Starting with therapy for back pain was linked to lower opioid addiction risk
☕ Includes a question for the family ↓
Back painPart of a story we are following · 2 articles · See every update
If your back suddenly starts to hurt, you have a good first move: start with hands-on, non-drug care. A large study found that people with new back pain who began with chiropractic care or physical therapy were less likely to be diagnosed later with opioid use disorder or an overdose.
The same study found the opposite for people who started with opioids. Higher-dose opioids carried the greatest risk. So the instinct to try a physical therapist or chiropractor first is a sound one, and it is something you can act on.
How the study worked
Researchers looked at Medicaid records from 25 US states, from 2016 to 2019. They followed adults under 65 who had never taken opioids and who started treatment for newly diagnosed low back pain. They counted new diagnoses of opioid use disorder or overdose over the next year, and compared people by their first treatment. It was an observational study, so it shows links rather than proof of cause. It was published Oct. 1, 2026, in JAMA Network Open.
What they found
Overall, about 1 in 50 people had a new diagnosis of opioid use disorder or overdose by the end of the follow-up: 2.3% at 13 months. At 7 months it was 1.4%.
The first treatment made a clear difference. Starting with chiropractic care was linked to about one-third lower risk, 32.8% to be exact. Starting with physical therapy was linked to about 31% lower risk, or 31.1%. These two had the biggest drops of any treatment in the study.
On the other side, starting with higher-dose opioids (more than 50 mg of morphine equivalent) was linked to about two and a half times the risk. The exact figure was 146.6% higher. Lower-dose opioids taken for more than 7 days were linked to 105.2% higher risk. Gabapentinoids, a type of nerve-pain medicine, were linked to 101.6% higher risk.
| First treatment | Change in risk vs. not using it |
|---|---|
| Higher-dose opioids | 146.6% higher |
| Lower-dose opioids for more than 7 days | 105.2% higher |
| Gabapentinoids | 101.6% higher |
| Chiropractic care | 32.8% lower |
| Physical therapy | 31.1% lower |
In plain words, the treatments that moved your body and did not involve a pill were tied to better outcomes. The results back guidelines that name non-drug care as the first choice for new low back pain.
Why gabapentinoids are in the list
Gabapentinoids are not opioids, and some people see them as a gentler option for pain. In this study, starting with them was linked to about the same added risk as lower-dose opioids taken for more than a week. That is worth knowing if a prescription like this is ever offered to you.
What you can do today
If your back starts hurting, book a visit with a physical therapist or a chiropractor. Many US states let you see a physical therapist without a referral, and Medicare and many insurance plans cover these visits, so call the number on your insurance card to check. In the meantime, stay gently active with short walks and use a warm compress.
Talk about it at home
When a back starts to hurt, a doctor can give you a pill, or a therapist can show you how to move so it heals. In this study, people who started with strong pain pills were more likely to run into trouble with those pills later. People who started with therapy were less likely to.
Try it at home
How could you find out whether walking or stretching feels better for a sore back? Try each one on different days and notice how you feel afterward.
Keep exploring
Copies this article and its questions so you can paste them into ChatGPT, Claude, Gemini or the AI you use, and keep the conversation going.
Questions and answers
- Is it risky to start with opioids for back pain?
- In this study, starting with higher-dose opioids was linked to the highest risk of opioid use disorder or overdose, 146.6% higher than not starting them.
- Which first treatments were linked to lower risk?
- Chiropractic care was linked to 32.8% lower risk and physical therapy to 31.1% lower risk.
- Are gabapentinoids a safer choice than opioids?
- Not in this study. Starting with them was linked to 101.6% higher risk of opioid use disorder or overdose.
- Who was in the study?
- Adults under 65 in Medicaid across 25 states who had never used opioids and began treatment for new low back pain.
