Episode summary In a trial of a thousand adults with back pain, researchers trained clinicians on which sentence to say out loud — "this is safe" rather than "this won't hurt you." Dr. Ya-Ling covers what the trial found, then turns to the practical question: what you're actually allowed to say, ask and expect the next time you're sitting in an appointment.

In this episode

• The PACBACK trial in brief: supported self-management outperformed standard medical care, and adding manipulation to it added nothing

• The three psychological shifts that accounted for around 76% of the effect

• Why a chiropractor is telling you manipulation wasn't the deciding factor

• Four things you're allowed to do in an appointment, including asking for a phrase to be said differently

• Why asking what a word doesn't mean is often more useful than asking what it does

• Why finding this kind of care isn't equally easy for everyone

• A question to use in the room: "does this feel safe?"

Resources mentioned - Bronfort G, Meier EN, Leininger B, et al. Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial. JAMA Internal Medicine, June 1, 2026. DOI: 10.1001/jamainternmed.2026.1893 - The Everyday Pain Guide series - Better Pain Coping, Dr. Ya-Ling's Substack

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