Last month, the American College of Physicians (ACP) released new clinical practice guidelines on noninvasive treatments for low-back pain, recommending that clinicians and patients initially select nonpharmacologic treatment as first-line therapy in most cases. It is an important event when the ACP suggests major changes in the treatment of a common clinical problem, and it is especially newsworthy when the problem is something as pervasive and costly as low-back pain and when the guideline includes recommendations to consider interventions as unconventional as tai chi or acupuncture.
Back pain management, as readers of this blog know, is a priority research topic for NCCIH.
So, prompted by this important event, I wanted to share a few thoughts on health care guidelines. NCCIH pays a lot of attention to health care guidelines. They help define the role of specific diagnostic and treatment modalities in the diagnosis and management of patients. Although our Center does not develop or issue guidelines, we use them to help us think about our research agenda and to develop evidence-based information for the public. We also link on NCCIH’s Web site to a wide range of clinical practice guidelines that include information about complementary and integrative health approaches.
I’m proud that some of our Center’s research was used in the development of these guidelines. However, they also serve as a reminder of how much there is left to do. As is emphasized in these guidelines, the evidence for benefit of the complementary practices for back pain is still a work in progress. The Guideline Committee, a group of highly expert clinicians, has made a risk-benefit assessment; the committee has weighed the promise of complementary treatments against the risks of current treatments, particularly overuse of drugs, and come to strong conclusions about what should be recommended to patients.
But their assessment is also important for those of us whose job it is to think about the research gaps. The guideline authors are clear in telling us that the evidence for treatments like massage, acupuncture, spinal manipulation, heat, lumbar supports is far from complete.
So, we have work to do!