A guidelines development committee consisting of members of the Canadian Chiropractic Association (CCA) and the Canadian Federation of Chiropractic Regulatory Boards (CFCRB) has succeeded in developing a series of chiropractic clinical practice guidelines on the treatment of a specific type of neck pain. Titled "Evidence-Based Treatment of Adult Neck Pain Not Due to Whiplash" and published in the September 2005 issue of the Journal of the Canadian Chiropractic Association, the guidelines represent the latest in the chiropractic approach to the care of adults with acute or chronic neck pain, with particular attention paid to the treatment aspect of chiropractic care.
In a statement on the CCA's Web site, the guidelines' authors emphasize that the document should not be considered "a standard of care or practice" for the treatment of neck pain. Rather, it comports a large body of previously uncollected information on the subject into a reasonably sized, user-friendly format, which leads to the conclusion that "manipulation is a validated part of chiropractic care."
"This CPG focuses on treatment, and does not explore fully the available systems of assessment," they write.
"The recommendations in this CPG were made with the caveat that it is each chiropractor's responsibility to implement the appropriate risk-management procedures when implementing the treatment recommendations."
In all, the guidelines include more than three dozen "explicit practice recommendations" related to the treatment and risk management of non-whiplash-related adult neck pain. In addition, the guidelines list 10 "unimodal treatments" that appear to offer relief from neck pain, along with seven "multimodal treatments" that provide some measure of relief.
Upon publication, Dynamic Chiropractic contacted the CCA and the CFCRB to comment on the importance of the neck pain guidelines and their potential impact on the chiropractic profession. In response, the following statement was submitted by Dr. Wanda Lee MacPhee, president of the CFCRB.
| Statement From Wanda Lee MacPhee, BSc, DC President, Canadian Federation of Chiropractic Regulatory Boards "This newly published clinical practice guideline on chiropractic treatment of acute and chronic neck pain is the first product of our state-of-the-art process for guidelines, including an exhaustive search of all levels of evidence in the literature base, extensive profession-wide review and consultation, as well as robust standards of publication. "This document clearly demonstrates the value of chiropractic treatments in caring for patients with acute and chronic neck complaints. It also represents a thorough review of recent safety concerns regarding cervical manipulation. Now we can state with confidence that the efficacy and safety of chiropractic care for cervical spine pain is supported by the evidence base available. "This is not a 'cookie-cutter' template for clinicians, but rather a tool to add to their expertise and clinical experience. The document offers chiropractors and their patients a clinically oriented synopsis of the current literature to update and enhance their patient care. This is also a great tool for the chiropractic research community to identify areas where future endeavors could most benefit the profession and the public. Clearly, the entire scope of chiropractic cannot be summarized in any one guideline. Further CPGs are underway related to whiplash and headache treatment, with future topics planned to include structural correction, lower back pain and (the) vertebral subluxation complex." | |
Guidelines Also Available Online
In addition to appearing in the Journal of the Canadian Chiropractic Association, the complete version of "Evidence-Based Treatment of Adult Neck Pain Not Due to Whiplash" is available online for practitioners to review free of charge. To access the guidelines, visit www.ccachiro.org/cpg to read both the published and unpublished draft versions.
