Guidelines

New WHO Guideline on Chronic LBP: Global Impact

By Frank M. Painter|November 7, 2024|Guidelines, Low Back Pain|

New WHO Guideline on Chronic LBP: Global Impact
World Health Organization Guideline:
Yes to Chiropractic; No to Most Drugs

SOURCE: Dynamic Chiropractic ~ February 2024

WHAT YOU NEED TO KNOW

“Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

The chiropractic profession was represented by several noted DCs in all aspects of development and review.

Within the short list of recommended interventions, most DCs provide at least three. Thus, it is not hard to conclude that doctors of chiropractic should be the first choice for chronic low-back pain management.

On Dec. 7, 2023, the World Health Organization (WHO) released its “Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.” [1] The purpose of the 244-page document is to “provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP in adults” that will improve outcomes. “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults.

The guideline reviews both the benefits and the harms of nonsurgical interventions in the management of chronic primary LBP. In addition to spinal manipulative therapy, the guideline is also in favor of structured exercise, acupuncture, massage, NSAIDs and topical cayenne pepper (Capsicum frutescens).

NSAIDs continue to be the only recommended pharmacotherapy. Among the medication interventions the guideline recommends against are opioids, antidepressants (tricyclic, serotonin and noradrenaline reuptake inhibitor), skeletal muscle relaxants, injectable local anaesthetics and pharmacological weight-loss medications.

Acetaminophen, benzodiazepines and cannabis-related pharmaceutical preparations received “no recommendation,” while listing potential harmful effects including “cardiovascular, renal and gastrointestinal harms and increased mortality risk” for acetaminophen; “potential harms including memory impairment, misuse, overdose deaths from respiratory depression, somnolence, fatigue and light-headedness potentially leading to falls” for benzodiazepines; and “evidence of possible adverse events, including harms associated with its nonmedicinal use” for cannabis-related pharmaceutical preparations.

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Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

By Frank M. Painter|November 17, 2022|Guidelines, Initial Provider, Low Back Pain|

Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

The Chiro.Org Blog

SOURCE: Healthcare (Basel) 2016 (Jul 15); 4 (3): 44 ~ FULL TEXT

OPEN ACCESS

Andreas Werber and Marcus Schiltenwolf

Department of Orthopedics and Orthopedic Surgery,
University Hospital Giessen,
Klinikstr. 33, 35392
Giessen, Germany

Despite the fact that unspecific low back pain is of important impact in general health care, this pain condition is often treated insufficiently. Poor efficiency has led to the necessity of guidelines addressing evidence-based strategies for treatment of lower back pain (LBP). We present some statements of the German medical care reality. Self-responsible action of the patient should be supported while invasive methods in particular should be avoided due to lacking evidence in outcome efficiency. However, it has to be stated that no effective implementation strategy has been established yet. Especially, studies on the economic impact of different implementation strategies are lacking.

A lack of awareness of common available guidelines and an uneven distribution of existing knowledge throughout the population can be stated: persons with higher risk suffering from LBP by higher professional demands and lower educational level are not skilled in advised management of LBP. Both diagnostic imaging and invasive treatment methods increased dramatically leading to increased costs and doctor workload without being associated with improved patient functioning, severity of pain or overall health status due to the absence of a functioning primary care gate keeping system for patient selection.

Opioids are prescribed on a grand scale and over a long period. Moreover, opioid prescription is not indicated properly, when predominantly persons with psychological distress like somatoform disorders are treated with opioids.

Keywords: guideline-based treatment; low back pain; somatisation.

From the FULL TEXT Article:

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A Narrative Review of Lumbar Fusion Surgery

By Frank M. Painter|June 6, 2019|Guidelines, Low Back Pain|

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice

The Chiro.Org Blog

SOURCE: J Chiropractic Medicine 2016 (Dec); 15 (4): 259–271

Clinton J. Daniels, DC, MS,
Pamela J. Wakefield, DC,
Glenn A. Bub, DC,
James D. Toombs, MD

Veteran Affairs Saint Louis Health Care System,
St. Louis, MO.

OBJECTIVE: The purpose of this narrative review was to describe the most common spinal fusion surgical procedures, address the clinical indications for lumbar fusion in degeneration cases, identify potential complications, and discuss their relevance to chiropractic management of patients after surgical fusion.

METHODS: The PubMed database was searched from the beginning of the record through March 31, 2015, for English language articles related to lumbar fusion or arthrodesis or both and their incidence, procedures, complications, and postoperative chiropractic cases. Articles were retrieved and evaluated for relevance. The bibliographies of selected articles were also reviewed.

RESULTS: The most typical lumbar fusion procedures are posterior lumbar interbody fusion, anterior lumbar interbody fusion, transforaminal interbody fusion, and lateral lumbar interbody fusion. Fair level evidence supports lumbar fusion procedures for degenerative spondylolisthesis with instability and for intractable low back pain that has failed conservative care. Complications and development of chronic pain after surgery is common, and these patients frequently present to chiropractic physicians. Several reports describe the potential benefit of chiropractic management with spinal manipulation, flexion-distraction manipulation, and manipulation under anesthesia for postfusion low back pain. There are no published experimental studies related specifically to chiropractic care of postfusion low back pain.

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Spinal Manipulative Therapy and Other Conservative Treatments

By Frank M. Painter|April 12, 2018|Guidelines, Low Back Pain|

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain:
A Guideline From the Canadian Chiropractic Guideline Initiative

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther. 2018 (Mar 29) [Epub]

André E. Bussières, DC, FCCS(C), PhD, Gregory Stewart, DC, Fadi Al-Zoubi, PT, MSc, Philip Decina, DC, Martin Descarreaux, DC, PhD, Danielle Haskett, BSc, Cesar Hincapié, DC, PhD, Isabelle Pagé, DC, MSc, Steven Passmore, DC, PhD, John Srbely, DC, PhD, Maja Stupar, DC, PhD, Joel Weisberg, DC, Joseph Ornelas, DC, PhD

School of Physical and Occupational Therapy,
Faculty of Medicine, McGill University,
Montreal, Québec, Canada

OBJECTIVE: &nbsp The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

METHODS: &nbsp The topic areas were chosen based on an Agency for Healthcare Research and Quality comparative effectiveness review, specific to spinal manipulation as a nonpharmacological intervention. The panel updated the search strategies in Medline. We assessed admissible systematic reviews and randomized controlled trials for each question using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. Evidence profiles were used to summarize judgments of the evidence quality and link recommendations to the supporting evidence. Using the Evidence to Decision Framework, the guideline panel determined the certainty of evidence and strength of the recommendations. Consensus was achieved using a modified Delphi technique. The guideline was peer reviewed by an 8-member multidisciplinary external committee.

RESULTS: &nbsp For patients with acute (0-3 months) back pain, we suggest offering advice (posture, staying active), reassurance, education and self-management strategies in addition to SMT, usual medical care when deemed beneficial, or a combination of SMT and usual medical care to improve pain and disability. For patients with chronic (>3 months) back pain, we suggest offering advice and education, SMT or SMT as part of a multimodal therapy (exercise, myofascial therapy or usual medical care when deemed beneficial). For patients with chronic back-related leg pain, we suggest offering advice and education along with SMT and home exercise (positioning and stabilization exercises).

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National Clinical Guidelines for Non-surgical Treatment

By Frank M. Painter|July 27, 2017|Guidelines, Low Back Pain|

National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

The Chiro.Org Blog

SOURCE: European Spine Journal 2018 (Jan); 27 (1): 60–75

Mette Jensen Stochkendahl, Per Kjaer,
Jan Hartvigsen, Alice Kongsted1,
Jens Aaboe, Margrethe Andersen, et al.

Department of Sports Science and Clinical Biomechanics,
University of Southern Denmark,
Campusvej 55, 5230, Odense M, Denmark.

PURPOSE: To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.

This is just one article from a series of 5:

The Non-pharmacologic Therapies Low Back Pain

METHODS: Two multidisciplinary working groups formulated recommendations based on the GRADE approach.

RESULTS: Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.

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Knowledge Transfer within the Canadian Chiropractic Community

By Frank M. Painter|April 10, 2017|Chiropractic Care, Evidence-based Practice, Guidelines|

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

The Chiro.Org Blog

SOURCE: J Can Chiropr Assoc. 2014 (Sep); 58 (3): 206–214

Greg Kawchuk, DC, MSc, PhD, Genevieve Newton, DC, PhD,
John Srbely, DC, PhD, Steven Passmore, Hons BKin, DC, PhD,
André Bussières, DC, FCCS (C), Jason W. Busse, DC, PhD,
and Paul Bruno, BHK, DC, PhD

Associate Professor and Canada Research Chair
in Spinal Function,
Faculty of Rehabilitation Medicine,
University of Alberta

Introduction

This two-part commentary aims to provide clinicians with a basic understanding of knowledge translation (KT), a term that is often used interchangeably with phrases such as knowledge transfer, translational research, knowledge mobilization, and knowledge exchange. [1] Knowledge translation, also known as the science of implementation, is increasingly recognized as a critical element in improving healthcare delivery and aligning the use of research knowledge with clinical practice. [2] The focus of our commentary relates to how these KT processes link with evidence-based chiropractic care.

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Guidelines

New WHO Guideline on Chronic LBP: Global Impact

New WHO Guideline on Chronic LBP: Global Impact World Health Organization Guideline: Yes to Chiropractic; No to Most Drugs

Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

Treatment of Lower Back Pain-The Gap between Guideline-Based Treatment and Medical Care Reality

A Narrative Review of Lumbar Fusion Surgery

A Narrative Review of Lumbar Fusion Surgery With Relevance to Chiropractic Practice

Spinal Manipulative Therapy and Other Conservative Treatments

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative

National Clinical Guidelines for Non-surgical Treatment

National Clinical Guidelines for Non-surgical Treatment of Patients with Recent Onset Low Back Pain or Lumbar Radiculopathy

Knowledge Transfer within the Canadian Chiropractic Community

Knowledge Transfer within the Canadian Chiropractic Community. Part 2: Narrowing the Evidence-Practice Gap

New WHO Guideline on Chronic LBP: Global Impact
World Health Organization Guideline:
Yes to Chiropractic; No to Most Drugs

Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain:
A Guideline From the Canadian Chiropractic Guideline Initiative