LOW BACK PAIN GUIDELINES
 
   

Low Back Pain Guidelines

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org
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Guidelines From Around The World   
 
   

Noninvasive Treatments for Acute, Subacute, and Chronic
Low Back Pain: A Clinical Practice Guideline From
the American College of Physicians

Ann Intern Med. 2017 (Apr 4);   166 (7):   514–530 ~ FULL TEXT

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation).

Clinical Practice Guidelines for the Noninvasive Management
of Low Back Pain: A Systematic Review by the Ontario
Protocol for Traffic Injury Management
(OPTIMa) Collaboration

Eur J Pain. 2016 (Oct 6).   doi: 10.1002/ejp.931 ~ FULL TEXT

We conducted a systematic review of guidelines on the management of low back pain (LBP) to assess their methodological quality and guide care. We synthesized guidelines on the management of LBP published from 2005 to 2014 following best evidence synthesis principles. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, DARE, National Health Services Economic Evaluation Database, Health Technology Assessment Database, Index to Chiropractic Literature and grey literature. Independent reviewers critically appraised eligible guidelines using AGREE II criteria. We screened 2504 citations; 13 guidelines were eligible for critical appraisal, and 10 had a low risk of bias. According to high-quality guidelines: (1) all patients with acute or chronic LBP should receive education, reassurance and instruction on self-management options; (2) patients with acute LBP should be encouraged to return to activity and may benefit from paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), or spinal manipulation; (3) the management of chronic LBP may include exercise, paracetamol or NSAIDs, manual therapy, acupuncture, and multimodal rehabilitation (combined physical and psychological treatment); and (4) patients with lumbar disc herniation with radiculopathy may benefit from spinal manipulation. Ten guidelines were of high methodological quality, but updating and some methodological improvements are needed.

Clinical Practice Guideline: Chiropractic Care for Low Back Pain
J Manipulative Physiol Ther. 2016 (Jan);   39 (1):   1–22 ~ FULL TEXT

This publication is an update of the best practice recommendations for chiropractic management of LBP. [9, 10, 12] This guide summarizes recommendations throughout the continuum of care from acute to chronic and offers the chiropractic profession and other key stakeholders an up-to-date evidence- and clinical practice experience–informed resource outlining best practice approaches for the treatment of patients with LBP.

An Updated Overview of Clinical Guidelines for the Management
of Non-specific Low Back Pain in Primary Care

Eur Spine J. 2010 (Dec);   19 (12):   2075–2094 ~ FULL TEXT

This review of national and international guidelines conducted by Koes et. al. points out the disparities between guidelines with respect to spinal manipulation and the use of drugs for both chronic and acute low back pain.

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

Annals of Internal Medicine 2007 (Oct 2);   147 (7):   492–504 ~ FULL TEXT

Researchers sought to determine the benefits and harms of acupuncture, back schools, psychological therapies, exercise therapy, functional restoration, interdisciplinary therapy, massage, physical therapies (interferential therapy, low-level laser therapy, lumbar supports, shortwave diathermy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography), spinal manipulation, and yoga for acute or chronic low back pain (with or without leg pain). Researchers conducted MEDLINE searchers and the Cochrane Database of Systematic Reviews and graded the methodologies of the studies. Researchers concluded that there was good evidence that cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation were moderately effective for chronic or subacute low back pain.

Diagnosis and Treatment of Low Back Pain:
A Joint Clinical Practice Guideline from
the American College of Physicians
and the American Pain Society

Annals of Internal Medicine 2007 (Oct 2);   147 (7):   478–491 ~ FULL TEXT

Low back pain is the fifth most common reason for all physician visits in the United States. [1, 2] Approximately one quarter of U.S. adults reported having low back pain lasting at least 1 whole day in the past 3 months [2], and 7.6% reported at least 1 episode of severe acute low back pain (see Glossary) within a 1-year period. [3] Low back pain is also very costly: Total incremental direct health care costs attributable to low back pain in the U.S. were estimated at $26.3 billion in 1998. [4] In addition, indirect costs related to days lost from work are substantial, with approximately 2% of the U.S. work force compensated for back injuries each year. [5] You will enjoy these recommendations because their ONLY recommendation for active treatment of acute low back pain is spinal adjusting (manipulation).

European Guidelines for the Management of
Acute Nonspecific Low Back Pain in Primary Care

European Spine Journal 2006 (Mar);   15 Suppl 2:  S169–191 ~ FULL TEXT

The primary objective of these European evidence-based guidelines is to provide a set of recommendations that can support existing and future national and international guidelines or future updates of existing guidelines.
Refer also to their 55-page document:   Amended version

European Guidelines for the Management of
Chronic Nonspecific Low Back Pain

European Spine Journal 2006 (Mar);   15 Suppl 2:  S192–300 ~ FULL TEXT

This particular guideline intends to foster a realistic approach to improving the treatment of common (nonspecific) chronic low back pain (CLBP).
Refer also to their 206-page document:   Amended version June 14th 2005
You may also like their:   Backpain Europe website

Royal College of General Practitioners
Clinical Guidelines for the Management
of Acute Low Back Pain

Royal College of General Practitioners ~ December 2001

This is Britian's follow-up to:   Bigos, Stanley J et al. “Acute Low Back Problems in Adults” released December 2001. Their comments on spinal manipulation were: “In acute and sub-acute back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which it has been compared.” AND “The risks of manipulation for low back pain are very low, provided patients are selected and assessed properly and it is carried out by a trained therapist or practitioner. Manipulation should not be used in patients with severe or progressive neurological deficit in view of the rare but serious risk of neurological complication.”

British Occupational Health Guidelines for the Management
of Low Back Pain at Work –– Principal Recommendations

Faculty of Occupational Medicine, London ~ March 2000

Disability from back pain in people of working age is one of the most dramatic failures of health care in recent years. Its greatest impact is on the lives of those affected and their families. This review and the guidelines based on it aim to reduce the toll of harm by providing a new approach to back pain management at work which is based on the best available scientific evidence and uses this to make practical recommendations on how to tackle the occupational health aspects of the problem.

Low-Back Pain:   Frequency, Management and Prevention
DIHTA - Danish Institute for Heath Technology Assessment ~ January 1999
The Danish Institute for Health Technology Assessment (DIHTA) describes LBP, then labels treatments in 3 categories: Generally recommended, recommended in certain conditions, or not recommended. The FIRST recommended “treatment” is manual therapy (which includes chiropractic).

Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain:
Risk Factors for Long–Term Disability and Work Loss

New Zealand Guidelines Group ~ 1997

This guide is to be used in conjunction with the New Zealand Acute Low Back Pain Guide. It provides an overview of risk factors for long–term disability and work loss, and an outline of methods to assess these at risk. Identification should lead to appropriate early management targeted towards the prevention of chronic pain and disability.

Evaluation of the Low Back Industrial Injury
California Industrial Medical Council ~ April 17, 1997
Low back problems are common among workers. In the majority of injured workers with low back problems, recovery occurs within the first month of symptoms. Those who have not improved at the end of one month of treatment may need further diagnostic evaluation and consideration of other treatment options. Management of low back problems in injured workers includes consideration of environmental and personal factors which may be causing or aggravating the problem, as well as providing appropriate treatment that leads to a return to productive work.

Manga Guidelines August 1993 & February 1998
Pran Manga, Ph.D., Professor of Health Economics @ University of Ottawa

Includes the original 1993 and the updated 1998 recommendations to the Canadian Government about inclusion of chiropractic in their Health Care System..

Chiropractic Care for Common Industrial Low Back Conditions
Chiropractic Technique 1993 (Aug);   5 (3):   119–125 ~ FULL TEXT

This is the first guideline I have seen which actually states the number of visits which may be appropriate for a variety of common low back conditions.   I have used these “Care Plans” for years, presenting them to third party's as a “working diagnosis” care plan, which need ongoing “fine tuning” during patient care. Check out this Chiropractic Technique article, and the attached care plans, which have been released exclusively to Chiro.Org by the National College of Chiropractic. Thanks, Dana! You will find other information like this in the GUIDELINES Section.

Download the “Care Plans” –   in Word 97 Format   or

in Adobe Acrobat Format

They are formatted, so you can add your own letterhead and mail them out to claim adjusters tomorrow! Just use “save-as” and they are all yours!

Guidelines for Chiropractic Quality Assurance and Practice Parameters --
Major Recommendations
  (The Mercy Conference)
Aspen Publishers ~ 1993

This outline of the “Mercy Center” Consensus Statement covers history and exam, diagnostic imaging, instrumentation (including Questionnaires, Algometry, Inclinometers and Thermography), clinical laboratory recommendations, and a detailed section on record keeping and patient consent.
You can purchase a copy of it right here

 
   

Council on Chiropractic Guidelines and Practice Parameters   (CCGPP)
The Low Back Pain Guidelines
 
   

Clinical Practice Guideline:
Chiropractic Care for Low Back Pain

J Manipulative Physiol Ther. 2016 (Jan);   39 (1):   1–22 ~ FULL TEXT

To facilitate best practices specific to the chiropractic management of patients with common, primarily musculoskeletal disorders, the profession established the Council on Chiropractic Guidelines and Practice Parameters (CCGPP) in 1995. [6] The organization sponsored and/or participated in the development of a number of “best practices” recommendations on various conditions. [21-32] With respect to chiropractic management of LBP, a CCGPP team produced a literature synthesis [8] which formed the basis of the first iteration of this guideline in 2008. [9] In 2010, a new guideline focused on chronic spine-related pain was published, [12] with a companion publication to both the 2008 and 2010 guidelines published in 2012, providing algorithms for chiropractic management of both acute and chronic pain. [10] Guidelines should be updated regularly. [33, 34] Therefore, this article provides the clinical practice guideline (CPG) based on an updated systematic literature review and extensive and robust consensus process. [9-12]

Algorithms for the Chiropractic Management of Acute and
Chronic Spine-Related Pain

Topics in Integrative Health Care 2012 (Dec 31);   3 (4) ~ FULL TEXT

The complexity of clinical documentation and case management for health care providers has increased along with the rise of managed care. Keeping up with the policies of different insurers and third party administrators can be a daunting task. To address these issues for doctors of chiropractic (DCs) and policymakers, the Council for Chiropractic Guidelines and Practice Parameters (CCGPP) developed three consensus documents. Each of these documents was the outcome of a formal consensus process in which a multidisciplinary Delphi panel consisting of experts in chiropractic and low back pain treatment came to agreement on terminology and treatment parameters for the chiropractic management of spine-related musculoskeletal pain. [1-3]

Management of Chronic Spine-Related Conditions:
Consensus Recommendations of a Multidisciplinary Panel

J Manipulative Physiol Ther 2010 (Sep);   33 (7):   484–492 ~ FULL TEXT

A multidisciplinary panel of experienced practitioners was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for complex patients with chronic spine-related conditions, based on both the scientific evidence and their clinical experience.

Chiropractic Management of Low Back Disorders:
Report From a Consensus Process

J Manipulative Physiol Ther 2008 (Nov);   31 (9):   651–658 ~ FULL TEXT

A broad-based panel of experienced chiropractors was able to reach a high level (80%) of consensus regarding specific aspects of the chiropractic approach to care for patients with low back pain, based on both the scientific evidence and their clinical experience.

Chiropractic Management of Low Back Pain and Low Back-Related
Leg Complaints: A Literature Synthesis

J Manipulative Physiol Ther 2008 (Nov);   31 (9):   659–674 ~ FULL TEXT

As much or more evidence exists for the use of spinal manipulation to reduce symptoms and improve function in patients with chronic LBP as for use in acute and subacute LBP. Use of exercise in conjunction with manipulation is likely to speed and improve outcomes as well as minimize episodic recurrence.   There was less evidence for the use of manipulation for patients with LBP and radiating leg pain, sciatica, or radiculopathy.
You will also enjoy the Original CCGPP LBP Document

 
   

AHCPR's “Acute Low Back Problems in Adults” Series      
 
   

Acute Low Back Problems in Adults   (Clinical Guide)
Bigos, Stanley J et al.
December 1994 (AHCPR Publication No. 95–0642).
U.S. Agency for Health Care Policy and Research

Acute Low Back Problems in Adults   (Quick Reference Guide)
Bigos, Stanley J et al.
December 1994 (AHCPR Publication No. 95–0643).
U.S. Agency for Health Care Policy and Research

Understanding Acute Low Back Problems   (Consumer/Patient Guideline)
Bigos, Stanley J et al.
December 1994 (AHCPR Publication No. 95-0644).
U.S. Agency for Health Care Policy and Research



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Updated 5–15–2017

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