Monday, January 5, 2015

Still Waiting

I has now been 21 years since the Federal Government came out with guidelines for the treatment of acute lower back pain in adults.  It was researched by a group called the Agency for Healthcare Policy and Research or AHCPR.  Their task was to find out the best and most efficient ways to treat common medical conditions such as lower back pain.  In lower back pain it recommended non steroid antiinflammatory medication, spinal manipulation, and exercise as the most effective treatments.

Today research continues to show that these three treatments are the best option for lower back pain.  A guideline from 2007 in the Annal of Internal Medicine suggested the same treatments to be the most effective treatments for lower back pain.  Here is a link to the study from the National Institutes of Health.  In 2010 a research article from the journal Spine suggested the same treatments.  They recommended NSAID and spinal manipulation for acute lower back pain and the addition of exercise for chronic back pain.  Here is a link from the NIH  And finally this is another study from 2010 which states that when MDs and DCs used lower back treatment guidelines that patients had "significant improvement in condition specific functioning.  Here is a link to the study
Why talk about an old study?  Well I have a friend who has lower back pain and was prescribed 3 opioid pain medications, 2 muscle relaxers, and two anti inflammatory medications for his lower back.  All the current (and past evidence) guidelines have not shown these types of treatments to be effective at all. In fact they are harmful.   No one has mentioned spinal manipulation or exercise for this patient.  Sadly with the AHCPR its funding was killed by Congress in 1998 after a group of spinal surgeons got mad that it suggest the lower back surgery was often unnecessary and harmful.
So here we are 21 years later still using ineffective and dangerous treatments in the treatment of lower back pain.  Hope I don't have to wait another 21 years for people to do the right thing?