Yes to Chiropractic

And no to most drugs, says the World Health Organization (WHO), which recently released its “Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.” The purpose of the document is to “provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP in adults” that will improve outcomes. “Spinal manipulative therapy” which includes chiropractic, is among the interventions the guideline recommends for all adults, including older adults. In addition to spinal manipulative therapy, the guideline is also in favor of structured exercise, acupuncture, massage, and topical cayenne pepper (Capsicum frutescens).

Among the medication interventions the guideline recommends against are opioids, antidepressants (tricyclic, serotonin and noradrenaline reuptake inhibitor), skeletal muscle relaxants, injectable local anaesthetics and pharmacological weight-loss medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) continue to be the only recommended pharmacotherapy.

Acetaminophen, benzodiazepines and cannabis-related pharmaceutical preparations received “no recommendation,” while listing potential harmful effects including “cardiovascular, renal and gastrointestinal harms and increased mortality risk” for acetaminophen; “potential harms including memory impairment, misuse, overdose deaths from respiratory depression, somnolence, fatigue and light-headedness potentially leading to falls” for benzodiazepines; and “evidence of possible adverse events, including harms associated with its nonmedicinal use” for cannabis-related pharmaceutical preparations.

Within the short list of recommended interventions, most chiropractors provide at least three: spinal manipulation, structured exercise and massage. Some also provide acupuncture as part of a multidisciplinary clinic. Thus, it is not hard to conclude that doctors of chiropractic should be the first choice when it comes to chronic low-back pain management.