Neck pain: Does care provider type influence opioid usage?

Neck pain is one of the most common conditions for otherwise healthy people to suffer from, unsurprising it’s also one of the most common conditions we see here at the clinic! Some research suggests that neck pain can affect as much as 1 in 3 adults each year[1] Whatever the exact number, it’s a big issue!


Treating neck pain

As a chiropractic clinic, we focus primarily on non-medication based approaches to treating pain, including neck pain. Of course, we’re not against short term usage of painkillers, or NSAID’s such as ibuprofen to help manage a painful condition – indeed, sometimes this is the only option available until care can be sought anyway. Where medication-based approaches to treatment can become a problem, however, is when those suffering from neck pain are prescribed powerful opioid-based medications which can come with a range of side effects. This is especially relevant since studies have identified a concerning relationship between neck pain and opioid use and suggest that people with neck pain are actually more likely to use opioids than those with other musculoskeletal pain, such as back pain.[2] The biggest concern here is that long term, up to 29% of patients with chronic pain who are prescribed opioids eventually come to misuse the opioids.[3]


Is opioid prescription linked to care provider type?

One interesting trend which emerges from the literature on musculoskeletal conditions indicates that initial provider type (that is to say, the type of care sought for the neck pain) may be associated with a lower risk of opioid use. One study found that those with neck pain who sought care from chiropractors and physical therapists had lower opioid exposure in the year following the start of care than those who initially sought care from primary care physicians (PCPs).[4]

Based on this suggestion, a new cohort study has recently investigated this linkage and found some interesting results. The study used existing research databases to compile profiles of patients suffering from neck pain (roughly 420,000 of them!) to examine whether the initial care provider people used to treat their neck pain had any bearing on opioid usage in the year following the painful episode.

The study[5] showed some very interesting conclusions – firstly, that more than 49% of neck pain sufferers who used opioids during the study period used opioids within 3 days of their diagnosis.

Secondly, the results showed that people seeking help for neck pain, who received their initial diagnosis from conservative therapists (ie. Chiropractors, physical therapists etc.) had lower odds of short- and long-term opioid use compared to those who were initially diagnosed by Primary care providers such as GP’s. Similarly, those who received their initial neck pain diagnosis from emergency medicine physicians were about 300% more likely to have an opioid prescription filled in the month following the visit compared to PWNP initially diagnosed by PCPs.

Those with an initial diagnosis from an orthopaedic surgeon or neurologist were 115% and 199% more likely, respectively, to have ongoing opioid prescription fills up to a year after the initial visit than those initially diagnosed by GP’s.

Thus, the study showed that the initial care provider is, in fact significantly associated with subsequent opioid use.

There’s an important caveat to keep in mind with this study – it was based on data from the US, where opioid use and prescription is already more common than is the case in the UK, but the fundamental point is certainly interesting.


Opioids and neck pain

Opioids are strong medications that are not handed out lightly in the UK – but there’s still good reason to want to avoid using them if at all possible. This study shows that a visit to a chiropractor or physical therapist may just be effective enough to at least reduce pain to a level where stronger medications are not required, and in our minds, that’s a win. Don’t get us wrong – if you’re experiencing incredibly serious neck pain (especially with a sudden onset), the GP is probably the right port of call and medication might be the right choice– however for cases that are slowly getting worse have lingered for quite some time, or are a repeat issue a visit to the Chiropractor may be the best way forward!


[1] Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc 2015;90:284-99.

[2] Weeks WB, Goertz CM, Long CR, Meeker WC, Marchiori DM. Association among opioid use, treatment preferences, and perceptions of physician treatment recommendations in patients with neck and back pain. J Manipulative Physiol Ther 2018;41:175-80.

Fischbein R, Mccormick K, Selius BA, et al. The assessment and treatment of back and neck pain: an initial investigation in a primary care practice-based research network. Prim Health Care Res Dev 2014;16:461-9.

[3] Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain 2015;156:569-76.

[4] Horn ME, George SZ, Fritz JM. 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

[5] Christopher J. Louis et al, Association of Initial Provider Type on Opioid Fills for Individuals With Neck Pain  Archives of Phys Med and Rehabilitation 2020 (Aug); 101 (8): 1407–1413

Blog by / November 19, 2021 / Blog

Dr. Paul Irvine is a doctor of chiropractic who graduated in 1994 with a Bachelor of Science degree from the University of NSW and in 1996, attained his Master of Chiropractic degree from Macquarie University in Australia. He practised in North Sydney for 5 years before he left Australia to travel and practise in the UK. He joined Complete Chiropractic in 2003 (est 1999) and took over the clinic in 2007