Guidelines Issued For Management of Low Back Pain
You can view this article in Medscape. (http://www.medscape.com/viewarticle/563639?src=mp)
The American College of Physicians (ACP) and the American Pain Society (APS) have issued a comprehensive joint clinical practice guideline for the diagnosis and treatment of low back pain. It was recommended that clinicians not routinely order imaging or other diagnostis tests unless the patients suffer from severe or progressive neurologic deficits or who are suspected to have cancer, infection, or other underlying condition as the cause of their low back pain. Patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis should undergo MRI or CT only if positive results would potentially lead to surgery or epidural steroid injection for suspected radiculopathy. In choosing an imaging procedure, MRI is preferred to CT. When self-care options do not result in improvement, clinicians should consider adding nonpharmacologic modalities shown to be of benefit. For acute low back pain, the only modality is spinal manipulation. For chronic or subacute low back pain, modalities shown to be of benefit are intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.
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No additional risk of stroke from visiting a chiropractor as opposed to seeking primary care from a GP: One key finding of the Bone and Joint Decade (BJD) Neck Pain Task Force Report
You can view a summary of key findings in this article in The Spine.
(http://www.spinejournal.com/pt/re/spine/fulltext.00007632-200802151-00004.htm;jsessionid=
LkvM80HS6Nl9vSRTRZh11Lm2KWzyTqyJgj1rmp1q3P6KQwQn3p4R!1966154792!181195628!8091!-1)
Chiropractors have long awaited the results of studies to show whether adjustments to the neck actually lead to vertebrobasilar artery (VBA) stroke. For a time as a clinic student at the Anglo European College of Chiropractic, we were taught to assess the risk of someone likely to suffer from a stroke by placing their necks in extension and rotation (looking up into a corner of the room) then observing for signs such as dizziness, pallor and nystagmus. There were no other special tests available to detect someone with pre-existing vertebral dissection. Within months, these tests were discarded as they were found to be unreliable.
Patients and chiropractors alike must find it reassuring that the BJD Neck Pain Task Force discovered no correlation between chiropractic adjustments and strokes. The previously perceived risk was “likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke”.
From a personal standpoint, modified adjustive techniques could be used to minimise the risk of further damaging the vertebral artery when coming across a patient identified as a high risk patient from history taking. Patients should be informed of risk factors for neck pain: age, gender, genetics, smoking, exposure to tobacco, degree of physical activity/inactivity. Prognosis for improvement decreases with age, poor health, including psychological health, prior neck pain episodes, worrying, frustration or anger in response to neck pain.
Neck pain was recommended to be classified into four Grades of severity, surgery perhaps being necessary for patients falling under Grade 3 (those with radiculopathies and neurologic signs) and 4 (those with serious pathology). A conservative trial should be offered for selected Grade 3 patients. Based on personal clinical experience, the majority of patients with radiating pain into the arm, numbness and tingling (possibly deserving a Grade 3), have had complete resolution of symptoms within 3 to 8 treatments over 2 weeks. Treatment options utilized at Integrative Chiropractic include: spinal manipulation, mobilization, soft tissue manipulation, education (treatments according to the Task Force as being safe, effective and worth considering), as well as ultrasound, electrical nerve stimulation (treatments adjudged as being unlikely to help). Some patients who discontinued treatment prior to discharge did so for several reasons: intensity of pain made it impossible for them to lie down comfortably supine or prone for longer than several minutes at a time, patients desiring an absolute and complete cessation of pain within a week. The majority of patients recovered with no residual numbness or pain.
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