A landmark NIH-funded randomized clinical trial published in JAMA provides new insights into managing acute and subacute low back pain (LBP)—one of the leading causes of disability worldwide. The study, titled "Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial," investigated whether spinal manipulation and clinician-supported self-management are more effective than guideline-based medical care for adults at increased risk of chronic disabling back pain.
Within the group of national experts, Steven Z. George, PhD, PT, Professor of Orthopaedic Surgery at Duke University, and Francis Keefe, PhD, Director of the Duke Pain Prevention and Treatment Research Program, acted as contributing authors, showcasing Duke’s leadership in advancing biopsychosocial methods for musculoskeletal pain.
Study Overview
- Design: 2×2 factorial randomized clinical trial
- Participants: 1,000 adults with acute or subacute LBP at moderate to high risk of chronicity
- Interventions: Supported self-management (with or without spinal manipulation); Spinal manipulation alone, and Guideline-based medical care.
- Duration: Up to 8 weeks of care, with 12-month follow-up
- Primary Outcomes: Disability (Roland-Morris Disability Questionnaire) and pain intensity.
Key Findings
- Supported self-management resulted in statistically significant but small reductions in disability over one year compared to medical care.
- No differences in pain intensity were observed between groups.
- Patients receiving supported self-management were more likely to achieve a≥50% reduction in disability (67%) than those receiving medical care (54%).
- Spinal manipulation alone showed no significant difference from medical care for either outcome.
Why It Matters
Low back pain is influenced by physical, psychological, and social factors, yet most treatments focus narrowly on symptom reduction. This study underscores the value of biopsychosocial strategies—helping patients build skills to manage pain and reduce reliance on medications.
“The most durable gains for back pain often come from equipping patients with skills for self-management —not just prescriptions.”— Steven George, PhD, Laszlo Ormandy Distinguished Professor of Orthopaedic Surgery, Duke University.
Read the full study: Bronfort G, Meier EN, Leininger B, et al. Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial. JAMA. doi:10.1001/jama.2025.21990.