Initial Back Pain Treatment Choice Shifts Later Opioid Use Disorder Risk
This large Medicaid cohort quantifies how first-line acute low back pain treatments, including gabapentinoids and short-course opioids, relate to later opioid use disorder or overdose diagnosis, giving pain and stewardship pharmacists risk estimates to support deprescribing and nonpharmacologic referral.
📅 Journal publication: Oct 1, 2026·Last updated: Oct 24, 2026
acute low back painopioid use disorderopioid overdoseopioidsgabapentinoidschiropractic carephysical therapyMedicaidretrospective cohortopioid stewardshipmultimodal analgesiamorphine milligram equivalentsPain Management
Background Information
Nonpharmacologic treatments cut opioid use disorder risk by 32.8%.
Evaluating initial treatments for acute low back pain (aLBP) is crucial to reduce opioid-related risks. Initial higher-dose opioids increased opioid use disorder (OUD) or overdose risk by 146.6%, while chiropractic care reduced the risk by 32.8%. The study supports using nonpharmacologic treatments such as chiropractic care and physical therapy as first-line therapies for aLBP to minimize OUD risk. Nonpharmacologic treatments for acute low back pain reduce opioid use disorder risk.
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Authors:Doan LV, Hung AM, Olfson M, Williams NT, Rudolph KE
Citation:Doan LV, Hung AM, Olfson M, et al. Initial Treatment for Acute Low Back Pain and Risk of Opioid Use Disorder and Overdose. JAMA network open. 2026;9(10):e2639420. doi:10.1001/jamanetworkopen.2026.39420
Subscribers receive access to a complete clinical analysis, available online and as a downloadable PDF.
Executive Summary
Study Design
Patient Population
Primary Outcomes
Secondary Outcomes & Safety Profile
Pharmacist Implications
Clinical Pearls
Limitations
Controversies & Evidence Gaps
Cost & Logistics
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