Results Show “Significantly Lower Risk for Receipt of an Opioid Prescription Among Chiropractic Care Users

For more than a decade, the Veterans Health Administration (VA) has worked to ensure that patients get the pain management they need, without the potentially devastating risks associated with opioid prescriptions. VA’s efforts in this area include making other treatment options, including evidence-based, nonpharmacologic interventions such as chiropractic care, available to Veterans across the VA health system, both on-site at VA facilities and in their local communities through the Community Care program.

Low back pain is a condition that plagues many Veterans. One study published in Pain Medicine found that for VA patients, “M54.5, Low Back Pain” was the most common musculoskeletal diagnosis code in the first two years after the adoption of ICD-10, both by outpatient visits (18.3%) and by unique patients (43.1%). Another report from the VA (Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans, January 2017) cites “Diseases of Musculoskeletal System Connective Tissue” (principally joint and back disorders) as the number one ailment of Iraq/Afghanistan veterans accessing VA treatment.

According to a recent study published in the Journal of General Internal Medicine, however, little is known on whether conservative care such as spinal manipulation when performed by a chiropractor provided in the VA health system has a downstream effect on the use of other healthcare services, including opioid prescriptions. The study authors, including Anthony Lisi, DC, Director of the Chiropractic Program in the VA, and a multidisciplinary research team, examined VA electronic health record data, including outpatient visits, prescriptions, and comorbid diagnoses, of more than 128,000 Veterans who had a low back pain visit with a VA primary care physician between 10/1/2015 and 9/30/2020. These Veterans had no VA LBP visits in the preceding 18 months, and then two subsequent VA LBP visits in the following 12 months. The authors only assessed VA care provided on-station only and did not include VA-purchased community care.

From the study’s “Discussion” section:

• “Our results add to the existing literature showing an inverse relationship between receipt of chiropractic care and receipt of opioid prescriptions among patients with LBP in private sector and VA populations.”
• “[O]ur current findings have important implications for both Veteran and the US adult general population given the high prevalence of LBP, its associated disability, chronic pain’s association with increased suicide risk, and the fact LBP has been documented in younger Veterans in more recent years.”

The study authors conclude:

• “Overall, initiation of opioid prescription after incident LBP visits to VA PCPs was significantly lower in Veterans who received subsequent chiropractic visits than those who did not.”
• “These results offer important insights for policy and practice as VA continues to refine its healthcare system to connect Veterans to the soonest and best care possible.”
• Presently, chiropractic care is provided in-house at 142 of 173 VA Medical Centers and 170 VA outpatient clinics, and while only 1.3% of VA healthcare users received such care in fiscal year 2022, it is projected that will increase to 2.3% by the end of FY 2027.”

Source:

Lisi AJ, Bastian LA, Brandt CA, Coleman BC, Fenton B, King JT Jr, Goulet JL. The Impact of Chiropractic Care on Opioid Prescriptions in Veterans Health Administration Patients Receiving Low Back Pain Care. J Gen Intern Med. 2025 May 20. doi: 10.1007/s11606-025-09556-w. Epub ahead of print. PMID: 40394439.