Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study.
<h4>Background</h4>Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica...
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Public Library of Science (PLoS)
2025-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0317663 |
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| author | Robert J Trager Zachary A Cupler Roshini Srinivasan Elleson G Harper Jaime A Perez |
| author_facet | Robert J Trager Zachary A Cupler Roshini Srinivasan Elleson G Harper Jaime A Perez |
| author_sort | Robert J Trager |
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| description | <h4>Background</h4>Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.<h4>Methods</h4>We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ≥18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ≤ 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.<h4>Results</h4>372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).<h4>Conclusions</h4>This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated. |
| format | Article |
| id | doaj-art-4df0070b01ae4b7691a77f1de0f0904a |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj-art-4df0070b01ae4b7691a77f1de0f0904a2025-02-05T05:31:55ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01201e031766310.1371/journal.pone.0317663Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study.Robert J TragerZachary A CuplerRoshini SrinivasanElleson G HarperJaime A Perez<h4>Background</h4>Patients receiving chiropractic spinal manipulation (CSM) for spinal pain are less likely to be prescribed opioids, and some evidence suggests that these patients have a lower risk of any type of adverse drug event. We hypothesize that adults receiving CSM for sciatica will have a reduced risk of opioid-related adverse drug events (ORADEs) over a one-year follow-up compared to matched controls not receiving CSM.<h4>Methods</h4>We searched a United States (US) claims-based data resource (Diamond Network, TriNetX, Inc.) of more than 216 million patients, yielding data ranging from 2009 to 2024. We included patients aged ≥18 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE ≤ 1-year prior. Patients were divided into two cohorts: (1) CSM and (2) usual medical care. We used propensity score matching to control for confounding variables associated with ORADEs. Comparative outcomes were analyzed by calculating risk ratios (RRs) and 95% confidence intervals (CIs) for the incidence of ORADEs and oral opioid prescription between cohorts.<h4>Results</h4>372,471 patients per cohort remained after matching. The incidence of ORADEs over 1-year follow-up was less in the CSM cohort compared to the usual medical care cohort (CSM: 0.09%; usual medical care: 0.30%), yielding an RR of 0.29 (95% CI: 0.25-0.32; P < .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68-0.69; P < .00001]).<h4>Conclusions</h4>This study found that adults with sciatica who initially received CSM had a lower risk of an ORADE compared to matched controls not initially receiving CSM, likely explained by a lower probability of opioid prescription. These findings corroborate existing practice guidelines which recommend adding CSM to the management of sciatica when appropriately indicated.https://doi.org/10.1371/journal.pone.0317663 |
| spellingShingle | Robert J Trager Zachary A Cupler Roshini Srinivasan Elleson G Harper Jaime A Perez Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. PLoS ONE |
| title | Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. |
| title_full | Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. |
| title_fullStr | Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. |
| title_full_unstemmed | Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. |
| title_short | Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study. |
| title_sort | association between chiropractic spinal manipulation for sciatica and opioid related adverse events a retrospective cohort study |
| url | https://doi.org/10.1371/journal.pone.0317663 |
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