Chiropractic Care for Lower Back Pain

Overseen By Maya Williams, BA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston Medical Center

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores ways to encourage more Primary Care Providers (PCPs) to refer patients with lower back pain to chiropractic care, particularly in underserved communities. Researchers are testing new strategies at three community health centers to determine if these can increase referrals. Patients with lower back pain who visit a PCP at one of these centers may qualify for the study. The trial compares the number of referrals before and after implementing these new strategies. As an unphased trial, it offers patients the chance to contribute to innovative strategies that could enhance healthcare access in their communities.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on increasing referrals to chiropractic care for lower back pain.

What prior data suggests that these implementation strategies are safe for increasing chiropractic care referrals?

Research has shown that chiropractic care is safe for treating lower back pain. Studies have found that most patients handle chiropractic treatments well, experiencing only minor side effects like soreness or stiffness, which resolve quickly. Serious side effects are rare.

Educational materials about these treatments often emphasize their safety and effectiveness, helping patients understand their options and make informed decisions. By learning more, patients can feel more confident about choosing chiropractic care for their lower back pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the chiropractic care trial for lower back pain because it explores a multi-level approach to treatment that goes beyond traditional methods like medications, physical therapy, or surgery. Unlike standard care, which typically focuses on direct patient treatment, this trial examines the effectiveness of implementing coordinated care at different levels: community health centers, primary care providers, and directly with patients. This comprehensive strategy aims to improve communication and consistency in treatment, potentially leading to better pain management and patient outcomes.

What evidence suggests that chiropractic care is effective for lower back pain?

This trial will compare standard care with an implementation strategy that includes institutional, PCP, and patient interventions. Research has shown that chiropractic care effectively relieves lower back pain. Studies have found that providing patients with information about their treatment options helps them make better choices. Fact sheets about low back pain treatments are more helpful for decision-making than traditional advice. Exercise therapies, such as yoga, have also proven effective in reducing low back pain and align well with chiropractic care principles. These methods are part of broader efforts to improve care quality for people with lower back pain. ^{1 2 3 6 7}

Who Is on the Research Team?

Eric J Roseen, DC

Principal Investigator

Boston Medical Center

Are You a Good Fit for This Trial?

This trial is for adults with lower back pain who visit community health centers in the Boston area. It includes patients, primary care providers (MDs, DOs, NPs, or PAs), and the health centers themselves if they agree to participate.

Inclusion Criteria

You have consented to take part in the study.

I have been diagnosed with lower back pain.

You are a CHC patient in the Boston area who primarily accesses care from their primary provider.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Implementation

Implementation strategies are piloted in community health centers to increase PCP referrals to chiropractic care for LBP

8 weeks

Multiple visits (in-person and virtual) for PCPs and patients

Follow-up

Participants are monitored for changes in referral rates and other secondary outcomes

14 months

What Are the Treatments Tested in This Trial?

Interventions

• Institutional interventions, PCPs interventions, Patient interventions

Trial Overview The study tests new ways to get more primary care doctors to refer patients with lower back pain to chiropractic treatments. It involves educational materials for patients and training seminars for doctors, plus changes in electronic health records.

How Is the Trial Designed?

Group I: Implementation Experimental Treatment 3 Interventions

Implementation will be deployed at the CHC, PCP, and patient level.

Group II: Standard of care Active Control 1 Intervention

Usual patient care without deployment of intervention.

Who Is Running the Clinical Trial?

Boston Medical Center

Lead Sponsor

Trials

410

Recruited

890,000+

National Center for Complementary and Integrative Health (NCCIH)

Collaborator

Trials

886

Recruited

677,000+

Published Research Related to This Trial

A study analyzing health insurance claims in New Hampshire found that adults receiving chiropractic services for low back pain had a 51% lower likelihood of experiencing adverse drug events (ADEs) compared to those who did not use chiropractic care.

While the study indicates a significant association between chiropractic service utilization and reduced risk of ADEs, it does not establish a causal relationship, highlighting the need for further research with larger datasets and improved methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association Between Utilization of Chiropractic Services for Treatment of Low Back Pain and Risk of Adverse Drug Events. Whedon, JM., Toler, AWJ., Goehl, JM., et al.[2019]

Between 2004 and 2012, there were 338 compensation claims related to chiropractic care in Denmark and Norway, with 300 claims analyzed; only 13.7% of these claims were approved for financial compensation, indicating a low approval rate compared to other healthcare providers.

The most common complaints included worsening symptoms after treatment and alleged disk herniations, with a significant portion of compensation costs linked to a few cases of serious adverse events like cervical artery dissection, suggesting that better patient education on treatment expectations could help reduce claims.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Compensation claims for chiropractic in Denmark and Norway 2004-2012. Jevne, J., Hartvigsen, J., Christensen, HW.[2018]

Chiropractic care for neck or low-back pain is generally safe, with most adverse events being benign and self-limiting.

The incidence of severe complications from chiropractic manipulation is extremely low, making it a useful therapy with negligible risks for serious adverse events.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse events following chiropractic care for subjects with neck or low-back pain: do the benefits outweigh the risks? Rubinstein, SM.[2022]

A systematic review of five studies on spinal manipulation (SM) found that about half of patients experience mild and transient adverse events after treatment, indicating that while side effects are common, they are generally not severe.

There is currently no reliable data on the incidence of serious adverse events related to spinal manipulation, suggesting that while they are likely rare, further research is needed to better understand their frequency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prospective investigations into the safety of spinal manipulation. Ernst, E.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11466992/

Interventions to improve the quality of low back pain care in ... This study aimed to identify ED LBP implementation interventions that have been trialed and evaluate their effects on ED-relevant outcomes.

2. jospt.org jospt.org/doi/10.2519/jospt.2021.0304

Interventions for the Management of Acute and Chronic ... Physical therapists can use exercise training interventions, including specific trunk muscle activation, for patients with acute low back pain (LBP).

3. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2836549

One-Page Patient Fact Sheets for Low Back Pain in ... This study suggests that fact sheets listing treatment options may better support decision-making than a traditional advice sheet.

4. pcori.org pcori.org/research-results/2016/comparing-two-therapy-programs-help-patients-manage-chronic-low-back-pain-stamp-study

Comparing Two Therapy Programs to Help Patients ... The research team wanted to learn if MBT worked better than CBT to help adults reduce chronic low back pain and improve their ability to do daily activities.

5. bmcmusculoskeletdisord.biomedcentral.com bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-025-08658-0

Evaluating the effectiveness of six exercise interventions for ... All six exercise therapies effectively alleviated low back pain, with yoga showing the best results.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11950946/

College of Physicians Guideline for Low Back Pain (IMPACt ... New data support that DC and PT treatments are effective, especially when delivered early in the patient care-seeking process., Challenges ...

7. bmj.com bmj.com/content/376/bmj-2021-067718

Psychological interventions for chronic, non-specific low ... For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care.