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Landmark Opioid Study

What is being called a “Landmark” trial study has shown something that impacts all patients suffering from low back and neck pain. The study which is being called “the OPAL trial” is the first randomized control trial (RCT) to look at the effectiveness and safety of a short course of opioids for acute nonspecific low back/neck pain. Conducted at the University of Sydney, this triple blinded RCT looked at the differences between opioids (oxycodone and oxycodone-naloxone) and a placebo in treating adults with acute low back and/or neck pain over a six week period (1). 347 people participated in the trial from 157 different clinics in Sydney, Australia. The results are eye opening, as after the six week period there was no significant difference in pain outcomes between the placebo group and the opioid group (1). In fact after one year, the placebo group actually reported lower pain scores, while the opioid group was at greater risk of opioid misuse, close to doubling their risk (1). Based on these findings, the authors have come to the conclusion: opioids should not be recommended for acute non-specific low back pain or neck pain (1). 

Where does chiropractic come in?

The opioid crisis has come to the forefront of the public’s eye in recent years in various aspects of our lives. From the rise in heroin overdoses and abuse throughout America to the popularity of Hulu’s miniseries Dopesick, which dives into the Sackler Family, Purdue Pharma, OxyContin and their role in the epidemic, opioid misuse is documented everywhere. We are continuing to learn more all the time about the misleadings these entities have passed on as facts in regards to opioids and their usefulness in pain management. As a chiropractor, low back pain is a symptom that we deal with on an hourly basis. It is easily the most common problem patients come and seek help with. And for good reason too, adjustments are an effective option for treating pain and improving functional outcomes in patients with low back pain (2). Chiropractic has also been found to be a cost effective treatment long term compared to opioid therapy for low back pain (3). 

Next time you or a loved one has a problem with their low back, remember what the current evidence says. Urge the person in need to seek a conservative option of care prior to seeking an opioid prescription for their pain management. Now with more than one doctor on staff, we have more availability than ever before to help our patients function at their highest level.


  1. Jones, C. M. P., Day, R. O., Koes, B. W., Latimer, J., Maher, C. G., McLachlan, A. J., Billot, L., Shan, S., Lin, C. C., & OPAL Investigators Coordinators (2023). Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet (London, England), S0140-6736(23)00404-X. Advance online publication.

  2. Franke, H., Franke, J. D., & Fryer, G. (2014). Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC musculoskeletal disorders, 15, 286.

  3. Whedon, J. M., Kizhakkeveettil, A., Toler, A., MacKenzie, T. A., Lurie, J. D., Bezdjian, S., Haldeman, S., Hurwitz, E., & Coulter, I. (2021). Long-term medicare costs associated with opioid analgesic therapy vs spinal manipulative therapy for chronic low back pain in a cohort of older adults. Journal of Manipulative and Physiological Therapeutics, 44(7), 519–526.

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