By Robert A. Leach, DC, MS, FICC, CHES
The 1994 Federal Guidelines on Back Pain Treatment
In November of 1994, the United States Agency for Healthcare Policy and
Research released the first (and only) Federal guidelines regarding treatment
of acute low back pain in America. More
than two dozen leading scientists from around the U.S. reviewed 40 years of data and reached the following
conclusions:
- Spinal manipulation (and the chiropractic term adjustment is used here) is safe and effective in the first month of acute back pain.
- Spinal manipulation (chiropractic) may be effective for chronic back pain, (however, it should be noted that there is growing evidence since that time supporting chiropractic for chronic back pain and arthritis).
- Spinal manipulation may be effective for back pain in conjunction with radicular or leg pain and discal herniation (however, again in 1994 the scientists noted there is no strong evidence regarding these type problems; subsequent more current research supports chiropractic treatment of disc hernia type problems).
There is strong support in the guidelines for a three pronged approach
including: 1- NSAIDs like ibuprophen (Advil) and acetaminophen (Tylenol),
2- Ice (and moist heat for milder pain), and 3- Spinal
manipulation (chiropractic adjustment), and indeed spinal manipulation is listed under the heading,
“Proven Treatment,” in a subsequent “Patient Guide,” that was a companion
guideline released for patients.
These procedures are in contrast with so-called “Other Treatments” including physical therapy procedures like ultrasound and muscle stimulation, and orthopedic procedures like injections, which the guidelines infer do not change or improve the natural history of back problems (i.e., these other procedures make you feel better while you are doing them, but they do not help you get well faster, or stay well…the guides actually point out that they may be expensive as well).
In addition, there are several things patients should know about back care that the scientists agreed upon:
- Avoid prolonged bed rest, and increase physical activity gradually
- Increase exercise including especially walking, treadmill or swimming gradually on a daily basis
- Gradually increase work activity, and after 3 months of continuing back pain, gradually increase lifting restrictions to allow lifting up to 60 lbs for men and 35 lbs for women (NIOSH 1993 revised recommendation).
- Even the presence of a herniated lumbar disc on an MRI does not necessarily imply patients will respond well to back surgery. Only 1 in 100 backs benefits from surgery. For this reason a month of conservative care is recommended, unless there are serious neurological symptoms and signs (e.g., loss of bowel or bladder function, rapid deterioration of muscle strength).
©2008 by Robert A. Leach