Last Medically Reviewed on 3/25/2026
When dealing with musculoskeletal pain in Omaha, whether it’s chronic low back pain or an acute injury—patients are often faced with two common options: chiropractic care or nonsteroidal anti-inflammatory drugs (NSAIDs). While both approaches can provide relief, the research shows important differences in effectiveness, safety, and long-term value.
Let’s break down what the current evidence says.
Efficacy: Similar Outcomes, Different Approaches
For chronic low back pain, both chiropractic care and NSAIDs provide improvements in pain and function.
NSAIDs have been shown to produce reductions in pain (about a 7-point improvement on a 100-point scale) and disability compared to placebo, but these improvements often fall below what is considered clinically meaningful.[1] For acute musculoskeletal injuries (outside of the low back), NSAIDs, especially topical and oral forms can be particularly helpful.[5]
Chiropractic care, particularly spinal manipulative therapy, demonstrates comparable effectiveness to NSAIDs and other recommended treatments, with moderate improvements in both pain and function.[2][3]
Evidence suggests that chiropractic care is equally effective as physical therapy for low back pain.[4]
Safety: A Key Differentiator
One of the most important distinctions between these treatments lies in their safety profiles.
NSAIDs are widely used, but they are not without risk. Well-documented complications include:
– Gastrointestinal bleeding
– Cardiovascular events
– Kidney (renal) issues[2][6][7]
The large PRECISION trial found that while celecoxib had similar cardiovascular safety compared to ibuprofen and naproxen, all NSAIDs increased gastrointestinal and renal risks.[8] Because of this, guidelines recommend using the lowest effective dose for the shortest duration possible.[9][2]
Chiropractic care, on the other hand, shows a favorable safety profile. Most side effects are mild and temporary, such as short-term soreness or stiffness.[2][3]
A systematic review found that spinal manipulation had lower harm ratings compared to NSAIDs, opioids, and invasive procedures.[10] Serious adverse events are rare, with some studies showing no increased risk compared to sham treatments.[3]
A deep dive into the safety of Chiropractic care can be found here: https://perrigochiro.com/is-chiropractic-care-safe-what-the-science-actually-says/
Cost: Short-Term vs. Long-Term Value
From a cost perspective, the comparison is more nuanced.
NSAIDs are inexpensive upfront—generic ibuprofen can cost as little as $5–10 for a typical course.[13] However, costs can increase significantly if complications arise, particularly those requiring medical intervention.
Chiropractic care often involves higher initial out-of-pocket costs, but some studies suggest lower overall healthcare spending in the long run. This may be due to reduced reliance on imaging, medications, and hospital-based care.[4][11][12]
That said, these studies have methodological limitations, so conclusions should be interpreted cautiously.[11]
Interestingly, utilization patterns also matter. Many patients receive fewer chiropractic visits than recommended, resulting in lower average costs ($434 vs. $2,555 for guideline-consistent care), which raises questions about whether some patients are receiving optimal treatment frequency.[14]
A deeper look at the cost of Chiropractic care in Omaha, Nebraska can be found here: https://perrigochiro.com/whats-the-price-the-real-cost-of-chiropractic-care-in-omaha/
What Do Clinical Guidelines Recommend?
According to the American College of Physicians:
– For chronic low back pain:
Nonpharmacologic treatments—including spinal manipulation—should be first-line therapy, with NSAIDs reserved for patients who do not respond adequately.[2]
– For acute non–low back musculoskeletal injuries:
Topical NSAIDs are recommended as first-line treatment.[5]
The Bottom Line
Both chiropractic care and NSAIDs can play a role in managing musculoskeletal pain—but they are not interchangeable.
– Chronic low back pain: Chiropractic care offers similar effectiveness with a stronger safety profile and is recommended as a first-line option, though NSAIDs can be particularly helpful in acute pain situations.
– Safety considerations: Chiropractic care carries fewer serious risks, while NSAIDs require careful use due to potential complications.
– Cost considerations: NSAIDs are cheaper upfront, but chiropractic care may reduce long-term healthcare utilization.
The best approach often depends on the individual patient, the type of injury, and long-term health goals. A thoughtful, evidence-based plan—rather than a one-size-fits-all solution—will always produce the best outcomes.
Frequently Asked Questions (FAQs)
Is chiropractic care better than NSAIDs for back pain?
Chiropractic care and NSAIDs provide similar levels of pain relief for chronic low back pain, but they differ significantly in safety. Research shows both offer modest improvements, though chiropractic care avoids the gastrointestinal, cardiovascular, and kidney risks associated with NSAIDs.[1][2][6][7] For this reason, clinical guidelines recommend chiropractic care and other non-drug therapies as a first-line treatment.[2]
Are NSAIDs safe to take long-term?
NSAIDs can be effective for short-term pain relief, but long-term use carries risks, including stomach ulcers, bleeding, heart complications, and kidney issues.[6][7] Most guidelines recommend using NSAIDs at the lowest effective dose for the shortest possible duration.[9][2] If you need ongoing pain management, non-drug options like chiropractic care may be a safer long-term strategy.
How effective is chiropractic care for chronic low back pain?
Chiropractic care has been shown to provide improvements in pain and function, similar to NSAIDs and physical therapy.[2][3][4] While no single treatment is a “magic fix,” chiropractic care is widely recommended as part of a conservative, first-line approach to managing chronic low back pain.
Does chiropractic care actually work, or is it just temporary relief?
Chiropractic care is supported by moderate-quality evidence showing real improvements in pain and function.[3][4] Like most treatments for musculoskeletal pain, results are often gradual and depend on consistency, proper diagnosis, and addressing contributing factors like movement, posture, and strength.
What is safer: chiropractic care or NSAIDs?
Chiropractic care generally has a more favorable safety profile. Most side effects are mild and temporary, such as soreness.[2][3] NSAIDs, while common, are associated with more serious risks like gastrointestinal bleeding and cardiovascular events.[6][7] Studies comparing treatments for low back pain have found spinal manipulation to have lower overall harm ratings.[10]
When should I use NSAIDs instead of chiropractic care?
NSAIDs are often recommended for acute injuries outside of the low back, such as sprains or strains, especially in the short term.[5] Topical NSAIDs in particular are considered a first-line option for these types of injuries. Chiropractic care may still play a role depending on the condition, but the evidence is currently strong for NSAIDs in these cases.
Is chiropractic care expensive compared to NSAIDs?
NSAIDs are cheaper upfront, often costing just a few dollars for a course of medication.[13] Chiropractic care involves higher initial costs, but research suggests it may reduce overall healthcare spending by decreasing the need for imaging, medications, and more invasive treatments.[4][11][12] The true cost depends on how care is used and the individual patient’s needs.
How many chiropractic visits do I need?
The number of visits varies depending on your condition, severity, and goals. Research shows many patients receive fewer visits than recommended, which may impact outcomes.[14] A personalized treatment plan based on your specific condition will provide the best results. For a more in depth look at average number of chiropractic sessions, visit: https://perrigochiro.com/how-many-chiropractic-sessions-do-i-need-what-the-science-says-in-2026/
Should I try chiropractic care before medication?
For chronic low back pain, yes. Clinical guidelines recommend starting with non-drug treatments like chiropractic care before turning to medications like NSAIDs.[2] This approach can help reduce reliance on medications while still effectively managing pain.
Can I combine chiropractic care and NSAIDs?
In some cases, yes. Short-term use of NSAIDs alongside chiropractic care may help manage pain while addressing the underlying mechanical issues. However, this should always be done under the guidance of a healthcare provider to minimize risks and ensure appropriate use.
Is chiropractic care effective for more than just back pain?
Chiropractic care is most strongly supported for spine-related conditions, such as low back and neck pain.[2][3] Evidence for other musculoskeletal conditions is more limited, but many patients still report benefit depending on the diagnosis and treatment approach.
What’s the best first step if I have back pain?
The best first step is to get an accurate diagnosis and start with conservative care. For most cases of low back pain, that means non-drug therapies like chiropractic care, movement-based rehab, and education before considering medications.[2]
References:
1. NSAIDs for Chronic Low Back Pain. Enthoven WTM, Roelofs PD, Koes BW. JAMA. 2017;317(22):2327-2328. doi:10.1001/jama.2017.4571.
2. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Qaseem A, Wilt TJ, McLean RM, et al. Annals of Internal Medicine. 2017;166(7):514-530. doi:10.7326/M16-2367.
3. Benefits and Harms of Spinal Manipulative Therapy for the Treatment of Chronic Low Back Pain: Systematic Review and Meta-Analysis of Randomised Controlled Trials. Rubinstein SM, de Zoete A, van Middelkoop M, et al. BMJ (Clinical Research Ed.). 2019;364:l689. doi:10.1136/bmj.l689.
4. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. Blanchette MA, Stochkendahl MJ, Borges Da Silva R, et al. PloS One. 2016;11(8):e0160037. doi:10.1371/journal.pone.0160037.
5. Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians. Qaseem A, McLean RM, O’Gurek D, et al. Annals of Internal Medicine. 2020;173(9):739-748. doi:10.7326/M19-3602.
6. Non-Steroidal Anti-Inflammatory Drugs for Acute Low Back Pain. van der Gaag WH, Roelofs PD, Enthoven WT, van Tulder MW, Koes BW. The Cochrane Database of Systematic Reviews. 2020;4:CD013581. doi:10.1002/14651858.CD013581.
7. Osteoarthritis. Kloppenburg M, Namane M, Cicuttini F. Lancet (London, England). 2025;405(10472):71-85. doi:10.1016/S0140-6736(24)02322-5.
8. Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis. Nissen SE, Yeomans ND, Solomon DH, et al. The New England Journal of Medicine. 2016;375(26):2519-29. doi:10.1056/NEJMoa1611593.
9. Chronic Low Back Pain in Adults: Evaluation and Management. Maharty DC, Hines SC, Brown RB. American Family Physician. 2024;109(3):233-244.
10. Benefits and Harms of Treatments for Chronic Nonspecific Low Back Pain Without Radiculopathy: Systematic Review and Meta-Analysis. Feise RJ, Mathieson S, Kessler RS, et al. The Spine Journal. 2023;23(5):629-641. doi:10.1016/j.spinee.2022.11.003.
11. A Systematic Review Comparing the Costs of Chiropractic Care to Other Interventions for Spine Pain in the United States. Dagenais S, Brady O, Haldeman S, Manga P. BMC Health Services Research. 2015;15:474. doi:10.1186/s12913-015-1140-5.
12. Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs. Legorreta AP, Metz RD, Nelson CF, et al. Archives of Internal Medicine. 2004;164(18):1985-92. doi:10.1001/archinte.164.18.1985.
13. Pharmacologic Therapy for Acute Pain. Amaechi O, Huffman MM, Featherstone K. American Family Physician. 2021;104(1):63-72.
14. Demographics of and Costs to Users of Chiropractic Services in the United States With Neck or Back Pain Not Meeting Guideline-Based Minimum Treatment Frequency Thresholds. Lewing B, Contreras J, Sansgiry SS. Alternative Therapies in Health and Medicine. 2023;29(4):102-109.
