December 31, 2025

@michaelokun

Looking for a better approach to treat your low back pain? Check out a new randomized trial that just dropped in JAMA. Spoiler alert: For acute or subacute low back pain, clinician-supported self-management "resulted in a small reduction in disability, but not pain, over a follow-up time of one year vs. medical care, while spinal manipulation showed no difference for either outcome." A biopsychosocial self-management strategy is an approach that addresses pain by targeting the body, the mind and daily behaviors, rather than focusing only on symptoms. Bronfort and colleagues describe results from the PACBACK randomized clinical trial that tested spinal manipulation, clinician-supported biopsychosocial self-management, or both and compared them w/ guideline-based medical care for addressing acute or subacute low back pain. Key points; - Supported self-management led to small, however meaningful reductions in disability over one year when compared w/ medical care. - Spinal manipulation alone did not outperform medical care for pain or disability. - Combining spinal manipulation w/ supported self-management did not add extra benefit beyond self-management alone. My take: This study reminds us that back pain is not simply a spine problem. Helping folks understand pain, stay active and build confidence in self-management can matter as much as any single hands-on technique. There were 5 points that resonated w/ me about this study: 1- Back pain is influenced by physical, psychological and social factors all working together. 2- Education, coaching and behavior change can all reduce disability even when pain levels appear similar. 3- More care does not always mean better outcomes, especially if it does not address how folks live w/ pain. 4- Empowering folks to manage pain frequently lowers health care use and reliance on medication(s). 5- The future of pain care likely blends evidence-based treatments w/ strategies that help folks regain both control and function. https://jamanetwork.com/journals/jama/fullarticle/2843255 #michaelokun #fixelinstitute #parkinson #pain #lowbackpain #lowbackpainrelief