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Research Review: Spinal Manipulation vs. NSAID (Diclofenac) for Acute Low Back Pain

The purpose of this randomized, double-blinded, placebo-controlled, parallel trial was to compare high-velocity low-amplitude spinal manipulation with chemical treatment. In this case, the chemical treatment was diclofenac, a nonsteroidal anti-inflammatory. The trial also included comparison with placebo. Considering the staggering impact of low back pain, the authors of this trial felt there were too few studies comparing spinal manipulation to nonsteroidal anti-inflammatory drugs or placebo. They aimed to test patient satisfaction and function, time off from work, and rescue medication, specifically.

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Choosing Wisely X-ray Recommendations Reflect Evolving Evidence, Accepted Standards

The first ACA Choosing Wisely® recommendation states: In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain. Some doctors of chiropractic may be surprised that ACA included this recommendation. There are many DCs who are committed to delivery of high-quality patient care that currently take or order X-rays on a majority of their patients because they believe that X-rays are a necessary component of the examination process. There are a number of reasons why this is the case.

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The Evolution of Low Back Pain Treatment

*Member-Exclusive Content* In February 2017, the American College of Physicians (ACP) published a guideline calling for both physicians and patients to consider non-pharmacological options first when treating acute, subacute, and chronic low back pain (LBP).  Specifically, it recommends superficial heat, massage, acupuncture, and spinal manipulation for acute and subacute LBP, and exercise, tai chi, yoga, spinal manipulation and progressive relaxation for chronic LBP.

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