In the Feb. 14, 2017 issue of Annals of Internal Medicine the American College of Physicians published a clinical practice guideline for non-invasive forms of treatment for acute, sub-acute, and chronic low-back pain.
I connected with one of the authors of the guideline, Dr. Amir Qaseem, to acquire further information about this new document.
In the guideline, Qaseem and his co-authors state that for those patients with acute or sub-acute low-back pain, physicians should recommend: heat, massage, spinal manipulation and acupuncture first, before recommending medication. For chronic low-back pain patients, physicians should recommend: exercise, stretching, yoga, and acupuncture. Only if the above remedies don’t work should the recommendation for chronic low-back pain be medication.
The authors evaluated roughly 61 spinal manipulation trials, some in a systematic review. The details regarding evidence rating and quality assessment can be found in the evidence review published along with the guideline.
Qaseem and his co-authors concluded, “Clinicians and patients should select nonpharmacologic treatment with superficial heat, massage, acupuncture, or spinal manipulation.” Since these “nonpharmacologic interventions (were) shown to be effective for improving pain and function in patients with acute and sub-acute low-back pain.”
What speaks volumes is what the clinical practice guideline did not recommend: low quality evidence showed exercise had no benefit for acute low-back pain; evidence was insufficient to determine the effectiveness of the following non-recommended treatments for acute and sub-acute low-back pain:
- all modalities and therapies largely associated with physiotherapy as presented by the authors: TENS, electrical muscle stimulation, inferential therapy, traction, core-stabilizing exercises, and multidisciplinary rehabilitation, ultrasound and taping.
Regardless, all of the above spinal manipulation was included as a recommendation after a systemic review of the best available research.
This is significant. Chiropractors are the world’s spinal manipulation specialists as they make up over 95 per cent of those who practice spinal manipulation.
In the US and Canada, pain medication and opioid use are at an all-time high, since over 25 per cent of people experience at least one day of low-back pain in the last three months. Qaseem also points out that total costs attributed to low-back pain are estimated at over $100 billion per year, two-thirds of which are lost wages and productivity.
These guidelines now encourage and educate the public and primary physicians that there are other options recommended to be utilized before turning to prescription drugs.
Back in 2015, I had the privilege of interviewing renowned chiropractor and president emeritus of Parker University, Dr. Fabrizio Mancini. I asked him about the importance of chiropractors becoming ambassadors for the profession through the media.
Mancini said, “I learned many years ago that if we do not control our message to the public, someone else will control it for us. It seems like the mainstream media only talks about the negative in our profession. That is only because we do not ‘pitch’ them our evidence and success stories.
“The public is ready for us, but they need to hear from us. It is up to us to make it happen by sharing the many good things we do for our patients.”
This journal article about the effectiveness of spinal manipulation after an extensive review of the evidence must be shared with mainstream media. I have already contacted two newspapers and one television station and we are currently arranging interviews to discuss the significance of this article to the public.
I encourage every chiropractor to do the same. Pitch this story to your local newspaper, newsletter, university or mainstream radio station, and public and community television stations. The profession must use opportunities like this to become ambassadors of our brand so the public can see that mainstream health professionals are recommending spinal manipulation for acute and sub-acute low-back pain.
Dr. Anthony Lombardi, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information.