The American College of Physicians and the American Pain Society have issued a Joint Clinical Practice guideline. The key recommendation: “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits for acute low back pain, such as spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive behavioral therapy, or progressive relaxation.”

The research supporting this recommendation: Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American College of Physicians Clinical Practice Guideline (Cho and Huffman, Annals of Internal Medicine, 2007) found “good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation are all moderately effective for chronic or subacute (longer than 4 weeks’ duration) low back pain.”

Also cited was Efficacy of Spinal Manipulation and Mobilization for Low Back Pain and Neck Pain: A Systematic Review and Best Evidence Synthesis (Spine Journal May-June 2004). “For acute low back pain (less than 4 weeks’ duration), the only nonpharmacologic therapies with evidence of efficacy are superficial heat and spinal manipulation.”

Presented as a service to the community by: Union County Chiropractic Clinic, 110 Skyline Drive, Maynardville, TN (865) 992-7000 www.unioncountychiropractic.com.