ACP’s new guidelines for the treatment of low back pain

This Harvard article directed me to the American College of Physicians (ACP) article elucidating new guidelines for the treatment of low back pain. Indeed, the Harvard article is a summary of it, and I’d like to provide my own summary for you.


Before I continue, I’d like to comment that I share actual research articles here because journalism is a different form of literature than scientific writing. Thus, it takes a different method of reading to process a research article than a news article. It’s a cognitive exercise to switch between different methods of reading, and you get the added benefit of knowing exactly what the scientists say about their research versus what the journalists say that the scientists say. I think anyone, despite what you studied in school, can learn to read and understand scientific research. It just takes practice.


The ACP provides three recommendations. They even grade their own recommendations, e.g. strong or weak, in addition to evaluating the quality of evidence that resulted in the recommendation.


The first recommendation is for treatment of patients with acute or subacute low back pain. This means that the patient has been experiencing low back pain for less than twelve weeks. The ACP strongly recommends the following treatment:


  • superficial heat
  • massage
  • acupuncture
  • spinal manipulation (That’s chiropractic, folks.)


I will comment that you can seek out of a combination of these forms of care, depending on the time available to you.


The second recommendation pertains to patients who have chronic low back pain. This means the low back pain has been ongoing for twelve or more weeks. The ACP strongly recommends the following:


  • exercise
  • multidisciplinary rehabilitation
  • acupuncture
  • mindfulness-based stress reduction (I wrote a series on this.)
  • tai chi
  • yoga
  • motor control exercise
  • progressive relaxation
  • electromyography biofeedback
  • low-level laser therapy
  • operant therapy
  • cognitive behavioral therapy
  • spinal manipulation (chiropractic, again)


I will not summarize ACP’s third recommendation because it is pharmacological in nature. As a chiropractor, I do not comment on the materia medica. I will, however, note that the ACP only weakly recommends this third, pharmacological recommendation. I think this gives quite a bit of credence to their first two, non-pharmacological recommendations. In particular, I’m honored that the organization doubly recommended chiropractic for treatment of low back pain.


I’d love to hear your thoughts. How would you have summarized ACP’s recommendations? Let me know in the comments, or at your next appointment.

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