One of the largest trials yet conducted on early low back pain has found that supported self-management modestly but measurably reduces disability. The PACBACK trial, published in JAMA with Duke's Steven George and Francis Keefe among the authors on a national team, randomised 1,000 adults with acute or subacute low back pain who were at moderate to high risk of progressing to chronic disability.
In a two by two factorial design, participants received supported self-management, spinal manipulation, their combination, or guideline-based medical care, delivered for up to eight weeks with a full year of follow-up. Self-management produced a statistically significant, if small, reduction in disability over twelve months compared with medical care: 67 per cent of that group achieved at least a 50 per cent reduction in disability, against 54 per cent receiving medical care.
Pain intensity did not differ between the groups, and spinal manipulation alone performed no better than medical care on either primary outcome, findings that sharpen rather than settle the debate over early intervention. For a condition that ranks among the leading causes of disability worldwide, the result supports equipping patients to manage their own recovery before chronic pain takes hold.