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April 2013


State Of Oregon Evidence-Based Clinical Guidelines Project Recommends Spinal Manipulation As Nonpharmacological Therapy Alternative For Treatment Of The Acute Phase Of Non-Specific Low Back Pain

This guideline was developed by a collaborative group of public and private partners to provide up-to-date evidence-based guidance on the evaluation and management of low back pain. Their treatment recommendations:

  • Initially, clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self- care options.
  • For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. For most patients, first-line medication options are acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).
  • For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation.

The US Department of Health and Human Services, Agency for Health Care Policy and Research (AHCPR) in their report on Acute Low Back pain of 1994 likewise recommended patient education combined with manipulation or NSAIDS or a combination of the two in the acute phase of care of nonspecific low back pain and sciatica. They also reported that traction was not found to be effective for treating acute low back symptoms.

State of Oregon Evidence-Based Clinical Guidelines Project, Evaluation and Management of Non-Specific Low Back Pain, October 2011

Bigos SJ, et. al. U.S. Department of Health and Human Services, Rockville, Maryland. AHCPR Publication No. 95- 0642, December 1994.

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