JAMA

Acute/subacute low back pain: Neither spinal manipulation nor clinician-supported self-care improved pain at 1 year

January 2, 2026

Clinician-supported biological/psychosocial patient self-management resulted in a small but statistically significant reduction in disability—but not pain intensity—at 1-year follow-up compared with guideline-based medical care, while spinal manipulation alone didn’t improve either outcome, in this randomized trial of adults with acute/subacute LBP who were at elevated risk of chronicity.

A thousand adults with acute/subacute LBP at moderate to high chronicity risk per STarT Back tool (mean age, 47 years; female, 58%) from U Minnesota and U Pittsburgh research clinics 2018-2023 were randomized to 8 weeks of interventions: clinician-supported self-management, spinal manipulation alone, the two combined, or guideline-based medical care. Chiropractors and physical therapists delivered both supported self-care and spinal manipulation. Outcomes were assessed by the Roland-Morris Disability Questionnaire and a numerical pain rating scale. At one year, there were no differences in pain intensity between groups; however, there was a small, statistically significant reduction in disability seen in the clinician-supported self-management group vs. the guideline-based medical care group.

Source:

Bronfort G, et al. (2025, December 29). JAMA. Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41460638/