New Oregon LBP Guidelines: Try Chiropractic First

SOURCE: Dynamic Chiropractic

By Vern Saboe, DC, DACAN, DABFP, FACO

Lobbyist, Oregon Chiropractic Association

The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommends spinal manipulation as the only nonpharmacological treatment for acute lower back pain. The guidelines, which have been adopted by the Oregon Health Authority, are a collaborative effort between the Center for Evidence-Based Practice, Oregon Corporation for Health Care Quality, Oregon Health and Sciences University’s Center for Evidence-based Policy, and the new Oregon Health Evidence Review Commission.

The Oregon Chiropractic Association (OCA) repeatedly gave written and oral testimony that the original draft guidelines placed too much emphasis on drugs and surgery. A close review of the original algorithm, “Management of Low Back Pain (LBP) (Image 2), relative to “#23 Signs or symptoms of radiculopathy or spinal stenosis,” reveals this. For example, if subsequent special imaging (MRI) revealed concordant nerve root impingement or spinal stenosis (#25), the original draft algorithm led the clinician into a surgical or other invasive procedure “dead end,” meaning there was no contingency for conservative chiropractic treatment (#26).

Image 2 (above)
—> Is Now Discontinued

Oregon LBP Guidelines The OCA responded with this author providing fellow Health Evidence Review Commission members with scientific clinical journal articles validating the efficacy of chiropractic spinal manipulation for lumbar radiculopathy and stenosis, with an emphasis on Dr. James Cox’s flexion-distraction technique research. Our evidence-based input resulted in a much-improved final version (Image 3) now recommending “#25 & #27 … continued conservative management, intensive interdisciplinary approach,” rather than leading medical clinicians down a path which led only to surgery or other invasive procedures.

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