Non-pharmacological treatments outperform opioid treatment for patients with chronic non-surgical pain

Updated prescribing guidelines published in 2014 and 2016 may explain a lower opioid use of 11.7% among patients with chronic nonsurgical pain.

According to a study published in Open JAMA Network. Chiropractic treatment increased the most among non-pharmacological treatment types, but acupuncture and massage therapy were the least common.

For the primary endpoint, the researchers looked at the association between calendar year (2011-2019) and mutually exclusive pain treatments. The secondary endpoint examined the prevalence of non-pharmacological treatments – both endpoint analyzes were stratified by type of pain.

“Between 2011 and 2019, the use of non-pharmacological treatments increased while neither the use of opioids nor non-pharmacological therapy decreased,” the study authors wrote.

Between 2016 and 2019, the study also found a large increase in non-pharmacological treatments. This may be a response to updated CDC guidelines from 2016, which suggested reducing opioid prescriptions for chronic pain.

In 2010, 19% of American adults suffered from chronic pain. It is estimated that this rate will increase over the next decade. Annual pain-related expenses can include healthcare costs, which can range between $261 billion and $300 billion, and lost productivity, which can cost up to $355 billion.

Previous studies have shown that low-risk, non-pharmacological treatments can reduce pain and improve function. These interventions may include acupuncture, consultation with a chiropractor, massage therapy, occupational therapy and physiotherapy.

These treatments may also have fewer adverse effects (AEs) than opioids, which are “associated with an increased risk of [AEs] including falls, abuse or diversion, preventable hospitalizations, and overdose mortality,” the study authors wrote.

The study authors sought to describe annual trends in mutually exclusive use of prescription opioids, non-pharmacological treatments, both or neither, use of various non-pharmacological treatments, the relationship between year schedule and type of treatment, and the annual use of treatment according to the severity of pain.

The researchers included 46,420 respondents in a serial cross-sectional analysis, in which they estimated the use of outpatient services among adults with chronic or surgical pain (and without cancer).

According to the results, only patients with chronic non-surgical pain used more non-pharmacological treatments than opioids. Specifically, the use of a chiropractor increased to 8.4% in 2012 and in 2019, 25.6% of all participants with chronic pain were treated by a chiropractor.

“Among cancer-free adults with pain, the annual prevalence of non-pharmacological pain treatments increased and the prevalent use of neither opioids nor non-pharmacological therapy decreased for the chronic and surgical pain cohorts,” wrote the authors of the study.

Limitations of the study include that the results are not generalizable to all populations. Additionally, the researchers did not include pharmacological substitutes for opioids. Instead, they combined all non-pharmacological treatments into one category and only identified chronic pain using the Agency for Healthcare Research and Quality.

“Our study has broad clinical and policy relevance, including expanding reimbursement for non-pharmacological healthcare professionals and equalizing direct access – without a physician referral – between these professionals in certain circumstances,” wrote the study authors.


Prichard, Kevin. Baillargeon, Jacques, Lee, Wei-Chen, et al. Trends in the use of opioids versus non-pharmacological treatments among adults with pain, 2011-2019. JAMA Netw Open. 2022;5(11):e2240612. doi:10.1001/jamanetworkopen.2022.40612

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