OBJECTIVE: To investigate whether pre-treatment verbal suggestions (positive, neutral, or negative) modulate the short-term effects of lumbar spinal manipulation in young adults with chronic non-specific low back pain (CNSLBP). DESIGN: Three-arm, triple-blind randomized controlled trial. METHODS: Sixty-six participants (mean age 21 years +/- 2,96; 76% women) with CNSLBP were randomly assigned to a positive, neutral, or negative verbal suggestion before a standardized lumbar spinal manipulation. Outcomes were assessed at baseline (t0), immediately post-intervention (t1), and 24 h later (t2). The primary outcome was pain intensity (NPRS-11). Secondary outcomes included stress (SNRS-11, PSS-10), pressure pain threshold (PPT), disability, kinesiophobia, sleepiness, expectations, tissue temperature, lumbar active range of motion (AROM), and blood biomarkers. RESULTS: All groups improved in pain at t1 and t2 (p < 0.05). The positive verbal instruction group showed greater pain reduction compared to the negative verbal instruction group at t1 (mean difference (MD) -1.41; p = 0.004) and t2 (MD -2.18; p = 0.001). Stress levels were significantly lower in the positive verbal instruction group compared to the negative verbal instruction group at t2 (MD -2.46; p = 0.001). PPT increased significantly in the positive verbal instruction group compared to the negative verbal instruction group at L5 (t1: MD 0.47; p = 0.001) and L3 (t2: MD 0.48; p = 0.001). No significant between-group differences were found for disability, kinesiophobia, sleepiness, lumbar AROM, tissue temperature, or blood biomarkers. CONCLUSION: Verbal suggestions modulate the short-term effects of spinal manipulation in young adults with CNSLBP.

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