ArticleBMJ open2024
Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data.
Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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The trial behind it
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis.Pain reports · 2026Review
- A survey of student loan burden among United States Chiropractors: Insights on debt, relief, and educational value.PloS one · 2026Article
- A description of serious adverse events following spinal manipulative therapy for adults with history of spine surgery: a single institution retrospective chart review.The Journal of manual & manipulative therapy · 2025Article
- Association Between Spinal Manipulative Therapy for Low Back Pain With or Without Sciatica and Opioid Use Disorder: A Retrospective Cohort Study.Health science reports · 2025Article
- Impact of complementary health approaches on opioid prescriptions among veterans with musculoskeletal disorders - A retrospective cohort study.The journal of pain · 2025Article
- Treatment Choices and Healthcare Services Utilization Amongst Lumbosacral Radiculopathy Patients: Results from a Randomized Controlled Trial.OBM integrative and complimentary medicine · 2025Article
- Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations.Journal of clinical medicine · 2024Review
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesPatients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management. However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored. We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care.
designRetrospective cohort study.
settingUS medical records-based dataset including >115 million patients attending academic health centres (TriNetX, Inc), queried 9 November 2023.
participantsOpioid-naive adults aged 18-50 with a new diagnosis of radicular LBP were included. Patients with serious pathology and tramadol use contraindications were excluded. Variables associated with tramadol prescription were controlled via propensity matching.
interventionsPatients were divided into two cohorts dependent on treatment received on the index date of radicular LBP diagnosis (CSM or usual medical care). PRIMARY AND SECONDARY OUTCOME MEASURES: Risk ratio (RR) for tramadol prescription (primary); markers of usual medical care utilisation (secondary).
resultsAfter propensity matching, there were 1171 patients per cohort (mean age 35 years). Tramadol prescription was significantly lower in the CSM cohort compared with the usual medical care cohort, with an RR (95% CI) of 0.32 (0.18 to 0.57; p<0.0001). A cumulative incidence graph demonstrated that the reduced incidence of tramadol prescription in the CSM cohort relative to the usual medical care cohort was maintained throughout 1-year follow-up. Utilisation of NSAIDs, physical therapy evaluation and lumbar imaging was similar between cohorts.
conclusionsThis study found that US adults initially receiving CSM for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up. These findings should be corroborated by a prospective study to minimise residual confounding.
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