Spinal Manipulation and Clinician-Supported Self-Management for Preventing Chronic Low Back Pain Impact: The PACBACK Randomized Clinical Trial - PubMed

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The PACBACK trial compared spinal manipulation and clinician-supported self-management versus medical care to prevent chronic low back pain impact.
The study involved 1,000 adults with acute or subacute low back pain at moderate to high risk of chronicity, with 93% completing the trial.
Clinician-supported self-management resulted in a statistically significant lower mean low back pain impact score compared to medical care, with a difference of -1.7 points.
Spinal manipulation did not show significant benefit over medical care, with a difference of -0.3 points.
The combination of self-management and spinal manipulation did not provide additional benefit beyond self-management alone.
Responder analyses showed 64% in the self-management group had at least a 50% reduction in pain impact, compared to 55% in the medical care group.
Supported self-management performed better on most secondary outcomes, including fewer reports of chronic pain interfering with activities.
Mediation analyses indicated that 76% of the self-management effects at one year were explained by psychosocial factors at six months.
The findings suggest that clinician-supported self-management is more effective than medical care for preventing chronic impactful low back pain, while spinal manipulation did not offer additional advantage.

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