When Ron Farabaugh,DC, of Columbus, Ohio received a copy of Aetna's guidelines for acute low back pain, he was astonished to see that there was no mention of manipulation. He immediately contacted the Ohio State Chiropractic Association (OSCA) with his concerns. Because of the national implications of Aetna's guidelines, the OSCA contacted the ACA; in turn, Pat Jackson, ACA vice president of professional development and research, promptly contacted an Aetna representative.
Aetna was informed that the U.S. Agency for Health Care Policy and Research in 1994 published its Acute Low Back Problems in Adults: Clinical Practice Guidelines. Under the rubric of "physical treatments," the multidisciplinary panel's only recommendation was spinal manipulation. Specifically, the panel said: "Manipulation can be helpful for patients with acute low back problems without radiculopathy when used within the first month of symptoms."
Aetna has since reissued its low back pain guidelines with the following statement: "A short course of physical therapy or other spine therapy, such as spinal manipulation or massage, may be beneficial."
"Not a rousing endorsement of manipulation," said a spokesperson from the Ohio State Chiropractic Association, "but it is a step in the right direction when a major insurance company changes its discriminatory practices and adheres to the research literature that has demonstrated manipulation's effectiveness for the treatment of back pain."
