Nonpharmacologic Care Lowers Opioid Risk for Back Pain

A study of Medicaid patients links guideline-based nonopioid treatment for acute low back pain to lower one-year risk of opioid use disorder or overdose.

Updated on Nov. 9, 2026 in Substance Abuse

Gouache-painted editorial illustration of a padded treatment table with a folded cream towel and resistance band in a quiet clinical room, evoking nonopioid back pain care. — A JAMA Network Open study found guideline-based nonopioid treatment for acute low back pain is linked to lower one-year opioid-use-disorder or overdose risk among 399,500 Medicaid patients. AI Illustration. Upload story photo >

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Would you rather try physical therapy before taking opioids for back pain?

A JAMA Network Open study published Oct. 19 found that guideline-compliant nonpharmacologic treatment for acute low back pain is associated with lower risk of an opioid use disorder or overdose diagnosis after one year. The analysis covered 399,500 Medicaid patients who began treatment for newly diagnosed acute low back pain from 2016 through 2019.

Why it matters

Opioids remain a common prescribing option for back pain, and the study ties higher-dose and longer opioid courses to substantially greater risk. For the United States, the findings point to nonopioid options as a lower-risk first approach for a condition that affects large numbers of patients.

Chiropractic care was associated with a 32.8 percent decrease in risk and physical therapy with a 31.1 percent decrease compared with not initiating either treatment. Gabapentinoids were associated with a 101.6 percent increase in risk.

The players

New York University

A private research university in New York City whose researchers led the study on opioid risk and back pain treatment.

JAMA Network Open

An open-access, peer-reviewed medical journal published by the American Medical Association that released the study.

The details

Researchers led by Lisa V. Doan of New York University examined outcomes for opioid-naive Medicaid patients who started treatment for acute low back pain. Initiating higher-dose opioids above 50 mg morphine equivalent, lower-dose opioids prescribed for more than seven days, or gabapentinoids each raised risk, while chiropractic care and physical therapy lowered it.

2016 through 2019: Patients in the study began treatment for newly diagnosed acute low back pain.
Oct. 19: The study was published online in JAMA Network Open.
Nov. 9: HealthDay published news coverage of the study.

Health Landscape

The 2016 CDC Clinical Practice Guideline for Prescribing Opioids for Pain recommends nonopioid therapies as first-line care for most pain. This study provides outcome data showing that patients who followed that approach had lower measured risk of opioid use disorder or overdose.

Patients with acute low back pain may ask their clinicians about chiropractic care or physical therapy before opioids. Discussing the higher risk associated with higher-dose opioids and longer prescriptions can help inform those decisions.

The takeaway

Nonopioid approaches such as physical therapy and chiropractic care are associated with lower opioid risk for acute back pain. Patients and clinicians can use this evidence when weighing first-line options.