"Cancel the Chiropractor" -- Australia's Largest Daily Tells Readers

Guidelines developed and funded by the Australian government for an enterprise called the National Musculoskeletal Initiative, have concluded that back pain patients should remain active as possible and be given the assurance that they will recover naturally.

These conclusions were reported by Nikolai Bogduk, BSc(med), PhD, professor of anatomy and musculoskeletal medicine at the University of Newcastle, and member of the chairman's panel of the American Back Society (ABS), before the National Health and Medical Research Council.

The guidelines, which would seem an easy protocol to implement (e.g., "Don't worry, you'll be fine. Just keep moving!) are being put to the test at 13 centers around Australia.

Reporting on the controversial guidelines is medical writer Melissa Sweet of the Sydney Morning Herald, Australia's oldest and largest newspaper. Her article, "Pain in you lower back? Get moving and cancel the chiropractor," published in the March 28, 1998 Saturday edition, opens with this definitive assertion: "Forget about extended bed rest, physiotherapy, surgery, chiropractic and exercise programs. These widely used treatments for acute lower back pain have been rejected."

Clearly, chiropractors, physiotherapists, and surgeons are questioning the guidelines. After Ms. Sweet's blithe dismissal of these options, she gives the physiotherapist and MDs a chance for rebuttal, but, alas, no chiropractor is heard from:

• The chairman of the Manipulative Physiotherapists' Association agrees with the recommendations to reduce x-rays, bedrest and surgery, and with the advice to remain active, but says the guidelines were "based on selective evidence and were biased against nonmedical research," adding that 12 out of 16 recent trials (reviewed in a recent issue of Spine) had found "positive effects from manipulation compared with other treatments."


• An MD spokesman for the Royal Australasian College of Physicians makes the surprising but welcomed admission that surgery for back pain is rarely advisable. The spokesman also notes that the guidelines will be "difficult to sell to patients," not because they are unfounded, but because the patients may perceive the advice as uncaring.

Ms. Sweet reports Dr. Bogduk's contention that "most common treatments and advice for acute lower back pain were not supported by evidence." He offers the verity that the Australian government "could save millions of dollars a year by restricting the use of x-rays for back pain." He then asserts: "You can achieve the same level of outcomes with far less expenditures and technical interventions," and then predicts that "many allied health professionals" (would be) out of business."

So what's going on down under? Well, when it comes to federally-funded low-back pain guidelines, not much.

Editor's note: You may recall that the Chiropractors' Association of Australia completed the first draft of a guideline document (Clinical Parameters of Australian Chiropractic Practice) back in Dec. 1995 during a three-day consensus conference in Canberra.