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Complementary/Alternative Treatment of Back Pain

Boyd R. Buser, D.O., FACOFP Pikeville, Kentucky, USA October 23, 2009. Complementary/Alternative Treatment of Back Pain. Published reports indicate 50 – 69% of persons with low back pain have utilized CAM Includes : Spinal Manipulation (and other manual therapies) Acupuncture Yoga

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Complementary/Alternative Treatment of Back Pain

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  1. Boyd R. Buser, D.O., FACOFP Pikeville, Kentucky, USA October 23, 2009 Complementary/Alternative Treatment of Back Pain

  2. Published reports indicate 50 – 69% of persons with low back pain have utilized CAM Includes: Spinal Manipulation (and other manual therapies) Acupuncture Yoga Prolotherapy And many others… Use of CAM in back pain is widespread

  3. Various clinical practice guidelines recommend: Spinal Manipulation Acupuncture Massage Yoga Heat Exercise Evidence of efficacy is varied

  4. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 2007; 147:478-491 (US) Spinal Manipulation/Manual Therapy

  5. Acute Low Back Problems in Adults. Agency for Health Care Policy and Research (AHCPR) – 1994, US Low back pain, Early management of persistent non-specific low back pain. National Institute for Health and Clinical Excellence (NICE) – 2009, UK Spinal Manipulation/Manual Therapy

  6. Techniques used and frequency of treatment are varied Often combined with other treatments Spinal Manipulation/Manual Therapy

  7. Chiropractic Predominantly “manipulation,” i.e., short amplitude, passive thrust Osteopathic In the US, D.O.’s provide full-scope medical care OMT includes many “non-manipulative” techniques Physiotherapy Wide variety of manual therapeutic approaches Spinal Manipulation/Manual Therapy

  8. In the US, highly regulated In many developing countries, manual therapies fall outside existing regulation Spinal Manipulation/Manual Therapy

  9. May 2002: WHO launched the WHO Traditional Medicine Strategy: 2002-2005 Four major objectives, including promoting proper use of Traditional Medicine (TM), and CAM WHO planned development of basic training guidelines for manual therapies Spinal Manipulation/Manual Therapy

  10. To provide minimum requirements for training To serve as a reference for national authorities for examination and regulation To review contraindications and ensure safe practice of manual therapies Purpose of WHO Guidelines

  11. WHO Guidelines on Basic Training and Safety in Chiropractic published in 2005 Three other manual therapy guidelines awaiting publication Legal Status of Manual Therapies also in process Current status of WHO Guidelines

  12. CAM is highly utilized for back pain Evidence base needs further development Are some approaches more effective? Appropriate “dosage”? Safety? Further regulation is needed for appropriate use/patient safety Conclusions

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