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PCA Deep Dive: Beyond the Pain Score: What Really Prevents Chronic Back Pain
PCA Deep Dive: Beyond the Pain Score: What Really Prevents Chronic Back Pain
In this episode of the Deep Dive, the focus is on a newly published randomized clinical trial, the PACBACK trial, from The Journal of the American Medical Association. This study examines spinal manipulation and clinician-supported biopsychosocial self-management versus standard medical care in treating acute and subacute low back pain in patients at high risk of chronic disability. The trial's findings emphasize the importance of long-term function over short-term symptom relief, showcasing how conservative, nonpharmacologic approaches, particularly self-management strategies, lead to significant reductions in disability. The episode also delves into the methodologies and tools used in the study, such as the Start Back screening tool, the Wellbeing Wheel, and the Behavior Change Wheel, offering a comprehensive look at how these approaches can transform patient care in chiropractic and physical therapy.
00:00 Introduction to the Deep Dive
00:06 Overview of the PACBACK Trial
00:35 Significance of Low Back Pain
00:45 Study Design and Methodology
02:18 Detailed Breakdown of Study Groups
03:16 Results: Disability and Pain Outcomes
05:40 Mechanisms Behind Supported Self-Management
06:06 Practical Implementation and Skills Taught
08:25 Responder Analysis and Key Statistics
08:58 Comparing Spinal Manipulation Therapy
11:41 Policy Implications and Systemic Challenges
12:53 Study Limitations and Final Thoughts
14:15 Conclusion and Key Takeaways
Title: Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial
Published: JAMA, December 29, 2025
Authors: Gert Bronfort, PhD, DC Eric N. Meier, MS Brent Leininger, PhD, DC, MS Michael Schneider, PhD, DC Roni Evans, PhD, DC, MS Carol Greco, PhD Linda Hanson, DC, MS Christine McFarland, BS, BA Roger Chou, MD John Connett, PhD Anthony Delitto, PhD, PT Steven Z. George, PhD, PT Ronald M. Glick, MD Francis Keefe, PhD John Licciardone, DO, MS, MBA Craig Schulz, DC, MS Dennis Turk, PhD Patrick J. Heagerty, PhD, MS
Journal Reference: JAMA. 2025; Published online December 29, 2025.
DOI: 10.1001/jama.2025.21990
This episode references findings from the PACBACK Randomized Clinical Trial published in JAMA in December 2025 by Bronfort and colleagues.
PCA Website: https://pennchiro.org/
PCA Email: [email protected]
Disclosure
The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to help translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision makers.
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By Pennsylvania Chiropractic AssociationPCA Deep Dive: Beyond the Pain Score: What Really Prevents Chronic Back Pain
In this episode of the Deep Dive, the focus is on a newly published randomized clinical trial, the PACBACK trial, from The Journal of the American Medical Association. This study examines spinal manipulation and clinician-supported biopsychosocial self-management versus standard medical care in treating acute and subacute low back pain in patients at high risk of chronic disability. The trial's findings emphasize the importance of long-term function over short-term symptom relief, showcasing how conservative, nonpharmacologic approaches, particularly self-management strategies, lead to significant reductions in disability. The episode also delves into the methodologies and tools used in the study, such as the Start Back screening tool, the Wellbeing Wheel, and the Behavior Change Wheel, offering a comprehensive look at how these approaches can transform patient care in chiropractic and physical therapy.
00:00 Introduction to the Deep Dive
00:06 Overview of the PACBACK Trial
00:35 Significance of Low Back Pain
00:45 Study Design and Methodology
02:18 Detailed Breakdown of Study Groups
03:16 Results: Disability and Pain Outcomes
05:40 Mechanisms Behind Supported Self-Management
06:06 Practical Implementation and Skills Taught
08:25 Responder Analysis and Key Statistics
08:58 Comparing Spinal Manipulation Therapy
11:41 Policy Implications and Systemic Challenges
12:53 Study Limitations and Final Thoughts
14:15 Conclusion and Key Takeaways
Title: Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial
Published: JAMA, December 29, 2025
Authors: Gert Bronfort, PhD, DC Eric N. Meier, MS Brent Leininger, PhD, DC, MS Michael Schneider, PhD, DC Roni Evans, PhD, DC, MS Carol Greco, PhD Linda Hanson, DC, MS Christine McFarland, BS, BA Roger Chou, MD John Connett, PhD Anthony Delitto, PhD, PT Steven Z. George, PhD, PT Ronald M. Glick, MD Francis Keefe, PhD John Licciardone, DO, MS, MBA Craig Schulz, DC, MS Dennis Turk, PhD Patrick J. Heagerty, PhD, MS
Journal Reference: JAMA. 2025; Published online December 29, 2025.
DOI: 10.1001/jama.2025.21990
This episode references findings from the PACBACK Randomized Clinical Trial published in JAMA in December 2025 by Bronfort and colleagues.
PCA Website: https://pennchiro.org/
PCA Email: [email protected]
Disclosure
The Pennsylvania Chiropractic Association did not generate this data. PCA Deep Dive reviews and discusses independent, peer-reviewed research to help translate long-term outcomes and clinical implications for patients, clinicians, policymakers, and healthcare decision makers.