American College of Physicians Recommends Spinal Manipulation as a Primary Treatment for Low Back Pain

The Annals of Internal Medicine just recently published an updated Clinical Practice Guideline for Managing Low Back Pain from the American College of Physicians highlighting spinal manipulation.

In the full guideline titled, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline”, authors reviewed studies related to non-surgical treatments for adults with low back pain including the use of medications as well as other noninvasive treatments. Based on this literature review, they determined “Surgery is rarely needed for patients with low back pain.”  Among the recommendations: Implement spinal manipulation and postpone pharmacologic management.

For most patients with acute (pain lasting less than 4 weeks) and subacute (pain lasting 4-12 weeks), they recommend clinicians and patients initially choose nonpharmacologic treatment such as: heat therapy, massage, acupuncture and SPINAL MANIPULATION. They recommend that medications such as ibuprofen or muscle relaxers be discussed only if these treatments do NOT work.

For patients with chronic pain, recommendations for first options for doctors and patients include exercise, rehabilitation therapy, acupuncture, motor control exercises (exercises to strengthen the back muscles), low-level laser therapy, and SPINAL MANIPULATION.

Again, they do not recommend medications until other options have been tried and failed to offer pain relief. In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. The American College of Physicians’ guideline specifies that “Opioids should be considered only if no other treatments work and only if there are more benefits than risks for an individual patient”.

When assessing the potential harm of various treatments, the guideline concluded that the type of care administered by chiropractors (spinal manipulation, exercise, and massage) posed no serious threat and was associated with only transient “muscle soreness.”

Since its inception, the chiropractic profession has provided a conservative alternative to medications and more invasive procedures. As research methods advance, the solid evidence for the safety and efficacy of chiropractic has grown.

This new guideline represents a growing trend of the health care community to recognize the benefits of conservative care, such as chiropractic, especially for patients with back pain. The chiropractic profession encourages those making health care choices to consider “chiropractic first, medications second, surgery last.”

The guideline also recommends patients discuss alternative treatments with their doctor.  Every patient is different and specific treatment must be geared to the patient’s diagnosis, overall health, lifestyle and risk factors.

Your doctor of chiropractic can offer spinal manipulation as well as therapies and exercises to help you obtain safe and effective pain relief without the risks that are associated with many medications and surgical procedures. Find a doctor of chiropractic near you.


SOURCE: “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain” published at on 14 February 2017.