Spine pain — low back, neck, and mid-back pain — has long been one of the most common reasons adults are prescribed opioid medications. With overdose deaths in the United States still exceeding 80,000 per year, families and clinicians alike are looking hard for effective non-drug options. A new study published in February 2026 in the journal Pain Reports offers the largest look yet at one of them: chiropractic care.
What did the new study find?
The short answer: patients with spine pain who saw a chiropractor had roughly 64% lower odds of receiving an opioid prescription than similar patients who did not.
A research team led by Peter Emary at McMaster University, with co-authors from the Veterans Affairs health system and Yale, pooled 20 studies covering a combined 6,036,058 patients, the largest dataset ever assembled on this question. Beyond the headline number, the studies pointed in the same direction on secondary measures too: patients who received chiropractic care and did use opioids tended to receive lower doses, for shorter durations, with lower rates of long-term opioid use. Not one of the 20 studies found chiropractic care associated with higher opioid use.
Why would chiropractic care reduce opioid use?
The short answer: pain that is managed well without drugs reduces the need for drugs, and chiropractic care starts from a non-drug default.
There appear to be two mechanisms at work. First, chiropractic care treats the mechanical drivers of spine pain directly, using spinal manipulation, mobilisation, soft-tissue work, and exercise. When pain drops to a tolerable level through these means, patients and their doctors simply never reach the point of considering an opioid. Second, there is a care-pathway effect: chiropractors do not prescribe opioids, so a patient who starts their care journey in a chiropractic office enters a pathway where opioids are not on the menu as a first resort.
What do health authorities recommend?
The short answer: non-drug care first.
The CDC's 2022 Clinical Practice Guideline for Prescribing Opioids recommends maximising non-pharmacologic and non-opioid therapies before considering opioids for most chronic pain conditions. This new six-million-patient analysis adds population-scale evidence consistent with that recommendation: where non-drug spine care is used, opioid prescribing is consistently lower.
Are there caveats to this research?
Yes, and they are worth knowing. Almost all of the included studies were observational — they tracked what happened in the real world rather than randomly assigning patients to treatments. People who choose chiropractic care may differ in other ways from people who do not, so the study shows a strong and consistent association, not absolute proof of cause and effect. The researchers themselves rated the certainty of the evidence as very low for that reason. What is not in dispute is the consistency: across 6 million records, every study pointed the same way.
Ready to explore drug-free relief for spine pain?
If you or someone you love is dealing with back or neck pain and wants to avoid or reduce reliance on pain medication, chiropractic care is a safe, guideline-aligned place to start. Our team will assess your condition, explain your options honestly, and build a hands-on, movement-based plan around your goals. Contact our clinic today to schedule an appointment — no referral needed.
Sources
Emary PC, Corcoran KL, Coleman BC, et al. Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis. Pain Reports. 2026;11(1):e1374. DOI: 10.1097/PR9.0000000000001374
Dowell D, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep. 2022;71(RR-3):1-95.