The American Chiropractic Association (ACA) commends a new effort by the American College of Physicians (ACP) to steer patients with back pain, as well as their doctors, to chiropractic and other low-cost, "high value” treatments before opting for more expensive choices such as surgery. The campaign’s message reinforces ACA’s longstanding recommendation of cost-effective, conservative care as a first line of defense against pain.
This is not the first time that ACP’s evidence-based guidelines have supported the use of conservative care for conditions such as chronic lower back pain. In 2007, the Annals of Internal Medicine published low-back pain guidelines developed by the American Pain Society and the American College of Physicians recommending that, for patients who do not improve with self-care, doctors should consider non-pharmacologic therapies such as chiropractic care, massage therapy and acupuncture.
ACP’s latest campaign, launched in mid-April, features a brochure about treating lower-back pain. The brochure states that imaging tests, which were found to be costly and often unnecessary, can lead to needless back surgery. In fact, surgery was named as a last resort—after all conservative options are exhausted. Patients were, however, advised to consent to imaging tests if they have signs of severe or worsening nerve damage or of a serious underlying problem.