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Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain

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Algorithms for the Chiropractic Management of
Acute and Chronic Spine-Related Pain

The Chiro.Org Blog


SOURCE:   Top Integrative Health Care 2012 (Dec 31); 3 (4)

Gregory A. Baker, DC, Ronald J. Farabaugh, DC,
Thomas J. Augat, DC, MS, CCSP, FASA,
Cheryl Hawk, DC, PhD, CHES



The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3]


Introduction:

The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3] Their recommendations were based on a combination of consideration of the current evidence and their clinical judgment. In addition, another consensus document related to care rendered by doctors of chiropractic for the purpose of health promotion, disease prevention, and wellness, developed through a project funded by the NCMIC Foundation, was also referenced to clarify terminology used in the algorithms. [4] (See Table 1.)

There are more articles like this @ the:

Clinical Model for the Diagnosis and Management Page and the:

Chronic Neck Pain and Chiropractic Page and the:

Low Back Pain and Chiropractic Page

Table 1.
Definition of terms related to acute and chronic care

The terms “supportive care” and “maintenance care,” which are frequently used within the chiropractic health care arena, are not consistent with general healthcare industry lexicon. Instead of “supportive care,” we use the more descriptive term, “ongoing/recurrent” care.

Chronic pain management can be divided into three categories:

  1. those who can home manage;

  2. those who can be managed with episodic care; and

  3. those who need “scheduled” ongoing care, which is a very small proportion of chronic pain sufferers. Those patients require proper documentation of responses to care and procedures, including therapeutic withdrawal response, multi-modal, multi-disciplinary consideration, patient education, etc.



Other related consensus-based terms: [1, 2]

  • Medically necessary care of acute conditions:
    “care that is reasonable and necessary for the diagnosis and treatment of a patient with a health concern and for which there is a therapeutic care plan and a goal of functional improvement and/or pain relief.”
    [1,p.461]

  • Medically necessary care for recurrent/chronic conditions:
    “care that is provided when the injury/illness is not expected to completely resolve after a treatment regimen but where continued care can reasonably be expected to result in documentable improvement for the patient.” [1,p.461]

  • Chiropractic management of chronic/recurrent conditions:
    “Chiropractic care provided for the purpose of preventing relapse and/or exacerbations of the original complaint(s) as well as associated comorbidities.” [2, p. 560]

  • Chiropractic wellness care or preventive care:
    “Chiropractic care provided for the purpose of preventing disease, optimizing function, and supporting the patient’s wellness-related activities.” [2, p. 560]

  1. Dehen MD, Whalen WM, Farabaugh RJ, Hawk C.
    Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent, and Wellness
    J Manipulative Physiol Ther 2010 (Jul); 33 (6): 458-463

  2. Hawk C, Schneider M, Evans MW, Jr., Redwood D.
    Consensus Process to Develop a Best-Practice Document on the Role of Chiropractic Care in Health Promotion, Disease Prevention, and Wellness
    J Manipulative Physiol Ther 2012 (Sep): 35 (7): 556-567

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About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been and remains my favorite hobby.

2 Comments

  1. mary May 16, 2013 at 7:25 pm

    What about the use of thereputical type equipment. This should surely help in come cases?

    • Frank M. Painter, D.C. May 16, 2013 at 8:00 pm

      Hi Mary

      The algo for acute care recommends 12 visits as a therapeutic trial. It does not define what that care would entail. Some DCs do use physiotherapy (stim, US etc) as a component of care, and some don’t.

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