Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
SOURCE: Ann Intern Med. 2017 (Feb 14) [Epub] ~ FULL TEXT
Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH;
Robert M. McLean, MD; Mary Ann Forciea, MD;
for the Clinical Guidelines Committee of the American College of Physicians (*)
From the American College of Physicians
and Penn Health System,
Minneapolis Veterans Affairs Medical Center,
Minneapolis, Minnesota; and
Yale School of Medicine,
New Haven, Connecticut.
The American College of Physicians (ACP) released updated guidelines this week that recommend the use of noninvasive, non-drug treatments for low back pain before resorting to drug therapies, which were found to have limited benefits. One of the non-drug options cited by ACP is spinal manipulation.
Chiropractors, who diagnose and treat musculoskeletal disorders, are experts in spinal manipulation.
On May 1, 2017, the New York Times published an editorial by Aaron E. Carroll, M.D., that mentions the new guideline in a generally positive light. The article appeared in a major, mainstream publication read by millions of people. “Spinal manipulation — along with other less traditional therapies like heat, meditation and acupuncture — seems to be as effective as many other more medical therapies we prescribe, and as safe, if not safer,” he wrote.
Talking points on new ACP guideline:
DESCRIPTION:   The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on noninvasive treatment of low back pain.
METHODS:   Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016. Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability and return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction, and adverse effects.
TARGET AUDIENCE AND PATIENT POPULATION:   The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute, subacute, or chronic low back pain.
RECOMMENDATION 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).
|WARNING: Before following Recommendation #1,
please review the
Contra-indications to NSAIDS use
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