3%. The proportion of patients receiving an opioid prescription was lower for chiropractic users (range = 12.3-57.6%) than nonusers (range = 31.2-65.9%). In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers (odds ratio = 0.36, 95% confidence interval = 0.30-0.43, P < 0.001, I2 = 92.8%).

The authors concluded that this review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.

These results are in line with a previous study showing that among New Hampshire adults with office visits for noncancer low-back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with nonrecipients. The underlying cause of this correlation remains unknown, indicating the need for further investigation.

The question is: what do such findings tell us?

I have no doubt that chiropractors will claim that using their services will reduce the opioid problem. But this is, of course, wishful thinking. The thing that will reduce it is not more chiro use but quite simply less opioid use!

The important thing to remember here is CORRELATION IS NOT CAUSATION!

People who drive a VW car are less likely to buy a Mercedes.

People who have ordered fish in a restaurant are unlikely to also order a steak.

People who use physiotherapy for back pain will probably use less opioids than those who don’t consult physios.

People who treat their back pain with massage therapy are less likely to also use opioids.

Etc.

Etc.

This is all very obvious, self-evident and perhaps even boring.

The most interesting finding here is in my view the fact that 31.2-65.9% of patients using chiropractic for their neck/back pain also took opioids. This seems to confirm what we often have discussed before:

CHIROPRACTIC TREATMENT IS NOT NEARLY AS EFFECTIVE AS CHIROS WANT US TO BELIEVE.

 

10 Responses to The association between chiropractic and opioid use

  • ” The authors concluded that this review demonstrated an inverse association between chiropractic use and opioid receipt among patients with spinal pain. Further research is warranted to assess this association and the implications it may have for case management strategies to decrease opioid use.”

    Sometimes the conclusions are straight forward and accurate… no need for manipulation

  • Uh, both papers said it was association/correlation.

    Who exactly is Ernst arguing against?

    • I am arguing that many chiros use this association for making conclusions that are not warranted.

      • Or one could state….fortunately there are some chiropractors that understand this is a correlation, not causation, and limit their discussions as such.

        But of course that would be admitting there are some good chiropractors out there.

        • if you do critical analyses, you focus on what deserves critique. got it?

          • LOL…what you did was not a critical analysis.

          • it is a critical analysis of sorts [full critical analyses, I do in peer reviewed papers not on blogs]:
            The question is: what do such findings tell us?
            I have no doubt that chiropractors will claim that using their services will reduce the opioid problem. But this is, of course, wishful thinking. The thing that will reduce it is not more chiro use but quite simply less opioid use!
            The important thing to remember here is CORRELATION IS NOT CAUSATION!
            People who drive a VW car are less likely to buy a Mercedes.
            People who have ordered fish in a restaurant are unlikely to also order a steak.
            People who use physiotherapy for back pain will probably use less opioids than those who don’t consult physios.
            People who treat their back pain with massage therapy are less likely to also use opioids.
            Etc.
            Etc.
            This is all very obvious, self-evident and perhaps even boring.
            The most interesting finding here is in my view the fact that 31.2-65.9% of patients using chiropractic for their neck/back pain also took opioids. This seems to confirm what we often have discussed before:

  • The last time I saw a chiropractor I went to my GP and got a massive prescription for painkillers immediately afterwards. I would like to see a study on the correlation of chiropractic care termination and analgesic use.

    • Ask ER physicians about the cases who come crawling into their ER in great pain after having tried chiropractic.

      • I am sure that ER physicians have plenty of case stories about patients who came crawling into ER after seeing the MD also.
        I know because I’m one of them, after a Lithotripsy procedure.

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