The prevalence of low back pain (LBP) among U.S. adults is estimated at 20%, and 23% of LBP patients report pain of high intensity with disability. The greatest burden placed on society occurs when LBP becomes chronic (cLBP).  Given higher rates of musculoskeletal disease within our nation’s Veteran population, cLBP-related disability is rampant.  The combination of cLBP and high medication use negatively impacts Veterans’ work productivity and quality of life, and generates substantial risk for long-term disability and opioid addiction. There is arguably no more important population than Veterans for evaluating effective non-pharmacological treatments that are safe, pain relieving, cost-effective, and contain promise to restore function and quality of life. One such option is chiropractic care. Studies examining the delivery of chiropractic interventions have been highly variable and there is no optimal “dosing” in terms of treatment duration or number of visits, therefore research is needed to determine efficacy and dosing.

This project has four objectives.

Objective #1:
Evaluate the comparative effectiveness of a low dose (1-5 visits) of chiropractic care against a higher dose (8-12 visits) in Veterans with cLBP at 10 weeks.

Objective #2:
Evaluate the comparative effectiveness at 52 weeks of chiropractic chronic pain management (CCPM; one scheduled chiropractic visit per month x 10 months), compared to no CCPM following the initial treatment period of 10 weeks.

Objective #3:
Evaluate the impact of CCPM on health services outcomes compared to usual care.

Objective #4:
Evaluate patient and clinician perceptions of non-specific treatment factors, effectiveness of study interventions, and impact of the varying doses of standard chiropractic care and the CCPM on clinical outcomes across 4 VA facilities using a mixed method, process evaluation approach.