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Complementary Care: When Is It Appropriate? Who Will Provide It?
- Marc S. Micozzi, MD, PhD
- College of Physicians of Philadelphia; Philadelphia, PA 19103. Requests for Reprints: Marc S. Micozzi, MD, PhD, College of Physicians, 19 South 22nd Street, Philadelphia, PA 19103.
The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain [1]. The 1994 guidelines for acute low back pain developed by AHCPR concluded that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidial anti-inflammatory drugs [1]. At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases. Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.
Because acute low back pain is the most prevalent ailment and most frequent cause of disability for persons younger than 45 years of age in the United States [1], adherence to these practice guidelines could substantially increase the numbers of patients referred for spinal manipulation. Chiropractors provide 94% of spinal manipulation [2, 3]; …
