Chiropractor Comments About Back Pain Treatment Guidelines

A doctor’s view of the American College of Physicians' Low Back Pain Treatment Recommendations: Garbage In = Garbage Out

Millions of dollars are spent every year in an effort to find the best treatment for patients with either acute or chronic low back pain. But the outcome of these efforts is lackluster at best—why? Because low back pain is not homogenous, not a specific condition or diagnosis, but only a symptom.

The latest recommendation for treatment of low back pain was published in the Annals of Internal Medicine by clinical committee members of the American College of Physicians (ACP). The recommendations are vague at best. It’s not really their fault. Garbage in = Garbage out. That’s an adage from computer programing and applies equally well here.
definition of GIGO: Garbage In Garbage OutDoctor Kai Tiltmann provides his comments about the American College of Physicians’ recent guideline on the treatment of low back pain. Photo Source: ACP reviewed and used studies of patients who had suffered low back pain, so they were destined to fail before they even began. No other medical condition is studied with such generality. Low back pain is a symptom, not a condition, and as a symptom, has many causes. If the low back pain cause is not identified, delineated and treated according to the specific pain triggers, then the outcomes of these studies will be bland at best. Everything works a little, but nothing works really well.

Some doctors tell patients that low back pain will just go way on its own and not to bother with treatment. But why do patients have low back pain to begin with? What are the causes and what are appropriate treatments for those specific causes? Until studies are done where specific pain triggers are identified and specific treatment is applied to those patients, low back pain studies will continue to fail.

According to the American College of Physicians, acute/sub-acute low back pain should be treated with:

  • Heat
  • Massage
  • Acupuncture
  • Spinal adjustments
  • Non-steroidal anti-inflammatory drugs (NSAIDs, such as Advil)

There are no dosing, duration, intensity or other recommendations. If you have low back pain, put some heat on it, if it doesn’t work try a massage, get acupuncture or adjusted.

As a chiropractor myself, I would like to know what the ACP recommends I do with a low back pain patient. What segments should be adjusted, how often, how deep, what side, and with what adjustment method—or does it really matter?

What about a patient with chronic low back pain?

The ACP recommends the following:

  • Exercise
  • Rehabilitation (Physical Therapy)
  • Acupuncture
  • Mindfulness stress reduction
  • Tai Chi
  • Yoga
  • Motor control exercises
  • Biofeedback, Relaxation
  • Laser
  • Cognitive behavioral therapy
  • Spinal manipulation
  • NSAIDs
  • Prescription medications, such as tramadol, opioids or duloxetine

What if the patient with acute low back does not respond to chiropractic adjustments, and their pain becomes chronic?

Consider—a patient who suffers from intermittent low back pain that travels down his right leg and, when pain is severe, his right big toe goes numb. He has good and bad days, and exercises 2 days a week incorporating core exercises and a yoga class. There was no specific trauma, and his symptoms have been going on for 6 months. Standard chiropractic adjustments do not help.

Many questions about treatment recommendations.

According to the ACP, there are 14 treatment options to select from. But which ones, how many, how frequently, for how long and does this recommendation ever change? Who recommends “said” exercises and ensures they are being performed correctly?

Which one of the 14 recommended interventions should be done first? These recommendations are vague at best and arbitrary at worst. It is unbelievable that after 200 years of medicine that this is the best we have to offer our patients.

No wonder low back pain is the number one worldwide cause of disability. Fortunately for our patients, we have a specific approach to identifying the cause of low back pain and prescribe the appropriate treatment for each unique case.

Updated on: 08/28/19
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