Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative

Bussières, André; Stewart, Gregory W.; Zoubi, Fadi Al; Decina, Philip; Descarreaux, Martin; Haskett, Danielle; Hincapié, Cesar A.; Pagé, Isabelle; Passmore, Steven; Srbely, John; Stupar, Maja; Weisberg, Joel; Ornelas, Joseph

doi:10.1016/j.jmpt.2017.12.004

Cited by 95 publications

(92 citation statements)

References 135 publications

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“…Ultimately, this should decrease the psychological and socioeconomic burden of chronic pain. This view is supported by evidence indicating that multimodal interventions are more effective than single modal interventions in, among others, children having chronic pain, adults with chronic nonspecific neck pain, chronic tension‐type headache, low back pain, fibromyalgia, pain following cancer, and osteoarthritis …”

Section: Resultsmentioning

confidence: 92%

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Nijs

D’Hondt

Clarys

et al. 2019

PM&R

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Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually‐tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.

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Section: Resultsmentioning

confidence: 92%

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Nijs

D’Hondt

Clarys

et al. 2019

PM&R

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“…Furthermore, there is no high quality evidence to demonstrate that patient management should be modified based on presence of benign radiographic findings that could not be determined from patient clinical history or exam alone. Current chiropractic clinical practice guidelines do not differentiate between treatment options based on the presence or absence of these benign radiographic findings [ 10 ]. Therefore, based on the evidence, the use of X-ray imaging to diagnose benign spinal findings will not improve patient outcomes or safety.…”

Section: Introductionmentioning

confidence: 99%

Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

et al. 2018

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The use of routine spinal X-rays within chiropractic has a contentious history. Elements of the profession advocate for the need for routine spinal X-rays to improve patient management, whereas other chiropractors advocate using spinal X-rays only when endorsed by current imaging guidelines. This review aims to summarise the current evidence for the use of spinal X-ray in chiropractic practice, with consideration of the related risks and benefits. Current evidence supports the use of spinal X-rays only in the diagnosis of trauma and spondyloarthropathy, and in the assessment of progressive spinal structural deformities such as adolescent idiopathic scoliosis. MRI is indicated to diagnose serious pathology such as cancer or infection, and to assess the need for surgical management in radiculopathy and spinal stenosis. Strong evidence demonstrates risks of imaging such as excessive radiation exposure, overdiagnosis, subsequent low-value investigation and treatment procedures, and increased costs. In most cases the potential benefits from routine imaging, including spinal X-rays, do not outweigh the potential harms. The use of spinal X-rays should not be routinely performed in chiropractic practice, and should be guided by clinical guidelines and clinician judgement.

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“…45 Radicular pain is defined as ectopic nociceptive firing within spinal nerves due to inflammation, mechanical strain, or possible ischemic damage to dorsal root ganglia, resulting in pain perceived in the nerve-supplied territory. 45 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Neurodynamics (neural mobilization) when tolerated 46 Spinal manipulation (thrust and/or nonthrust as tolerated) 10,14,16,39,47 Directional preference exercises 42 Neurogenic claudication: pain caused by intermittent compression and/or ischemia of a single or multiple nerve roots 48 Interventions: Education about the condition 13,[25][26][27][28][29]33,34 Spinal manipulation (thrust and/or nonthrust as tolerated) [49][50][51] Neurodynamics (neural mobilization) [49][50][51] Muscle stretching 49,51 Lumbar mobilization exercise 49,51 Self-management via a cognitive behavioral approach including goal-setting, graded activity, pacing, relaxation, and body positioning techniques to reduce lumbar lordosis 49,51 Home exercises when tolerated 49,51 Comanage with other providers when needed 52 Central sensitization...…”

Section: Consensus Statements: 6 Components Of Multimodal Chiropractimentioning

confidence: 99%

“…13 Alhough guidelines generally describe evidence-based treatments for persons with LBP, they typically do not provide chiropractic management recommendations at a condition level for a range of commonly occurring diagnoses causing or contributing to neuromusculoskeletal LBP. [14][15][16] To address this information gap, the authors searched the scientific literature for evidence to inform chiropractic management decisions for patients with specific known or suspected LBP diagnoses and other factors that contribute to symptom augmentation or perpetuation. The purpose of this research was to develop and present an evidence-based chiropractic, multimodal treatment decision aid for managing LBP in US veterans using a consensus-building Delphi process.…”

Section: Introductionmentioning

confidence: 99%

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

Vining

Shannon

Salsbury

et al. 2019

Journal of Manipulative and Physiological Therapeutics

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Objective: The purpose of this study was to develop a clinical decision aid for chiropractic management of common conditions causing low back pain (LBP) in veterans receiving treatment in US Veterans Affairs (VA) health care facilities. Methods: A consensus study using an online, modified Delphi technique and Research Electronic Data Capture web application was conducted among VA doctors of chiropractic. Investigators reviewed the scientific literature pertaining to diagnosis and treatment of nonsurgical, neuromusculoskeletal LBP. Thirty seed statements summarizing evidence for chiropractic management, a graphical stepped management tool outlining diagnosis-informed treatment approaches, and support materials were then reviewed by an expert advisory committee. Email notifications invited 113 VA chiropractic clinicians to participate as Delphi panelists. Panelists rated the appropriateness of the seed statements and the stepped process on a 1-to-9 scale using the RAND/University of California, Los Angeles methodology. Statements were accepted when both the median rating and 80% of all ratings occurred within the highly appropriate range. Results: Thirty-nine panelists (74% male) with a mean (standard deviation) age of 46 (11) years and clinical experience of 17 (11) years participated in the study. Accepted statements addressed included (1) essential components of chiropractic care, (2) treatments for conditions causing or contributing to LBP, (3) spinal manipulation mechanisms, (4) descriptions and mechanisms of commonly used chiropractic interventions, and (5) a graphical stepped clinical management tool. Conclusion: This study group produced a chiropractic clinical decision aid for LBP management, which can be used to support evidence-based care decisions for veterans with LBP.

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Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative

Cited by 95 publications

References 135 publications

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Current evidence for spinal X-ray use in the chiropractic profession: a narrative review

Development of a Clinical Decision Aid for Chiropractic Management of Common Conditions Causing Low Back Pain in Veterans: Results of a Consensus Process

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