Low Back Pain…Danish Style

Increasingly, governments and health organizations around the world are recognizing that the problem of low back pain is enormous, widespread and very costly. Often this realization prompts studies in low back pain, its causes, its costs, current treatments and preventive measures. The motivating reason for conducting such studies is an attempt to ascertain more closely how much this problem does cost and what can possibly be done to contain costs. If cost containment is not readily possible then the examiners seek to discover which treatments or therapies are most effective for low back conditions.

The Scandinavian country of Denmark is the latest to study this problem and has recently released their findings. The Danish Institute for Health Technology Assessment conducted the work and produced guidelines "to manifest today's knowledge on the problem and the most rational way to handle it." The Danish government is committed to ensuring that the results of this study are integrated into their health care system post haste.

A 14 member multidisciplinary panel which included a Danish chiropractor assembled the guidelines. Law in Denmark has incorporated chiropractic only since 1992.

The guidelines are in two volumes. The first volume deals with a comprehensive look at back pain, its various clinical manifestations and complications, its risks, and diagnosis. The second volume deals with the numerous treatments available and identifies the health professionals who work in the field of low back pain.

Under this latter section, one can find chiropractic in the section entitled "The chiropractor in the primary health care sector" Here the scope of chiropractic in the back care field is defined as "diagnosis, treatment and prevention of biomechanical functional lesions for patients suffering from low back pain.".

The Danish guidelines divide treatment recommendations into three areas: (1) treatment that can be generally recommended (2) treatment methods that can be recommended for certain conditions only (3) treatment that cannot be recommended

Treatments that the Danish study could not recommend for low back pain were: corsets and braces, traction, ultrasound, laser therapy and short-wave therapy.

Treatments recommended for only certain conditions include the following: injections generally, including injections into trigger points, facet joints, and epidural areas, massage, acupuncture, hot and cold therapy, back surgery, bed rest, and transcutaneous nerve stimulation (TENS)

Under treatments which can generally be recommended we find what they called manual therapy which includes chiropractic, listed first. It is cited as being an advantage due its effectiveness and "moderate cost". In the guidelines manual treatment is recommended for (a) patients suffering from acute low back symptoms and functional disabilities of more than 2-3 days in duration, (b) as an initial treatment for acute flare-ups of chronic or recurrent back pain, (c) an element of a broader strategy for people with long term back trouble, and (d) as an element of a conservative treatment regime in patients suffering from nerve root irritation and sciatica.

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