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Joint HHS-DoD-VA Initiative Funding Chiropractic Research

Study Will Examine the Effects of Different Doses and Maintenance of Chiropractic Care for Low-Back Pain

Through an interagency partnership, the US Department of Health and Human Services (HHS), the US Department of Defense (DoD), and the US Department of Veterans Affairs (VA) recently announced a multi-component research project focusing on nondrug approaches for pain management addressing the needs of service members and Veterans.

A grant to Palmer College is among 12 research projects focusing on developing, implementing, and testing cost-effective, large-scale, real-world research on nondrug approaches for pain management and related conditions in military and Veteran health care delivery organizations. The National Institutes of Health (NIH) will be the lead HHS agency in the partnership.

GoertzDCeJournalPhotoThe researchers for the Palmer project, led by Christine Goertz, DC, PhD, Palmer’s Vice Chancellor of Research and Health Policy (pictured), will develop and implement a pragmatic randomized trial that looks at the effects of different doses and maintenance of chiropractic care for low-back pain. The Palmer research project will be jointly funded by the National Center for Complementary and Integrative Health (NCCIH) and the NIH’s Office of Research on Women’s Health.

“Finding solutions for chronic pain is of critical importance, especially for military personnel and veterans who are disproportionately affected,” said NIH Director Francis S. Collins, MD, PhD. “Bringing the science to bear through these real-world research projects will accelerate our search for pain management strategies for all Americans, especially as we work to address the nation’s opioid crisis.”

Along with manual therapies like spinal manipulation, massage, and acupuncture, other types of approaches being studied include movement interventions (structured exercise, tai chi, yoga), psychological and behavioral interventions (e.g., cognitive behavioral therapy), mindfulness/meditative interventions, integrative approaches that involve more than one intervention, and integrated models of multi-modal care. 

The NCCIH, part of NIH, is contributing more than half of the total funding, and it is the lead for the multi-agency initiative, which is called the “NIH-DoD-VA Pain Management Collaboratory.” This initiative also addresses the need to focus on “advancing better practices for pain management,” which is outlined in HHS’ “5-Point Strategy” to combat the opioid crisis.

Studies report nearly 45 percent of soldiers and 50 percent of Veterans experience pain on a regular basis, and there is significant overlap among chronic pain, post-traumatic stress disorder (PTSD), and persistent post-concussive symptoms. Data from the VA demonstrates a critical need within the VA for the specific type of health care doctors of chiropractic specialize in providing. A quarterly report of Veterans who served in Iraq, Afghanistan, and other theatres in the Global War on Terrorism and who have accessed VA health care resources (Analysis of VA Health Care Utilization Among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans, June 2015) cites “diseases of Musculoskeletal System/Connective System,” such as back pain, as the number one ailment of Iraq/Afghanistan veterans accessing VA treatment.

Although opioids are often prescribed to treat chronic pain, research has not shown them to be very effective, and there are many issues with long-term use. Thus, there is a need for nondrug approaches to complement current strategies for pain management and to reduce the need for, and hazards of, excessive reliance on opioids.

“Pain is the most common medical condition requiring treatment for military personnel,” said Dr. George Ludwig, principal assistant for research and technology, US Army Medical Research and Materiel Command (AMRMC). “Current drug treatments have limited efficacy and are often associated with severe adverse events, significant cognitive and physiological side effects, and pose a significant risk of abuse, misuse, addiction, tolerance, and diversion. The proposals funded under this interagency partnership will provide a significant step forward in pain management in our wounded service members. We are pleased to be working with our interagency partners in driving changes to clinical practice that will impact the military, our veterans, and the Nation as a whole.”

About the Palmer Center for Chiropractic Research (PCCR)

The Palmer Center for Chiropractic Research is dedicated to advancing health care for patients by developing knowledge and translating knowledge that improves the practice of chiropractic. Headquartered on Palmer’s Davenport campus, the PCCR is the most highly-funded chiropractic research center in the U.S. Within the past 10 years, the PCCR has been awarded grants from the National Institutes of Health, National Center for Complementary and Integrative Health, the US Health Resources and Services Administration and the Department of Defense, in addition to private foundation grants. Since 2000, these grants have totaled more than $35 million.

Since its inception in 1995, PCCR has achieved several historical firsts:

  • First chiropractic institution to receive a grant directly from the National Institutes of Health (NIH) to establish a formal research center
  • First chiropractic institution to receive a total of four multi-million dollar developmental center awards from NIH
  • First chiropractic institution to conduct simultaneous research projects funded by three different government funding agencies - the NIH, Health Resources and Services Administration and DoD
  • First chiropractic institution to receive a research curriculum grant for providing master of science degree training of chiropractors in high-level clinical research

Current high-priority areas of study include:

  • Integrating health care for musculoskeletal pain and mental health disorders for veterans
  • Evaluating chiropractic care practiced in integrated clinic settings
  • Growing emphasis on multi-disciplinary health services research and health policy initiatives
National Institutes of Health Press Release, “Federal Agencies Partner for Military and Veteran Pain Management Research,” September 20, 2017
Palmer Center for Chiropractic Research,