{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T06:10:02Z","timestamp":1752127802492,"version":"3.41.2"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Low back pain (LBP) is the most common reason for outpatient opioid prescribing: a quarter of patients receive prescriptions, leading to opioid use disorder (OUD) in 5%. Guideline-recommended multimodal interventions often face implementation barriers, and effective modalities (e.g., electrical stimulation) lack coverage. A multimodal mechanical stimulation (M-Stim) device for LBP has demonstrated safety and efficacy in pain reduction, but its impact on opioid use has not yet been determined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As part of an NIH-funded double-blind study to reduce pain and opioid use, patients with moderate-to-severe LBP presenting to two suburban chiropractic centers were randomized to receive either the M-Stim device or a transcutaneous electrical nerve stimulation (TENS) unit for 30\u2005min daily, in addition to other therapies. Analgesic use was reported daily for 28 days, with new prescribing followed weekly for 3 months. The primary outcome was prescribing in the opioid-na\u00efve subjects. Secondary endpoints included risk factors for prolonged use in the opioid-na\u00efve subjects, milligram morphine equivalents (MME) for opioid users between the first and last 2 weeks, and prescribing compared with national rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After informed consent, 159 eligible patients were randomized to M-Stim (87) or TENS (72) (mean age 42.6 years, 54% female, BMI 30.9, NRS 5.5) between 23 June 2022 and 31 December 2023. Zero opioid-na\u00efve M-Stim participants (<jats:italic>n<\/jats:italic>\u2009=\u200943) received prescriptions (0% vs. 8.6%, Fisher's exact <jats:italic>p<\/jats:italic>\u2009=\u20090.086), and those taking opioids used significantly fewer MME [7.5 (SD 3.54) vs. 498.5 MME (SD 474.9), <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001] for fewer of reported days [M-Stim 2\/47 (4.2%)] compared with TENS [<jats:italic>n<\/jats:italic>\u2009=\u200936, 38\/102 (37%), RR 0.11 (95% CI 0.28\u20130.44), <jats:italic>p<\/jats:italic>\u2009=\u20090.0018]. M-Stim significantly reduced MME in opioid users [\u221244.6% (32.33 MME), <jats:italic>p<\/jats:italic>\u2009=\u20090.02], use days for those with BMI \u226530 [\u22123 (99% CI \u22125.73 to \u22120.26), <jats:italic>p<\/jats:italic>\u2009=\u20090.032], and prescribing compared with national rates [9.8% vs. 25%, \u221263%, RR 0.32 (95% CI 0.16\u20130.66), <jats:italic>p<\/jats:italic>\u2009=\u20090.002] while TENS did not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among chiropractic patients with moderate-to-severe LBP, added use of a multimodal M-Stim device in the opioid-na\u00efve subjects significantly reduced factors associated with OUD compared with TENS and reduced use days for those with BMI \u226530. This novel device is a potential alternative to prescribing opioids as first line for LBP management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p><jats:uri>https:\/\/clinicaltrials.gov\/study\/NCT04491175<\/jats:uri>, identifier NCT04491175.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpain.2025.1612572","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T05:31:48Z","timestamp":1752125508000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preventing opioid prescribing for low back pain using multimodal mechanical stimulation vs. TENS: a randomized-controlled trial"],"prefix":"10.3389","volume":"6","author":[{"given":"Amy L.","family":"Baxter","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jena L.","family":"Etnoyer-Slaski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica Allia Rice","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Swartout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey L.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. 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