In Search of the Holy Grail for Low Back Pain. Or anything that works at all.

This presentation examines the current state of low back pain care in the United States, from its staggering public health burden to the persistent gap between evidence-based guidelines and real-world clinical practice. Drawing on landmark pragmatic clinical trials — including the ACT I study in active-duty military personnel, the VERDICT trial in Veterans, and the ongoing IMPACt-LBP cluster randomized trial — this talk presents a comprehensive picture of what the evidence supports, where payment policy falls short, and what it will take to translate research into meaningful change. The session concludes with a forward-looking framework for advancing non-pharmacological low back pain care through payment reform, health systems transformation, and patient-centered research.

By the end of this session, participants will be able to:

• Summarize the evidence base and clinical practice guideline recommendations for non-pharmacological approaches to low back pain, including spinal manipulation, exercise, acupuncture, and cognitive behavioral therapy, and identify key gaps between guideline recommendations and current coverage and payment policies.
• Describe the design, rationale, and key findings of pragmatic clinical trials evaluating chiropractic care for low back pain in military and Veteran populations, including the ACT I and VERDICT studies, and explain why pragmatic trial methodology is particularly well-suited to real-world pain management research.
• Identify the primary barriers to implementing evidence-based, non-pharmacological low back pain care at the policy, health systems, and research levels, and discuss strategies — including payment reform, interdisciplinary care models, and implementation science — for closing the gap between what the evidence supports and what patients currently receive.