American College of Physicians issues guideline for treating nonradicular low back pain

Treatment recommendations include massage, acupuncture, spinal manipulation, tai chi, and yoga

Philadelphia, February 14, 2017 — The American College of Physicians (ACP) recommends in an evidence-based clinical practice guideline published today in Annals of Internal Medicine that physicians and patients should treat acute or subacute low back pain with non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation. If drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

Low back pain is one of the most common reasons for all physician visits in the U.S. Most Americans have experienced low back pain. Approximately one quarter of U.S. adults reported having low back pain lasting at least one day in the past three months. Pain is categorized as acute (lasting less than four weeks), subacute (lasting four to 12 weeks, and chronic (lasting more than 12 weeks).(more)

From the American College of Physicians and the American Pain Society

The American College of Physicians and the American Pain Society released joint guidelines on diagnosing and treating low back pain in the October 2, 2007, issue of Annals of Internal Medicine. In 2006, ACP and APS convened a multidisciplinary panel of experts to come up with recommendations for primary care physicians to diagnose and treat low back pain. The recommendations say that clinicians should not routinely order imaging or other diagnostic tests such as X-rays, CAT scans, and MRIs for patients with nonspecific low back pain. They should reserve these tests for patients who have severe or progressive neurologic deficits or suspected underlying conditions, such as cancer or infection.

Landmark decision for the management of chronic low back pain

The University of Pittsburgh Medical Center (UPMC) has adopted landmark guidelines for the management of chronic low back pain.

As of 2012, candidates for spinal surgery under the UPMC Health Plan must undergo a minimum of 3 months of conservative care, including chiropractic and health coaching before surgery is scheduled. This has been implemented in response to the high success rates of chiropractic intervention and the soaring rates of spine surgery.

Gerard Clum, DC, former president of the World Federation of Chiropractic and Life Chiropractic College West, and current executive committee member of the Foundation for Chiropractic Progress, stated, “The UPMC should be congratulated for its leadership is establishing policies to assure that the least invasive and most likely to be successful care strategies, including chiropractic care, are applied for a meaningful period of time before surgical considerations are made. This decision is both an important recognition of the value of chiropractic care in the acute low back pain environment as well as recognition of the clinical and economic downsides to spinal surgery in this situation.”

SOURCE: UPMC Health Plan Policy and Procedure Manual, October 2011: Surgical Management of Low Back Pain
(partial list of considerations prior to spine surgery to determine medical necessity).