The Role, Value, and Impact of Chiropractic Care on Mental Health and Brain Health

Anxiety, Depression, Grief, Sleep, Meditation, and Technology-Related Mood Influences

A Narrative Review with a Practice-Based Outcomes Framework

Clinical Note

This manuscript summarizes research for educational purposes and does not replace individualized medical or mental health care. Chiropractic care is not a stand-alone treatment for depression, anxiety disorders, or grief disorders. Individuals experiencing suicidal ideation or acute mental health crisis should seek immediate professional help (U.S.: call/text 988, Suicide & Crisis Lifeline).

Abstract

Background: Mental health symptoms (anxiety, depression), sleep disturbance, and chronic pain frequently co-occur, forming reinforcing clinical cycles that impair function and quality of life. Chronic pain affects a substantial proportion of adults and is consistently associated with increased mental health burden. Chiropractic care is commonly utilized for musculoskeletal pain and functional limitation, and recent research has expanded outcome measurement to include whole-person domains such as sleep, fatigue, and emotional distress.

Objective: To synthesize current evidence on the role, value, and impact of chiropractic care—including spinal manipulative therapy (SMT)—on mental health–adjacent and brain health–related outcomes, with emphasis on anxiety, depression, grief, sleep, mindfulness interfaces, and technology-related mood influences.

Methods: A narrative review of clinical practice guidelines, systematic reviews, randomized and pragmatic trials, secondary analyses, and mechanistic studies (EEG, somatosensory evoked potentials, biomarkers) relevant to chiropractic care and psychosocial outcomes. Evidence is interpreted using a biopsychosocial framework with explicit separation between clinical outcome evidence and mechanistic plausibility.

Results: The strongest evidence supports chiropractic care for musculoskeletal pain and functional outcomes, with guideline endorsement for spinal manipulation in low back pain. Large pragmatic trials demonstrate improvements in health-related quality of life across PROMIS-29 domains, including mental health–relevant constructs, when chiropractic care is added to usual medical care. Mediation analyses suggest these broader benefits are largely indirect, occurring through reductions in pain and pain interference rather than direct treatment of mental health disorders. Evidence for sleep improvement is mixed but evolving, with growing randomized trial literature relying primarily on self-reported measures. Mechanistic studies demonstrate neurophysiological and biomarker changes following SMT that are hypothesis-generating for brain health but do not establish mental health treatment efficacy. Technology exposure—including social media, electronic media use, and AI-mediated content—shows consistent associations with sleep and mood outcomes and represents an important contextual factor in modern clinical presentations.

Conclusion: Chiropractic care is best supported as a nonpharmacologic intervention for musculoskeletal pain that may indirectly support mental well-being through improvements in pain, function, and potentially sleep. Claims that chiropractic care directly treats anxiety, depression, or grief are not supported by current high-quality clinical evidence. Best practice emphasizes integrated biopsychosocial care, appropriate screening, referral pathways, and collaborative management.

Keywords: chiropractic, spinal manipulative therapy, PROMIS-29, anxiety, depression, sleep, neuroplasticity, EEG, BDNF, digital health, AI

1. Introduction

Mental health symptoms and sleep disturbance commonly cluster with chronic pain, forming self-reinforcing cycles in which pain worsens sleep, poor sleep amplifies emotional distress, and anxiety or depression increase pain sensitivity and disability. Chronic pain affects a large proportion of U.S. adults and is consistently linked to reduced quality of life and increased mental health burden. Population-level and clinical studies demonstrate frequent co-occurrence of musculoskeletal pain with anxiety and depressive symptoms.

Chiropractic care is widely utilized for back and neck pain, and spinal manipulation is included among guideline-supported nonpharmacologic options for low back pain. Given the strong overlap between pain, sleep, and mood, it is clinically relevant to evaluate whether chiropractic care influences broader outcomes such as anxiety, depression, sleep quality, and overall health-related quality of life.

Simultaneously, technology exposure—social media use, late-night screen time, continuous connectivity, and AI-mediated content feeds—has become a major contextual factor influencing sleep, mood, and stress. These exposures plausibly shape clinical presentations commonly seen in chiropractic settings, including fatigue, headaches, neck pain, insomnia, and stress-related complaints.

2. Methods

Design: Narrative review and evidence synthesis (not a formal systematic review).

Sources emphasized:

• Clinical practice guidelines for musculoskeletal pain
• High-level evidence summaries and systematic reviews
• Pragmatic trials and secondary analyses using PROMIS measures
• Mechanistic studies (EEG, somatosensory evoked potentials, biomarkers)
• Systematic reviews on electronic media use and AI tools in mental health

Key outcomes of interest: Anxiety, depression, sleep disturbance/quality, stress-related measures, pain intensity and interference, physical function, and health-related quality of life.

Interpretive framework: A biopsychosocial model with explicit distinction between:

• Clinical outcome evidence
• Mechanistic or biomarker evidence

3. Results and Evidence Synthesis

3.1 Chiropractic Care and Mental Health Outcomes

3.1.1 Primary evidence: pain and function as the foundation

The American College of Physicians guideline for low back pain includes spinal manipulation among recommended initial nonpharmacologic options for acute and subacute presentations. Updated Cochrane reviews conclude that SMT may slightly reduce pain and moderately improve function compared with sham or usual care, while also noting variability, heterogeneity, and limitations in adverse event reporting.

Clinical implication: The most defensible value proposition for chiropractic care remains improvement in musculoskeletal pain and function—outcomes that strongly influence emotional well-being and distress.

3.1.2 Pragmatic trial evidence for whole-person outcomes

A large pragmatic comparative effectiveness trial in active-duty U.S. service members demonstrated statistically significant improvements across PROMIS-29 domains when chiropractic care was added to usual medical care. These domains included pain interference, physical function, fatigue, sleep disturbance, anxiety, and depression.

Secondary causal mediation analyses explicitly examined whether changes in pain mediated improvements in broader biopsychosocial outcomes. Findings support an indirect pathway, whereby reductions in pain intensity and interference account for a substantial portion of observed improvements in mental health–relevant domains.

Evidence-aligned phrasing:

• “Chiropractic care may indirectly support mental well-being by reducing pain interference and improving function.”
• Avoid claims that chiropractic care directly treats anxiety or depressive disorders.

3.1.3 Historical limitations of psychological outcome research

Earlier systematic reviews noted that psychological outcomes were rarely primary endpoints in spinal manipulation trials, limiting conclusions about direct mental health effects. Recent pragmatic trials using whole-person outcome frameworks represent progress, but a robust mental health–first evidence base remains under development.

3.2 Sleep Outcomes: Insomnia and Sleep Quality

Sleep represents a critical bridge variable linking pain and mental health. Improvements in sleep can reduce emotional distress, while sleep disruption exacerbates pain sensitivity and mood symptoms.

• Early reviews reported limited high-quality evidence supporting SMT for insomnia.
• More recent scoping reviews identify a growing number of randomized trials evaluating manual therapy and sleep quality, though most rely on self-reported measures and only rarely include objective sleep assessment.

Practical interpretation: Chiropractic and manual therapies may improve sleep for some patients, particularly when sleep disturbance is pain-related. Evidence remains heterogeneous and insufficient to support claims for primary insomnia treatment.

3.3 Brain Health and Neurophysiology

3.3.1 Neurophysiological findings

Experimental studies demonstrate that spinal manipulation can alter cortical processing related to somatosensory integration. Some paradigms identify changes involving prefrontal cortical sources, and other work suggests modulation of sensorimotor integration following cervical manipulation.

Responsible interpretation: These findings demonstrate neurophysiological change—not clinical treatment of mood disorders. The relevance likely relates to pain modulation, body awareness, and sensorimotor integration rather than direct emotional regulation.

3.3.2 Biomarker studies

A pragmatic randomized controlled trial comparing chiropractic care with sham intervention reported between-group differences in biomarkers such as BDNF, cortisol, and inflammatory cytokines over 12 weeks in adults with subclinical spinal pain.

Interpretive caution: Biomarker modulation is biologically interesting and hypothesis-generating but does not establish clinical mental health benefit. Correlation with validated patient-centered outcomes remains necessary.

3.3.3 Autonomic nervous system claims

A recent systematic review and meta-analysis concluded that evidence supporting autonomic nervous system modulation by spinal manipulation is low quality overall, with limited and inconsistent findings.

Clinical implication: Strong claims regarding “resetting” the autonomic nervous system or directly improving mood through autonomic mechanisms are not currently evidence-supported.

3.4 Grief: Scope and Ethical Boundaries

Grief is a normal human response distinct from depressive disorders, though a subset of individuals develop persistent and impairing symptoms recognized as Prolonged Grief Disorder by the American Psychiatric Association.

Evidence-aligned role for chiropractic care:

• Address physical sequelae associated with grief and stress (muscle tension, headaches, reduced activity).
• Screen for prolonged or disabling grief and refer appropriately.
• Avoid positioning spinal manipulation as a primary intervention for grief disorders.

3.5 Mindfulness and Meditation: Complementary Strategies

Mindfulness-based interventions and cognitive behavioral therapies demonstrate evidence for improving chronic pain–related outcomes and quality of life. These approaches are complementary rather than competitive with chiropractic care.

Clinical relevance: Chiropractic clinics may support patients by encouraging evidence-based mindfulness resources, reinforcing sleep hygiene and self-efficacy, and addressing fear-avoidance while managing musculoskeletal contributors to pain.

3.6 Technology and AI: Modern Contextual Factors

3.6.1 Electronic media and sleep/mood

Systematic reviews and meta-analyses consistently demonstrate associations between social media or electronic media use and poorer sleep quality, increased sleep problems, and mental health symptoms—particularly with problematic or late-night use.

Clinical translation: Technology-related sleep disruption may amplify pain sensitivity, muscle tension, headaches, and emotional distress, making digital hygiene relevant even within musculoskeletal care contexts.

3.6.2 AI tools: opportunity and risk

AI applications in mental health show potential benefits in symptom monitoring and guided interventions but also raise ethical and safety concerns. Evidence remains heterogeneous, and AI tools should not replace licensed mental health care.

4. Discussion

4.1 The most defensible impact pathway

Across the literature, the most evidence-aligned interpretation is:

• Chiropractic care improves pain and function.
• Reduced pain interference improves sleep and quality of life.
• Improved sleep and functioning reduce emotional distress.

This represents indirect mental health support, not direct psychiatric treatment.

4.2 Mechanistic findings: promising but preliminary

Neurophysiological and biomarker studies suggest plausible biological pathways but require replication, validated mental health endpoints, and longer follow-up before clinical conclusions can be drawn.

5. Safety, Scope, and Clinical Responsibility

5.1 Adverse events and informed consent

While serious adverse events are rare in low back pain trials, reporting remains incomplete. Cervical procedures warrant heightened screening, informed consent, and vigilance for early warning symptoms.

5.2 Mental health scope

Treatment of mental health disorders lies outside chiropractic scope. Chiropractors can responsibly contribute through screening (e.g., PHQ-9, GAD-7), education, and referral within integrated care models.

6. Practice-Based Outcomes Framework (Optional Application)

This review supports a pragmatic outcomes model focusing on validated measures of pain, sleep, and mental health–relevant quality-of-life domains, with mediation analyses exploring indirect effects.

7. Conclusion

Chiropractic care has its strongest evidence base in improving musculoskeletal pain and function. Research supports its potential to influence broader quality-of-life outcomes—including sleep and emotional distress—primarily through indirect pathways related to pain reduction and functional improvement. Mechanistic findings are promising but preliminary. A clinically responsible chiropractic model emphasizes guideline-aligned care, sleep and lifestyle support, technology-aware counseling, and systematic screening and referral for mental health conditions.