New Neck Pain Best Practices Guideline in Development
Dynamic Chiropractic Staff
The Clinical Compass (originally the Council on Chiropractic Guidelines and Practice Parameters – CCGPP) recently issued a call for interested DCs to help shape a new best practices guideline for chiropractic care of neck pain. The Delphi method is being utilized, meaning it will solicit "the opinions of experts through a series of carefully designed questionnaires interspersed with information and opinion feedback in order to establish a convergence of opinion."
The Clinical Compass, which had completed selection of Delphi panel members as of Aug. 31, explains the rationale underlying the necessity for this project as follows:
While we know Clinical Practice Guidelines (CPG's) are the holy grail of the research hierarchy, we also know that there is still a lot of work to do to understand our interventions and their subsequent outcomes for patients. Absence of evidence does NOT mean absence of effectiveness. The practical application? Recently two of the largest insurance companies made medical policy decisions EXCLUDING common treatments in a chiropractic office. Because there are no CPG's around these interventions, the insurance companies are inappropriately denying payment. A BPG [Best Practice Guideline] helps to solve these enormous injustices.
For additional information regarding this important project, including an explanation of the project and an orientation to the Delphi process, visit www.clinicalcompass.org.
While cervical disc pathology can unquestionably produce radiculopathy, many patients presenting with arm pain, paresthesia or perceived weakness do not exhibit the clinical behavior of true nerve-root compromise. In these cases, failure to differentiate the primary pain generator may lead to unnecessary spinal injections, nerve ablation procedures or surgical consultation despite limited likelihood of benefit.
The New Jersey Board of Chiropractic Examiners has made a precedential decision, concurring with the Association of New Jersey Chiropractors' (ANJC) position paper on chiropractic X-ray guidelines. In plain terms, the board ruled, consistent with the ANJC position, that insurance companies cannot use medical X-ray rules or recommendations, like those written by the American College of Radiology (ACR), to decide whether a chiropractor's X-ray was necessary.
For decades, chiropractors have been told the answer to more professional referrals is simple: educate medical doctors about chiropractic. There is some truth in that advice; but it is also incomplete. The modern challenge is not simply getting another healthcare professional to know that chiropractors exist. It is becoming the kind of clinician (and building the kind of professional relationship) that makes collaboration easy and sustainable.
