Chiropractic, Pain Research / 28.04.2026
What the Evidence Now Says About Spinal Manipulation for Lower Back and Neck Pain
[caption id="attachment_73490" align="aligncenter" width="500"] Pexels[/caption]
Spinal manipulation has moved from contested intervention to first-line non-pharmacologic recommendation for several musculoskeletal conditions. The shift is documented in major clinical guidelines, supported by Cochrane reviews, and reinforced by comparative effectiveness data showing favorable risk profiles relative to standard pharmacologic care. The clinical question for primary care has changed from whether to consider chiropractic referral to which patients benefit most and what selection criteria identify evidence-based providers.
The 2017 American College of Physicians clinical practice guideline placed spinal manipulation among the recommended first-line treatments for acute, subacute, and chronic low back pain, alongside heat, exercise, and acupuncture. Subsequent updates and parallel guidelines from the United Kingdom's NICE, the Canadian Chiropractic Guideline Initiative, and the Lancet Low Back Pain Series Working Group have reinforced the same position.
Pexels[/caption]
Spinal manipulation has moved from contested intervention to first-line non-pharmacologic recommendation for several musculoskeletal conditions. The shift is documented in major clinical guidelines, supported by Cochrane reviews, and reinforced by comparative effectiveness data showing favorable risk profiles relative to standard pharmacologic care. The clinical question for primary care has changed from whether to consider chiropractic referral to which patients benefit most and what selection criteria identify evidence-based providers.
The 2017 American College of Physicians clinical practice guideline placed spinal manipulation among the recommended first-line treatments for acute, subacute, and chronic low back pain, alongside heat, exercise, and acupuncture. Subsequent updates and parallel guidelines from the United Kingdom's NICE, the Canadian Chiropractic Guideline Initiative, and the Lancet Low Back Pain Series Working Group have reinforced the same position.
Behavioral health demand across the United States has reached a level that is forcing structural reconsideration across the healthcare workforce, with federal estimates indicating that more than 120 million Americans live in areas with insufficient mental health services. This places sustained pressure on access, continuity of care, and patient outcomes. The consequences are visible through extended wait times, higher patient acuity at intake, and growing reliance on emergency departments for psychiatric crises — together signaling a system operating beyond comfortable capacity.
Graduate nursing education sits directly within this pressure point, as psychiatric training pathways carry responsibility for expanding workforce supply, maintaining clinical depth, and preparing clinicians for increasingly complex presentations. Programs in 2026 face scrutiny tied to how effectively they prepare practitioners for real clinical demands, so curriculum design, accreditation expectations, and clinical partnerships continue to adapt in response to sustained national need.
Dr. Edward Liu[/caption]
MedicalResearch.com Interview with:
Edward Liu, MD
Geisinger College of Health Sciences
Scranton, PA 18509
Medicalresearch.com: What is the background for this study?
Response: Prescription drugs have high levels of uniformity that plant-based products cannot achieve. Given the liberalization of state-laws regarding medical marijuana1 over the past three-decades and increasing evidence of evidence of cannabis for conditions like chronic pain,2 we were interested in the use of the prescription formulation of delta(Δ)9-tetrahydrocannabinol (THC). A prior pharmacoepidemiology report found that prescription THC (dronabinol) to Medicaid patients decreased from 2016 to 2020. There were also pronounced state-level disparities in prescribing with a 130-fold difference when correcting for population between the highest and lowest states.
There was no research on this topic among Medicare patients. To address this gap, we obtained prescription numbers nationally and at a state level from 2014 to 2019 for Medicare Part D patients.
Source: IMAGE[/caption]
