The UW Clinical Learning, Evidence And Research (CLEAR) Center played a key role in the PACBACK (Spinal Manipulation and Patient Self-Management for Preventing Acute to Chronic Back Pain) study a large NIH-funded randomized clinical trial that tested whether non-drug treatments can prevent acute and subacute low back pain from becoming chronic disability.
PACBACK was a Phase 3 randomized clinical trial that enrolled 1,000 adults with acute or subacute low back pain at moderate to high risk of chronic disability and followed participants for one year after treatment. Participants were randomized to one of four groups: spinal manipulation therapy, clinician-supported biopsychosocial self-management, a combination of both, or guideline-based medical care.
PACBACK brought together a multidisciplinary team of investigators from leading institutions including the University of Minnesota, University of Pittsburgh, Duke University, Oregon Health & Science University, University of North Texas Health Science Center, and the University of Washington, combining expertise across chiropractic medicine, physical therapy, psychology, biostatistics, and clinical pain research. UW CLEAR investigators Eric Meier, MSPhD, and Patrick Heagerty, PhD, provided key statistical and methodological leadership for the study. Dr. Heagerty is a Professor of Biostatistics at the University of Washington and former department chair, nationally recognized for his work in clinical trial design and longitudinal data analysis. MDr. Meier served as a study biostatisticianco-investigator and co-author on the JAMA publication, contributing to data analysis and interpretation.
Key findings from the study, published in JAMA, include:
- Supported self-management (an approach that teaches patients skills to manage physical, psychological, and social aspects of pain) resulted in statistically significant but small reductions in disability over 12 months compared with medical care.
- Neither spinal manipulation alone nor pain intensity differences were statistically superior to standard care.
- A higher proportion of patients in the supported self-management groups (alone or combined with spinal manipulation) achieved at least 50% reduction in disability compared with medical care.
PACBACK was funded by the National Center for Complementary and Integrative Health (NCCIH) and other NIH mechanisms under the HEAL Initiative, reflecting the CLEAR Center’s mission to advance musculoskeletal research through rigorous analytics and interdisciplinary partnerships, helping translate evidence into care strategies that reduce disability and prevent the transition from acute to chronic low back pain.