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New ACP Clinical Practice Guidelines on Nonpharmacologic Treatment for Low-Back Pain

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March 02, 2017
Josephine P. Briggs, M.D.
Josephine P. Briggs, M.D.

Director
National Center for Complementary and Integrative Health

View Dr. Briggs’ biographical sketch

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!

Comments

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This is, indeed, cause for celebration. As someone who has experienced tangible benefits from treatment modalities like BodyTalk, acupuncture, and chiropractic, it is heartening to know that people who were as-of-yet unaware of these as options, will now be guided to try them before being placed on riskier pharmaceutical solutions. I hope that in the future it won’t be this way, but isn’t it ironic that clinicians, by virtue of being MUCH more oriented toward healing/releiving suffering in the patient, end up much less inclined to conduct the very research that would make their practices more broadly/academically accepted?! I hope that the impetus for the heartening article above is a sign that our society is moving in a positive direction… Thank you!

Excellent article, thanks for sharing such information.

Since these alternate treatments are now part of the guidelines, does that mean that they will be covered by medicare and other insurances?

Perhaps driven by the increasing number of side effects including serious ones, from the overuse of epidureals which are used off label for back pain.Google “Arachnoiditis” a inflammation of the arachnoid membrane, and the patient testimonials as well, for a glimpse at the issues.

Certainly it is good to know that someone has benefitted from treatment like Acuupuncture and chiropractic treament. My wife has been suffering with chronic lower back pain for many many years.  We are great believer of alternative medicines, however she has not had any luck som far.  Can the person who benefitted from practising such treatment provide place of treatment with telephone number of the facility.

I see the acupuncture and acupressure works very well. But I don’t understand this technique! 

@Orest. Good question. Because NCCIH is a research agency, we don’t deal with insurance-related issues. However, our fact sheet, “Paying for Complementary and Integrative Health Approaches”(nccih.nih.gov/health/financial), has general information about coverage for complementary health approaches and may be of help to you. Information on Medicare is available from the Centers for Medicare & Medicaid Services (www.cms.gov/). Their handbook, “Medicare & You 2016” ( www.medicare.gov/Pubs/pdf/10050.pdf) explains what services Medicare covers.

@Arun Agarwal. Our “How To Find a Complementary Health Practitioner” page (nccih.nih.gov/health/howtofind.htm) has resources that may help your wife find an appropriate clinic in your area. Our information about complementary health approaches for low-back pain may also be of use (nccih.nih.gov/health/pain/lowback.htm).

@Jose. The effects of acupuncture (a technique in which practitioners stimulate specific points on the body) on the brain and body are only beginning to be understood. NCCIH is continuing to fund research to evaluate acupuncture’s effectiveness for various kinds of pain and other conditions, and to further understand how the body responds to acupuncture and how acupuncture might work. Please visit our “Acupuncture” page (nccih.nih.gov/health/acupuncture) for more information.

This page last modified March 02, 2017