Chronic pain is a pervasive and growing problem in the United States.

• It is estimated that about 20% of adults in the U.S. – or one in five — experience chronic pain.1
• Chronic pain is more common among older adults, females, unemployed adults who worked previously, veterans, adults living in poverty, people in non-metropolitan areas, and those with public health insurance.1
• New cases of chronic pain occur more frequently among adults than new cases of other common chronic conditions such as diabetes, depression and high blood pressure.2
• There has been a rise in the prevalence of mental health conditions such as depression and anxiety in the past few years, and research shows these conditions can exacerbate chronic pain – and vice versa.3

Chronic Pain and musculoskeletal conditions are especially problematic due to related costs and disability.

• Chronic pain costs roughly $500-$600 billion a year as result of healthcare costs and loss in productivity.4
• In the United States alone, musculoskeletal conditions are a leading cause of disability, accounting for more than 130 million patient visits to healthcare providers annually. They are the No. 1 reason people visit their physician.5

Globally, back pain ranks as one of the most common and debilitating causes of chronic pain.    

• Low back pain is the single leading cause of disability worldwide.6
• The number of people worldwide living with back pain is projected to rise 36% over the next 30 years, from 619 million currently to 843 million in 2050.7
• One-half of all working Americans admit to having back pain symptoms each year.8
• In the U.S., low back pain is one of the leading reasons why people are prescribed opioids.9
• Risk factors for back pain include work-related ergonomics, obesity and smoking.7

Prescription opioids are not a good strategy for managing low back pain long term.

• Research shows that opioids do not provide clinically meaningful pain relief for people with chronic back pain.10
• As many as one in four people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction.11
• Almost 80 percent of Americans prefer to first try options other than prescription drugs for their pain.12

Clinical guidelines encourage patients with common musculoskeletal conditions to try non-drug treatments.

• In 2017, the American College of Physicians (ACP) updated its guidelines for the treatment of acute and chronic low back pain to recommend first using noninvasive, non-drug treatments—including spinal manipulation—before resorting to over-the-counter and prescription drugs. 13
• The Joint Commission, which accredits every major U.S. hospital, recognized the value of non-drug approaches in 2015 by adding chiropractic to its pain management standard.14
• The Department of Defense/Veterans Administration 2017 guideline for the treatment of low back pain includes spinal manipulation as a non-drug, noninvasive option. 15
• In the 2022 Clinical Practice Guideline for Prescribing Opioids, the Centers for Disease Control and Prevention promotes “diverse approaches and varied pain management solutions” and specifically encourages use of non-opioid/nonpharmacologic therapies as a first line of treatment against subacute and chronic pain.16

Research supports the use of non-drug approaches such as chiropractic services for chronic pain and to reduce reliance on prescription opioids.

• A 2018 study focusing on adults with office visits for noncancer low back pain found that the likelihood of filling an opioid prescription was significantly lower (55% lower) for recipients of services delivered by chiropractors compared with nonrecipients.17
• A study published in the journal Pain Medicine found that chiropractic users had 64% lower odds of receiving an opioid prescription than non-users.18
• The Department of Veterans Affairs reports that it reduced opioid prescriptions by 63% using its Whole Health approach, which includes non-drug treatments for pain such as chiropractic care.19
• From 59%-90% of those who use alternative therapies (e.g., chiropractic) for chronic pain find it to be helpful.20

 Visiting a chiropractor first for treatment for common musculoskeletal conditions may reduce the likelihood of receiving an opioid prescription later. 

• A 2017 study published by the Mayo Clinic found that people with neck pain initiating care with chiropractors had lower odds of using advanced imaging, injections and opioid medications.21
• A study published in the British Medical Journal found that patients who saw a chiropractor as their initial provider for low back pain had 90% decreased odds of both early and long-term opioid use. 22
• A 2022 study focusing on older Medicare beneficiaries with spinal pain found that use of chiropractic care is associated with a significantly lower (56% lower) risk of filling an opioid prescription.23

References

1. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI: http://dx.doi.org/10.15585/mmwr.mm7215a1.
2. Nahin RL, Feinberg T, Kapos FP, et al. Estimated rates of incident and persistent chronic pain among U.S. adults, 2019–2020. JAMA Network Open. 2023;6(5):e2313563.
3. “Chronic Pain and Mental Health Often Interconnected,” American Psychiatric Assn., 2020; https://www.psychiatry.org/news-room/apa-blogs/chronic-pain-and-mental-health-interconnected.
4. Gaskin DJ, Richard P. The Economic Costs of Pain in the United States. In: Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. Appendix C. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92521/.
5. Watkins-Castillo S, ed. The Burden of Musculoskeletal Disease in the United States. Rosemont, IL: American Academy of Orthopedic Surgeons; 2008.
6. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428.
7. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatology, June 2023. DOI: https://doi.org/10.1016/S2665-9913(23)00098-X.
8. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
9. Mojtabai R. National trends in long-term use of prescription opioids. Pharmacoepidemiology and Drug Safety, 2017; doi: 10.1002/pds.4278.
10. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, Tolerability, and Dose-Dependent Effects of Opioid Analgesics for Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med.2016;176(7):958–968. doi:10.1001/jamainternmed.2016.1251.
11. Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82. http://dx.doi. org/10.1111/j.1360-0443.2010.03052.
12. “Americans Prefer Drug-Free Pain Management Over Opioids,” Gallup-Palmer College of Chiropractic Annual Survey of Americans, http://www.gallup.com/reports/217676/americans-prefer-drug-free-pain-management-opioids.aspx
13. Qaseem A et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. DOI: 10.7326/M16-2367
14. The Joint Commission, “Clarification of the Pain Management Standard,” Joint Commission Perspectives, November 2014.
15. VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain, Sept. 2017, https://www.healthquality.va.gov/guidelines/Pain/lbp/VADoDLBPCPGPatientSummary092917.pdf
16. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1.
17. Whedon et al. Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids J Altern Complement Med. 2018 Jun;24(6):552-556. doi: 10.1089/acm.2017.0131. Epub 2018 Feb 22. PMID: 29470104 DOI: 10.1089/acm.2017.0131.
18. Kelsey L Corcoran, Lori A Bastian, Craig G Gunderson, Catherine Steffens, Alexandria Brackett, Anthony J Lisi, Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis, Pain Medicine, pnz219, https://doi.org/10.1093/pm/pnz219.
19. “VA Continues to Reduce Opioid Prescribing Throughout the Pandemic,” Vantage Point (official blog of the U.S. Department of Veterans Affairs), May 13, 2021. https://blogs.va.gov/VAntage/88759/va-continues-to-reduce-opioid-prescribing-throughout-the-pandemic/
20. Urits I, Schwartz RH, Orhurhu V, et al. A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care. Adv Ther. 2021;38(1):76-89. doi:10.1007/s12325-020-01554-0
21. Horn et al. Influence of Initial Provider on Health Care Utilization in Patients Seeking Care for Neck Pain. Mayo Clin Proc Innov Qual Outcomes. 2017 Oct 19;1(3):226-233. doi: 10.1016/j.mayocpiqo.2017.09.001. eCollection 2017 Dec. PMID: 30225421 PMCID: PMC6132197.
22. Kazis LE, Ameli O, Rothendler J, et al. Observational retrospective study of the association of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ Open 2019; 9:e028633. doi: 1136/bmjopen-2018-028633.
23. Whedon et al. Association between chiropractic care and use of prescription opioids among older Medicare beneficiaries with spinal pain: a retrospective observational study. Chiropr Man Therap. 2022 Jan 31;30(1):5. PMID: 35101064, PMCID: PMC8802278, DOI: 10.1186/s12998-022-00415-7.