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Does Chiropractic Chronic Pain Management Help Veterans with Chronic Low Back Pain? Results from Phase 2 of the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) Pragmatic Randomized Trial
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Does Chiropractic Chronic Pain Management Help Veterans with Chronic Low Back Pain? Results from Phase 2 of the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) Pragmatic Randomized Trial

Cynthia Long, Stacie Salsbury, Robert Vining, Erin Krebs, Thad Abrams, Paul Shekelle, Robert Wallace, Jon Lurie, Anthony Lisi and Christine Goertz
The journal of pain, Vol.41(Supplement), 105690
03/2026
DOI: 10.1016/j.jpain.2025.105690

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Abstract

The Phase 2 VERDICT pragmatic randomized trial was conducted at 4 geographically diverse VA chiropractic clinics to evaluate the effectiveness of chiropractic chronic pain management (CCPM, scheduled monthly visit) versus No-CCPM over 42-weeks for veterans with chronic low back pain. 677 veterans [mean age 51 years (22-87), 23% female; 30% racial/ethnic minorities] were re-randomized to CCPM or No-CCPM after completing 10-weeks of either higher-dose (8-12 visits) or lower-dose chiropractic care (1-5 visits). The primary outcome was Roland Morris Disability Questionnaire (RMDQ) and secondary outcomes included average LBP intensity; Pain, Enjoyment and General activity (PEG); and PROMIS domains at 52 weeks. Outcomes were modeled with mixed-effects regression over time, adjusted for site, age, sex and baseline LBP intensity. The difference in mean change of RMDQ between CCPM and No-CCPM was not statistically significant in the lower dose group (1.0; 95% CI: -0.2-2.2), nor the higher dose group (-0.8; -1.9-0.5). CCPM had more improvement in pain intensity (0.6; 0.1 to 1.0), PEG (0.8; 0.3 to 1.2); and PROMIS pain interference (2.1; 0.7-3.5) in the lower dose group, but not the higher dose group (difference in mean change: pain intensity 0.1; -0.4-0.6, PEG 0.3; -0.2-0.8, and pain interference 1.4; -0.1 to 2.8). Veterans with chronic low back pain did not show significantly different changes in LBP-related disability with CCPM versus No-CCPM. CCPM improved pain intensity, severity and interference in the lower dose group, but not the higher dose group. VERDICT is registered at clinicaltrials.gov (NCT04087291) and funded by National Institutes of Health (UH3AT009761).

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