AHCPR AGENCY FOR HEALTH CARE POLICY AND RESEARCH

AHCPR l 1994 US GOVERNMENT STUDY ON ACUTE LOW BACK PAIN IN ADULTS l SPINAL MANIPULATION IS THE MOST EFFECTIVE FORM OF CARE IN THE FIRST MONTH OF ACUTE LOW BACK PAIN

AHCPR l SINCE 94% OF MANIPULATION IS PERFORMED BY CHIROPRACTORS PATIENTS SHOULD BE REFERRED FOR ALL ACUTE LOW BACK PAIN

AHCPR l THREE MAJOR GUIDELINES IN THE STUDY

AHCPR l 1) IF MANIPULATION HAS NOT RESULTED IN SYMPTOMATIC IMPROVEMENT IN 1 MONTH OF TREATMENT, IT SHOULD BE STOPPED AND REEVALUATED. THIS PUTS A DUTY “STANDARD OF CARE” ON THE PHYSICIAN TO PERFORM AN OBJECTIVE EVALUATION

AHCPR l TO DETERMINE FURTHER CARE. SUBJECTIVE IMPROVEMENT IS NOT SUFFICIENT TO JUSTIFY CONTINUATION OF CARE

AHCPR l TWO METHODS OF ASSESSMENT l 1) VAS - DOCUMENT IN PATIENT’S OWN HANDWRITING l 2) OBJECTIVE INDICATORS - ADLS AND OSWESTRY

AHCPR l 2) EVIDENCE SUGGESTS THAT PLAIN FILM X-RAYS ARE RARELY USEFUL IN EVALUATING OR GUIDING THE TREATMENT OF ACUTE LOW BACK PAIN IN THE ABSENCE OF “RED FLAGS”. X-RAYS SHOULD ONLY BE TAKEN AFTER INITIAL ASSESSMENT AND TREATMENT

AHCPR l ROUTINE LOW BACK PAIN DOES NOT WARRANT X-RAYS l NO “RED FLAGS” - NO X-RAYS

AHCPR l WHAT IS A “RED FLAG”? l 1) ARTHRITIS l 2) DISC HERNIATION l 3) PREVIOUS TRAUMA l 4) FRACTURE l 5) TUMOR

AHCPR l SUBLUXATION IS NOT A REASON TO X-RAY

AHCPR l WHEN TO X-RAY IN ACUTE LOW BACK PAIN l 1) TRAUMA - SIGNIFICANT TRAUMA OF ANY AGE PERSON l 2) MILD TRAUMA IN AGE >50 l 3) HISTORY OF PROLONGED STEROID USE

AHCPR l 4) ANYONE OVER AGE 70 l 5) PRIOR CANCER OR SERIOUS INFECTION l 6) DRUG ABUSE l 7) LOW BACK PAIN WORSE WITH REST l 8) UNEXPLAINED WEIGHT LOSS

AHCPR l 3) PATIENT WITH ACUTE LOW BACK PAIN ALONE WITH NEITHER SUSPICIOUS FINDINGS OR SIGNIFICANT NERVE ROOT COMPRESSION NOR ANY (+) RED FLAGS, DO NOT NEED SURGICAL CONSULTATION FOR A LUMBAR DISC

AHCPR l ALWAYS LOOK FOR RED FLAGS IN THE EXAM AND HISTORY ON EVERY PATIENT l THIS PUTS THE DUTY ONTO THE PMD TO REFER NOT TO AN ORTHOPEDIST BUT TO A CHIROPRACTOR

AHCPR l THE USE OF PT AND MODALITIES ARE NOT RECOMMENDED FOR ACUTE LOW BACK PAIN. THIS WOULD INCLUDE ICE, HEAT, DIATHERMY, MASSAGE, ULTRASOUND, T.E.N.S., AND ACUPUNCTURE

AHCPR l YOU SHOULD HAVE WRITTEN IN YOUR CONSENT FORM THAT THESE MODALITIES MAY OR MAY NOT BE BENEFICIAL AND THAT THEY UNDERSTAND THAT YOU STILL WANT TO USE THEM. l ALSO INFORM THEM THAT THEIR INSURANCE MAY NOT PAY