SMT & Clinician-Supported Biopsychosocial Self-Management for Acute Low Back Pain

Date Posted:

February 2026

Study Title:

Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial

Authors:

Bronfort G, Meier EN, Leininger B, Schneider M, Evans R et al.

 

Clinical practice guidelines for low back pain consistently recommend nonpharmacologic management for both acute and subacute LBP, including education, activity modification, exercise, remaining active, and spinal manipulation/manual therapy. Despite these recommendations, medication-based care remains common.

Symptom-based approaches do not always account for psychological and social factors, which are known to significantly influence recovery and the transition from acute to chronic LBP. Self-management interventions addressing these biopsychosocial factors may reduce symptoms and disability in the longer-term. However, as you’ve likely encountered in practice, patients often face barriers that make it difficult to initiate and/or maintain self-management effectively without your assistance due to lack of knowledge, skills, and motivation.

Clinician-supported biopsychosocial (BPS) self-management approaches aim to address these factors through patient education, exercise, and behavior change strategies. However, the effectiveness of these approaches, alone or in combination with spinal manipulation therapy (SMT), in patients at increased risk for chronicity remains uncertain.

The purpose of this randomized clinical trial was to evaluate the effectiveness of SMT, clinician-supported BPS self-management, and their combination, compared with guideline-based medical care, in adults with acute or subacute LBP at increased risk of chronic disabling pain.