Oregon LBP Guidelines: Try Chiropractic First

New LBP guidelines recommend spinal manipulation as only nondrug intervention for first four weeks of care.

The new State of Oregon Evidence-Based Clinical Guidelines for the Evaluation and Management of Low Back Pain recommend 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 Universitys Center for Evidence-based Policy, and the new Oregon Health Evidence Review Commission.

An earlier draft entitle, Management of Low Back Pain (LBP) placed the majority of its emphasis on the use of drugs and surgery.  This protocol would have led doctors down a path where less invasive (and more effective) procedures would have been bypassed.

It was pointed out that the risk-to-benefit ratio favored spinal manipulation over drug therapy, including the recommended first-line medications acetaminophen and NSAIDs, and most certainly over narcotic medications.  This was done using the following sobering facts:

Acetaminophen (e.g., Tylenol) is the leading cause of acute liver failure in the United States, resulting in approximately 140,000 poisoning cases, 56,000 ER visits and approximately 100 deaths each year. Oregonians were unknowingly taking more than one product that contained acetaminophen, increasing the likelihood of unintentional overdoses and poisoning. Non-steroidal anti-inflammatory drugs (NSAIDs) are the second leading cause of peptic ulcers, resulting in more than 100,000 hospitalizations at an estimated $2 billion in additional health care costs and 17,000 deaths yearly in the U.S. NSAID use is also associated with cardiovascular mortality, particularly in the elderly. These associations exist for both COX-2 inhibitors such as Celebrex and non-selective NSAIDs such as ibuprofen and naproxen.

Changes were made to the draft document after scientific clinical journal articles validating the efficacy of chiropractic spinal manipulation for lower back pain was provided to members of the Health Evidence Review Commission.  The current guidelines now include chiropractic spinal adjustments (manipulation) as the sole non-drug, recommendation for acute lower back pain.

Source: Dynamic Chiropractic Volume 31, Number 1

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