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Chiropractic Patients with Low Back Pain Less Likely to Receive Benzodiazepine Prescription, New UH Connor Whole Health Study Suggests

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UH Clinical Update | October 2022

People who initially see a chiropractor for low back pain radiating into their legs are significantly less likely than patients seeing other providers to be prescribed a benzodiazepine like Valium or Xanax through the year after their first chiropractic visit. That’s according to a new study from UH Connor Whole Health using national data. Importantly, this difference is unlikely to be explained by patients’ preference to avoid prescription medications.

Why it matters: Study results suggest that seeing a chiropractor first helps put patients with low back pain on a guideline-based care pathway with regards to avoiding benzodiazepines, which aren’t typically recommended for the condition.

Clinical guidelines for low back pain recommend against benzodiazepines:

“Recent clinical practice guidelines from the National Institute for Health and Care Excellence (2020), Veterans Affairs and Department of Defense (2019), Global Spine Care Initiative (2018) and Belgian Health Care Knowledge Centre (2017) recommended against prescribing benzodiazepines for low back pain while those of the American College of Physicians (2017) concluded there was insufficient evidence for their effectiveness in acute or subacute low back pain,” the research team writes in the journal BMJ Open.

Study Methods

For the study, UH Connor Whole Health chiropractor Robert Trager, DC, and his co-authors analyzed thousands of patient electronic medical records from across the U.S. in the TriNetX database, including adults between the ages of 18 and 49 with a diagnosis of radicular low back pain. They then divided patients into two equal study cohorts – those who had received chiropractic spinal manipulative therapy (CSMT) and those who had not. The team used a statistical technique called propensity score matching to control for factors that could influence the likelihood of patients to be prescribed benzodiazepines.

What They Found

The odds of a patient receiving a benzodiazepine prescription were lower in the CSMT cohort over all follow-up windows, with statistical significance for each window. The percent of patients receiving a benzodiazepine prescription:

  • At three months: CSMT patients: 4.4 percent, non-CSMT patients, 7.6 percent
  • At six months: CSMT patients: 6.3 percent, non-CSMT patients, 9.9 percent
  • At 12 months: CSMT patients, 9.4 percent, non-CSMT patients, 13.3 percent

“These results provide real-world evidence of practice guideline-concordance among patients entering the CSMT care pathway with respect to benzodiazepine prescription,” Dr. Trager says. “They reinforce the use of CSMT as a first-line non-pharmacological option for adults with radicular low back pain.”

What it Means for Clinical Practice

Dr. Trager says he hopes these study results will encourage more primary care providers to refer patients suffering from low back pain for CSMT with a chiropractor.

“Spinal manipulation is the most common therapy that chiropractors use, and it's supported already by evidence for treatment of low back pain,” he says. “There have been other studies that show that if a patient with back pain sees a chiropractor first, they are less likely to get an opioid prescription. Our findings suggest they are also less likely to get a benzodiazepine prescription. Our study shows that chiropractic or CSMT can lead patients into a positive care pathway.”

To refer a patient for chiropractic care at UH Connor Whole Health, please call 216-285-4070.

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