Although national and international guidelines advise against treatment with pain medication, nearly half of patients with lumbar spinal stenosis used prescription pain medication in the year prior to treatment initiation. Use gradually increased, peaked around the start of treatment, and declined in the year following completion of the course.
A small group of patients accounts for the majority of use
The study shows a markedly skewed distribution: the 10% of patients with the highest use accounted for 43–68% of total medication use, depending on drug type (paracetamol, NSAIDs, opioids, gabapentinoids). This points to a complex and heterogeneous patient population in which standard solutions do not fit everyone.
Who is at greatest risk of continued medication use?
Women, patients with comorbidities, and patients with existing use of paracetamol, opioids, or gabapentinoids had a 5–16% higher risk of continued use after the course. Patients with long-cycle higher education had a lower risk, which may reflect social differences in the management of chronic pain.
The use declines—but challenges remain
Although the use of pain medication decreases after inclusion in a guideline-based chiropractic course, the use of paracetamol and gabapentinoids remains high one year later. The researchers behind the study call for more targeted strategies for planned tapering, especially among long-term high users.
Unique Danish registry data
The study is based on nationwide registries, including the Danish Register of Medicinal Product Statistics and the National Patient Register, and provides unique insight into medication use among patients included in a structured care pathway.
Implications for chiropractic practice
The study supports the view that chiropractors play an important role in safe, evidence-based pain management for lumbar spinal stenosis, including attention to inappropriate use of pain medication. In collaboration with general practitioners, chiropractors can help identify patients who may benefit from targeted tapering. Overall, the findings underscore the need for individualized, patient-centred strategies in chiropractic practice.
The study is published as an open-access article and is funded by the Region of Southern Denmark and the University of Southern Denmark.
Rikke K. Jensen, Mathias Bech, Christian V. Skovsgaard, Jesper Ryg, Jan Hartvigsen, Melker S. Johansson. Use of prescribed analgesics before and after a standardised chiropractic care programme among patients with lumbar spinal stenosis: a nationwide cohort study. Chiropractic & Manual Therapies 2026.
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