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Back Pain | Cost Effectiveness | Patient Satisfaction | Utilization | Government Recommendations | Safety

Government Recommendation for Management Protocols

In today’s evidence-based health care environment, governments are engaged in developing scientific protocols for the management of various health care conditions. Interventions provided by health care professionals are now being scrutinized and examined as never before, to ensure that effective, efficacious and safe health care interventions are available and given priority in the public’s best interest. The chiropractic profession encourages guideline development based on scientific research.

Recent government guidelines continue to support the previous studies on the effectiveness, cost-effectiveness and safety of chiropractic spinal manipulation recommending chiropractic management for acute low back pain.

Rosen, M. et al. (1994) Back Pain. Report of a CSAG Committee on Back Pain, HMSO, London, England.

In 1994. A British Clinical Standard Advisory Group was asked by the United Kingdom Health Ministers to develop guidelines for patients with back pain. The group found that there is considerable evidence that manipulation can provide short-term symptomatic benefit in some patients with acute back pain and recommended that manipulation should be available as a therapeutic option for the treatment of National Health Service (NHS) patients with back pain, and should be carried out by appropriately trained therapists or practitioners.

Bigos, S., Bowyer, O., Braen, G., et al. (1994) Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14. AHCPR Publication No. 95-0642. Rockville, MD; Agency for Health Care Policy and Research Public Health Service, U.S. Department of Health and Human Services.

In December 1994, the Agency for Health Care Policy and Research (AHCPR, a division of the US Department of Health and Human Services) released a clinical practice guideline entitled Acute Low Back Problems in Adults. The guideline was developed by a 23-member expert multidisciplinary panel, using rigorous scientific methodology. The guideline concluded that relief of discomfort of low back pain can be accomplished most safely by only two methods: non-prescription medication and/or spinal manipulation. Most other therapies currently in use for the treatment of low back pain were found to be either ineffective or unsubstantiated by scientific research. Side-effects associated with the use of medication were found to be greater than those associated with manipulation, which were very limited.

Spitzer, W.O., et al. (1995) Whiplash-Associated Disorders (WAD): Redefining Whiplash and its Management: Quebec Task Force on Whiplash-Associated Disorders.

The Quebec Task force consisted of an 18-member expert multidisciplinary panel whose mandate was to undertake a comprehensive review and study of whiplash-associated disorders (WAD). One of the sections of the report dealt with clinical guidelines for the diagnosis, treatment and prognosis of WAD. It was the Task Force consensus that the use of non-steroidal anti-inflammatory agents and analgesics, short-term manipulation and mobilization by trained persons and active exercises are useful in Grade II and III WAD, and that manipulative treatments by trained persons for the relief of pain and facilitating early mobility can be used in WAD.

Royal College of General Practitioners (1996) Clinical Guidelines for the Management of Acute Low Back Pain, Great Britain.

The Royal College of General Practitioners, in consultation with the Chartered Society of Physiotherapy, Osteopathic Association of Great Britain, British Chiropractic Association and the National Back Pain Association constructed clinical guidelines on low back pain management, based on extensive international scientific evidence. One of the principal recommendations of the guidelines is "to consider manipulative treatment within the first 6 weeks for patients who need additional help with pain relief or who are failing to return to normal activities" based on high level evidence that within the first six weeks of onset of acute or recurrent low back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which it has been compared.