Confusion Reigns Down Under

Following the lead of several other countries: Canada, the US, Denmark and Britain, Australia is the latest nation to have developed Guidelines for dealing with the low back pain conundrum. This latest effort is designed to replace the awful previous work that had been conjured up a few years ago in that country without any chiropractic input or thought.

It is quite amazing to me that anyone would attempt to gather together a committee of experts from the field of spinal pain and not a include a single thought from the world's largest group of spine care professionals. Such was the arrogance of organized medicine in Australia when the original draft guidelines were conceived.

Thankfully, this time our profession was included in the process, and as a result, the Guidelines, which cover musculoskeletal pain in general, are much more balanced and realistic. These Australian Guidelines were broader than other countries. They looked at spinal pain: lower back, thoracic (mid-back) and neck, as well as musculoskeletal pains in the shoulder and knee. According to the January 2004 copy of The Chiropractic Report, the publication of these Guidelines are in 3 parts: the full 259 page document with all scientific references, and 2 summaries, one for general practitioners, and one for the public. And, surprizingly, there are major variations between the 3.

The reason these 5 countries developed guidelines for acute spinal pain is basically twofold: to examine the scientific literature and draw out whatever therapies and treatment methods that seem to be effective and safe, and to offer the consumer, the insurance payor who foots the bill, and the practitioner something scientific to go by so that time and money are not wasted on therapies that have little or no value. Sometimes the findings of the committees that draw up these guidelines are shocking. Age old tried and true treatment methods are found to be quite lacking in evidence. Physiotherapy has been particularly hard hit by some of these Guidelines, as much of their traditional work has simply been proven to be ineffective and unsupported by scientific evidence.

Maybe I'm just paranoid, but sometimes it seems that what we chiropractors do with the spine needs to be absolutely and unequivocally supported to be even mentioned by these Guideline committees whereas if a single shred of evidence can be found for medical therapies, however weak the evidence is, that therapy will be included. I guess that's the plight of 'being second and trying harder'.

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