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New Medical Low Back Pain Guidelines Encourage Alternative Approaches
The Research
The October, 2007 issue of the “Annals of Internal Medicine”, a publication of the “Journal of the American Medical Association”, published an article directed toward “all clinicians caring for patients with low (lumbar) back pain of any duration, either with or without leg pain”. Bear in mind that this is a medical journal directed towards medical doctors. This study was coauthored by the American College of Physicians (ACP) and the American Pain Society (APS), both of which are medical organizations that speak to medical doctors. The researchers, consisting of a multidisciplinary panel, conducted a literature search of all valid studies on the effectiveness of various treatments on low back pain. Their purpose was to determine the safest, most effective treatments for low back pain and then recommend treatment guidelines to physicians based upon their findings.
The Unrecognized Epidemic
Low back pain is epidemic throughout the world. 80% of people in the USA visit a physician at some time in their life for low back pain. It is the second most common reason for loss of work. The cost of low back pain to our society, both financial and in terms of suffering, is tremendous.
What They Determined
Based upon their findings, these organizations published “evidence based guidelines” for clinicians to follow when treating low back pain. After ruling out serious cause of low back pain like cancer, bone infection, or disc rupture, they recommended self care with over the counter medications like Ibuprofen and Advil along with rest and back care information. If a short period of self care is not effective, they recommend:
“For patients who do not improve with self-care options, clinicians should consider the addition of non-pharmacological therapy with proven benefits – for acute low back pain, spinal manipulation; for chronic or sub acute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy or progressive relaxation.”
What This Means
So what does this mean? They are telling physicians that unless it is a surgical emergency, they should
- First advise the low back pain patient to do self-care consisting of rest, over the counter medications for pain and inflammation, and avoiding activities that aggravate the pain. They did not advise long term use of these medications due to their “relative lack of long term efficacy and safety…”. This means they won’t cure the problem and may harm your health if used too long.
- If the pain does not go away with a few days of this, they recommend “spinal manipulation” (chiropractic) if the back pain began recently (acute).
- If the problem has been there for some (sub acute) or a long time (chronic), they recommend you try several therapies simultaneously, including
· therapeutic exercises
· acupuncture
· massage therapy
· spinal manipulation (chiropractic)
· yoga
· cognitive behavioral therapy or progressive relaxation (meditation)
Conspiracy Of Silence
It is validating for me to see that medical research has proven that the various treatments I have used to treat low back pain for years are so effective that they should be utilized before trying long term drug therapy and surgery. I have been using spinal manipulation, massage, and acupuncture on these conditions for over 25 years. I have also recommended and taught yoga and meditation to my patients throughout this time. I also feel quite angry that this information has not been announced via the mass media to the population.
If a drug or surgical procedure were to have been shown to be the best treatment, you can bet your bottom dollar that it would be plastered all over the front pages of the major newspapers and be the top story on the major TV newscasts. Instead this vital information languishes in medical journals that the average person never reads.
Help Spread The Word
It is my mission to spread this information as far into the general public as I can. Please help me in this mission. Tell everyone you know with back pain about this. Send this newsletter to everyone in your email address book. Only a grassroots effort like this will succeed in breaking the conspiracy of silence that keeps everyone from learning the truth about what does and does not work for low back pain.
Reference
Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, October 2007; 147: 478-91.
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