{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T21:51:39Z","timestamp":1788385899262,"version":"build-2803163510"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001297","name":"Elisabeth Severance Prentiss Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001297","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UM1TR004528"],"award-info":[{"award-number":["UM1TR004528"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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 \u226518 years with sciatica, excluding those post-spine surgery, prior anesthesia, serious pathology, high risk of ORADEs, and an ORADE \u2264 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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\u20130.32; <jats:italic>P<\/jats:italic> &lt; .00001). CSM patients had a lower risk of receiving an oral opioid prescription (RR of 0.68 [95% CI: 0.68\u20130.69; P &lt; .00001]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317663","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T18:51:18Z","timestamp":1738090278000},"page":"e0317663","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between chiropractic spinal manipulation for sciatica and opioid-related adverse events: A retrospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4714-1076","authenticated-orcid":true,"given":"Robert J.","family":"Trager","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-9810","authenticated-orcid":true,"given":"Zachary A.","family":"Cupler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshini","family":"Srinivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elleson G.","family":"Harper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime A.","family":"Perez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"pone.0317663.ref001","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1080\/03007995.2020.1865889","article-title":"Insight into chronic pain in the United States: descriptive results from the Prescription Opioid Misuse and Abuse Questionnaire (POMAQ) validation study.","volume":"37","author":"KS Coyne","year":"2021","journal-title":"Curr Med Res Opin."},{"key":"pone.0317663.ref002","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.3390\/jcm10071366","article-title":"Prescribing Patterns of Pain Medications in Unspecific Low Back Pain in Primary Care: A Retrospective Analysis.","volume":"10","author":"S Di Gangi","year":"2021","journal-title":"J Clin Med"},{"key":"pone.0317663.ref003","first-page":"145","article-title":"The Prevalence of Long-Term Opioid Therapy in Spine Center Outpatients Following Initiation of Tramadol: The Spinal Pain Opioid Cohort (SPOC).","volume":"6","author":"C Manniche","year":"2022","journal-title":"Chron Pain Manag."},{"key":"pone.0317663.ref004","article-title":"Medication recommendations for treatment of lumbosacral radiculopathy: A systematic review of clinical practice guidelines.","author":"MR Price","year":"2024","journal-title":"PM R"},{"key":"pone.0317663.ref005","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.36076\/ppj.2008\/11\/S105","article-title":"Opioid complications and side effects","volume":"11","author":"R Benyamin","year":"2008","journal-title":"Pain Physician"},{"key":"pone.0317663.ref006","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1002\/pds.4157","article-title":"Assessing the accuracy of opioid overdose and poisoning codes in diagnostic information from electronic health records, claims data, and death records.","volume":"26","author":"CA Green","year":"2017","journal-title":"Pharmacoepidemiology and Drug Safety"},{"key":"pone.0317663.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain\u2014United States, 2022.","volume":"71","author":"D Dowell","year":"2022","journal-title":"MMWR Recommendations and Reports"},{"key":"pone.0317663.ref008","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12998-022-00435-3","article-title":"Systematic review of guideline-recommended medications prescribed for treatment of low back pain. 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