First-line Treatment of Chronic Spinal Pain
Written by Editor   
Friday, October 20, 2017 08:06 AM

Spinal manipulation should be considered as a first-line conservative treatment. It is now suggested as the first-line intervention by current research as not a single study examined in a recent systematic review found spinal manipulation less effective than conventional care.

Decades worth of research outcomes suggests that knowledge and guidelines related to both acute and chronic spinal pain are now available to inform practice.  The implementation of evidence-informed care services for persistent spinal pain have emerged along with published recommendations from recent systematic reviews. For example, exercise, tai chi, yoga, mindfulness-based stress reduction and other psychological therapies, spinal manipulation and massage, acupuncture, nonsteroidal anti-inflammatory drugs (NSAIDs; although less effective than previously reported), duloxetine, tramadol and skeletal muscle relaxants (short-term relief only) seem to have a positive role. 

Yet, commonly encountered treatments, such as passive physical therapies opioids paracetamol, benzodiazepines, systemic corticosteroids, tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants, do not seem to contribute much to outcomes.

The future of persistent pain management is less about doing more research and producing more guidelines but rather implementing existing care frameworks and models of care with a view to obtaining better outcomes for patients at a reasonable cost. 

It is very likely, indeed desirable, that care frameworks and models of care will evolve and be updated every 5–6 years, so stakeholders should keep an eye out and keep themselves informed as to how care services are changing.