Pharmacological Treatment of Low Back Pain Increased Overdose-Related Hospitalizations by 300% Compared to Chiropractic (Non-Pharmacological Treatment) circa 2025.

BY: Mark Studin, DC, FPSC, FASBE(C), DAAPM

Low back pain (LBP) is one of the most prevalent and disabling chronic conditions worldwide. It is estimated that upwards of 80% of adults experience low back pain at some point in their lives.[i] Furthermore, LBP incidents continue to rise worldwide, making it the leading cause of disability globally, and approximately 20% of acute cases become chronic, where these individuals bear a disproportional rate of LBP issues.[ii] Additionally, LBP sufferers are a prime reason for opioid use.[iii]

Treating low back pain is 1 area most chiropractors have in common globally. No matter the focus of a chiropractic practice, neck and low back pain, based on my independent research, is one of the most common maladies treated in chiropractic. When considering outcomes for LBP care paths, patient satisfaction, increased drug use, and overdose hospitalizations are prime areas of consideration.

Bronfort et. al. (2022) reported, “While the ‘biopsychosocial model’ for LBP has been promoted for decades, it is still incompletely and inadequately applied in research and clinical practice. Indeed, the majority of back pain cases remain poorly treated with a heavy emphasis on symptom management using a ‘one size fits all’ approach that fails to address sufferers’ unique needs. This has resulted in the persistent use of marginally effective and potentially harmful unimodal therapies (injections, drug therapies, etc.) with a primarily physical focus. Further, current back pain management practices often contradict clinical guideline recommendations by failing to offer treatment options with scientific support, including complementary approaches.”

Although LBP remains an epidemic worldwide,[iv] and the cost of managing back pain is increasing substantially[v], with consistently poor outcomes, medicine has dogmatically held onto the label of "non-specific low back pain." Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology (e.g., infection, tumor, osteoporosis, fracture, structural deformity, an inflammatory disorder, radicular syndrome (discs), or cauda equina syndrome). It represents approximately 95% of all back pain and is persistently labeled non-specific because medicine cannot define a specific diagnosis.[vi] 

Ntedan (2020), in a 4-year study and a cohort of 8,023,162, reported that 96% of chiropractic recipients were satisfied with their outcomes, including LBP and other spinal maladies.[vii] As medicine is highly trained in anatomical pathology, its education lacks chiropractic’s forte, training in diagnosing and treating spinal biomechanical pathology with non-pharmacologic care. 

Despite the overwhelming evidence, the Mayo Clinic, one of the world's prominent medical institutions, lists chiropractic in the last section under "Alternative Medicine" and states it "might ease symptoms" after checking with their doctor [MD]. Chiropractic is listed last after physical therapy, drugs (including antidepressants and narcotics), surgery, implanted nerve stimulators, radiofrequency ablation (surgery), steroid injections, and most of all, doing nothing. [viii] 

Physical therapy (PT) is still considered the “first-line treatment” for non-specific back pain, even with the evidence pointing otherwise. Farrokhi et. al (2023) reported that opioid use increased by 80% in 89.9% of cases with any combination of PT modalities was used for LBP. If only a PT manipulation was performed, there was no reduction in opioid use, and if any combination of PT therapy was performed, there was a 52% increase in opioid use.[ix] Conversely, Whedon et al (2018) reported that chiropractic care reduced opioid use by 55% in the general population, by 56% in the senior population, and decreased opioid costs by 74%. 

The utilization of pharmacological (opioid and benzodiazepine (Gabapentinoids) management of LBP revealed that the incidence of drug-related overdose hospitalization was 200% less for both drug users and non-pharmacological treatment that included non-pharmacological treatments. For those using only non-pharmacological treatments, there was a 300% reduction in the incidence of drug-related overdose hospitalization.[x] This study “lumps together” chiropractic and physical therapy; however, based on the above studies, it has been found that physical therapy alone using mixed modalities increases opioid use in 89.9% of the patients, whereas chiropractic has been found to reduce opioid use by 55%. 

Conclusion

A Google Scholar search for "low back pain" yields approximately 4.56 million results, showcasing a vast array of opinions and approaches on how to manage this widespread condition. Despite the overwhelming number of treatment options discussed, chiropractic care consistently emerges as one of the most effective first-line options in many of these studies. Yet, many healthcare providers cling to outdated and ineffective care models that rely heavily on pharmacological intervention.

This persistent reliance on failed treatment paths not only delays patient recovery but also contributes significantly to the rise in drug-related overdose hospitalizations and escalating healthcare costs. The core issue lies in attempting to solve a mechanical problem, such as spinal dysfunction or joint misalignment, with a pharmacological approach, which inherently cannot address the root cause of the pain. Medications may temporarily mask symptoms, but do not correct the underlying biomechanical issues.

Chiropractic care, by contrast, addresses the mechanical nature of low back pain directly and effectively. Research shows that it independently reduces drug-related overdose hospitalizations by an astonishing 300%, further supporting its role as a superior first-line treatment. This growing body of evidence makes a compelling case for rethinking our standard care pathways and placing chiropractic at the forefront of conservative, non-drug interventions for low back pain.

[i] Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37.

[ii] Bronfort, G., Maiers, M., Schulz, C. et al. Multidisciplinary integrative care versus chiropractic care for low back pain: a rando clinical trial. Chiropr Man Therap 30, 10 (2022). 

[iii] Moshfegh J, George SZ, Sun E. Risk and risk factors for chronic opioid use among opioid-naive patients with newly diagnosed musculoskeletal pain in the neck, shoulder, knee, or low back. Ann Intern Med. 2019;170(7):504–5.

[iv] Balagué, Federico, et al. "Non-specific low back pain." The Lancet 379.9814 (2012): 482-491

[v] Government Accountability Office. Medicare Part B imaging services: rapid spending growth and shift to physician offices indicate the need for CMA to consider additional management practices. Washington, DC: Government Accountability, 2008

[vi] Oliveira, Crystian B., et al. "Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview." European Spine Journal 27.11 (2018): 2791-2803

[vii] Ndetan, H., et al. "Chiropractic Care for Spine Conditions: Analysis of National Health Interview Survey." Journal of Health Care and Research 2020.2 (2020): 105

[viii] Back Pain (2021)Mayo Clinic, retrieved from https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911

[ix] Farrokhi, S., Bechard, L., Gorczynski, S., Patterson, C., Kakyomya, J., Hendershot, B.D., Condon, C.R., Perkins, L.M., Rhon, D.I., Delitto, A., and Schneider, M., 2023. The Influence of Active, Passive, and Manual Therapy Interventions for Low Back Pain on Opioid Prescription and Health Care Utilization. Physical therapy, p.pzad173

[x]Dow, Patience M., et al. "Association of Pharmacologic and Nonpharmacologic Management of Acute Low Back Pain with Overdose Hospitalizations: A Nested Case-Control Study." Journal of Integrative and Complementary Medicine (2025).