{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:31:28Z","timestamp":1779316288035,"version":"3.51.4"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2020,3,6]],"date-time":"2020-03-06T00:00:00Z","timestamp":1583452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Council on Chiropractic Guidelines and Practice Parameters"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and Setting<\/jats:title>\n                  <jats:p>We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012\u20132017.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects<\/jats:title>\n                  <jats:p>We included adults aged 18\u201384\u2009years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain. We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30\u2009days of diagnosis) and nonacute (all other patients).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The total number of subjects was 101,221. Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients (in Connecticut: hazard ratio [HR] = 1.55, 95% confidence interval [CI] = 1.11\u20132.17, P\u2009=\u20090.010; in New Hampshire: HR = 2.03, 95% CI = 1.92\u20132.14, P\u2009&amp;lt;\u20090.0001). Similar differences were observed for the acute groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30\u2009days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnaa014","type":"journal-article","created":{"date-parts":[[2020,1,13]],"date-time":"2020-01-13T20:13:00Z","timestamp":1578946380000},"page":"3567-3573","source":"Crossref","is-referenced-by-count":39,"title":["Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain"],"prefix":"10.1093","volume":"21","author":[{"given":"James M","family":"Whedon","sequence":"first","affiliation":[{"name":"Southern California University of Health Sciences, Whittier, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W J","family":"Toler","sequence":"additional","affiliation":[{"name":"Southern California University of Health Sciences, Whittier, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louis A","family":"Kazal","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Bezdjian","sequence":"additional","affiliation":[{"name":"Southern California University of Health Sciences, Whittier, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin M","family":"Goehl","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth, Hanover, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Greenstein","sequence":"additional","affiliation":[{"name":"Kaizo Health, Rockville, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,3,6]]},"reference":[{"key":"2020122823505020500_pnaa014-B1"},{"key":"2020122823505020500_pnaa014-B2","year":"2011"},{"issue":"3","key":"2020122823505020500_pnaa014-B3","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jpainsymman.2007.10.003","article-title":"Epidemiology of regular prescribed opioid use: Results from a national, population-based survey","volume":"36","author":"Hudson","year":"2008","journal-title":"J Pain Symptom Manage"},{"issue":"7","key":"2020122823505020500_pnaa014-B4","doi-asserted-by":"crossref","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann Intern 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analysis of risk factors and health care services","volume":"29(Suppl","author":"Rhee","year":"2007","journal-title":"Clin Ther"},{"issue":"4","key":"2020122823505020500_pnaa014-B9","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jmpt.2016.02.016","article-title":"Cross-sectional analysis of per capita supply of doctors of chiropractic and opioid use in younger Medicare beneficiaries","volume":"39","author":"Weeks","year":"2016","journal-title":"J Manipulative Physiol Ther"},{"issue":"3","key":"2020122823505020500_pnaa014-B10","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.mayocpiqo.2017.09.001","article-title":"Influence of initial provider on health care utilization in patients seeking care for neck pain","volume":"1","author":"Horn","year":"2017","journal-title":"Mayo Clin Proc Innov Qual Outcomes"},{"key":"2020122823505020500_pnaa014-B11","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.1093\/pm\/pny114","article-title":"Opioid use 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occupational back injury: Results from a prospective study of workers in Washington State","volume":"38","author":"Keeney","year":"2013","journal-title":"Spine"},{"issue":"1","key":"2020122823505020500_pnaa014-B18","doi-asserted-by":"crossref","first-page":"e183044","DOI":"10.1001\/jamanetworkopen.2018.3044","article-title":"Coverage of nonpharmacologic treatments for low back pain among US public and private insurers","volume":"6","author":"Heyward","year":"2018","journal-title":"JAMA Netw Open"}],"container-title":["Pain 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