The following paper was presented at the 41st Annual Post Graduate Review in Family Medicine, February 2006. It was just published in the August 2006 issue of the Canadian Journal of CME. This issue features the University of British Columbia. Free full text is available. Full issue
Olson DH, Bishop PB. Chiropractic spinal manipulative therapy: international guidelines reviewed. Can J CME 2006; 18(8):76-7.Excerpt: Acute lower back pain is a frequent complaint of patients in a medical practice. Chiropractic spinal manipulative therapy (CSMT) is a commonly utilized treatment modality for patients with acute lower back pain, with over 5.4 million patients consulting a chiropractor in Canada on an annual basis. Recent studies have demonstrated that Canadian family physicians may be unclear on the indications for referring a patient with acute lower back pain for CSMT. In the last decade, 12 countries have independently convened multidisciplinary expert panels to critically review the scientific literature on acute lower back pain. The result has been a remarkably consistent set of clinical practice guidelines, based on sound scientific evidence, rather than on consensus, that are designed to assist family physicians in the management of these patients. Family physicians have been reluctant to adopt these guidelines and it has been demonstrated that there is a poor association between what family physicians believe to be effective for treating patients with acute lower back pain and what has actually been found to be effective. Large scale clinical trials in Canada and Spain have shown that family physician treatment recommendations are highly guideline-discordant. This paper will review these clinical practice guideline recommendations and in particular, will summarize the guideline recommendations for the use of CSMT in the treatment of acute lower back pain. For links to selected chiropractic guidelines, see Practice Guidelines.