06/23/2025
Despite evidence for managing low back pain, the gap between the evidence and practice is pervasive as previously discussed (Foster et al., 2018). This is evidenced by too many highly regarded medical institutions continuing to recommend less successful pathways to help curb opioid use. States such as New York are taking opioid reduction to the next level and recently signed into law S.4640. A mandate for providers to consider op**te alternatives, including allopathic non-opioid and non-allopathic pathways to treat neuromusculoskeletal conditions before prescribing opioids. Regarding the largest users of opioids, back pain patients, which account for approximately 50% of opioid use, the care path should follow the evidence in the literature. The arbiter for low back pain, as all treatment should follow evidence-based outcomes.
Even though there are many stakeholders in this $750 billion industry, the evidence shows that physical therapy realizes upwards of an 80% increase in opioids in 90% of patients, with a 0% reeducation in the last 10%. In contrast, chiropractic has a 55% reduction in opioid use for the same population of low back pain patients with a 74% decrease in opioid drug costs. Consistent with those statistics, chiropractic has reduced secondary disability by 313% compared to physical therapy for back-related conditions and by 239% for primary disability for the same (Blanchette et al., 2017), where medicine is diagnosing 95% of patients with low back pain as nonspecific and predominantly referring to perpetual failed pathways. At the same time, chiropractic helps 96% of its patients, including low back pain (Ntedan et al., 2020). This is not a referendum against physical therapy or medicine, as collaboration with every healthcare discipline is required, and each provider brings a unique skill set to the healthcare marketplace. However, with low back pain, the evidence in the literature strongly suggests that to help eradicate the low back pain epidemic and reduce the use and costs of opioids, chiropractic should be the first provider.