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New guidelines in spine care

Low back pain is epidemic in the nation with nearly 100 million sufferers that has led to the pandemic of prescription opioid painkiller abuse. Medical officials at the CDC and NIH as well as professional health associations have recently changed their guidelines to manage this pandemic of back pain and opioid addiction.

On Feb. 14, the American College of Physicians updated its clinical guidelines on the management of back pain, “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.”

Overall, the ACP guidelines emphasize nondrug conservative “hands-on” treatments such as spinal manipulation and therapeutic massage as first-line treatments. The guidelines also state over-the-counter nonsteroidal anti-inflammatories or muscle relaxants should be considered only after nondrug therapy fails. The ACP guidelines strongly discourage the use of opioids for chronic pain as did the CDC guideline released last year.

This new guideline comes on the heels of other significant medical studies on low back pain:

In 2010 the North American Spine Society also recommended spinal manipulation— five to 10 sessions over two to four weeks — should be considered before surgery.

In 2012 the NASS also found “patients with lumbar radiculopathy due to lumbar disc herniation, 60 percent will benefit from spinal manipulation to the same degree as if they undergo surgical intervention. For the 40 percent that are unsatisfied, surgery provides an excellent outcome.”

The FDA found off-label use of epidural steroid injections to be no better than placebo, sometimes dangerous such as loss of vision, stroke, paralysis and death, and ESI have never been approved by the FDA for back pain.

Recent research found Ibuprofen to be no better than placebo for back pain and can increase heart attack risk by 31 percent.

New research also found Pregabalin (Lyrica) for acute and chronic sciatica was no better than placebo; in fact, the incidence of adverse events was significantly higher in the pregabalin group than in the placebo group.

Researchers now suggest 50 percent of low back pain and 69 percent of neck pain is joint pain, which explains why spinal manipulation and other manual therapies that restore normal joint motion work so well for both pain control and functional improvement.

This revelation is a big problem considering over 60 percent of prescription opioid use involves various musculoskeletal disorders, such as chronic low back (30 percent) and neck pain (5.2 percent), extremity pain (22.5 percent) and headaches (4.1 percent), conditions that chiropractors may help with nondrug treatments.

Dr. Scott Boden, director of the Emory Spine Center noted: “Many, if not most, primary medical care providers have little training in how to manage musculoskeletal disorders.” He suggested “The best thing is to have an organized, integrated approach that uses state-of-the-art and cost-effective care.”

People suffering from back pain should consider following the new guidelines and seek nondrug help from a local chiropractor before using any drugs, shots, or spine surgery.

J.C. Smith, M.A., D.C. is a practicing chiropractor in Warner Robins.