New WHO guidelines provide strong endorsement for chiropractic
The World Health Organization (WHO) launched its Guideline for the Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings.
The WHO Guideline presents a strong endorsement of the EPIC (evidence-based, people-centred, inter-professional and collaborative) pillars that were set out by the World Federation of Chiropractic (WFC) in 2017.
Spinal manipulation, dry needling, a structured exercise program, massage, education and advice were the modalities recommended for use in all patients, including older adults.
TENS, therapeutic ultrasound, traction and lumbar braces/supports were all found not to be of value, with recommendations against their use as part of low back care for adults.
The Guideline was also scathing of most forms of commonly used forms of pharmacological interventions, with only non-steroidal anti-inflammatory (NSAID’s) medication receiving a conditional recommendation.
Opioids, benzodiazepines, antidepressants, anticonvulsants, muscle relaxants, cannabis-related preparations and paracetamol (acetaminophen) all received the thumbs-down, with explicit guideline advice not to use or recommend. No herbal remedies were recommended, with the exception of topical cayenne pepper (capsicum).
The Guideline was supportive of the use of multicomponent biopsychosocial interventions, of shared decision-making and the need to acknowledge patient needs, preferences and context.
Speaking after the launch, WFC Secretary-General Dr Richard Brown commented, “This important WHO Guideline is a strong endorsement of what many evidence-based Chiropractors do in their clinics and offices around the world, every single day.
Chiropractors have consistently high levels of patient satisfaction as a consequence of strong, empathic communication, a hands-on approach, their use of exercise and lifestyle advice, and their support for inter-professional and collaborative care models. The recommendations in this Guideline provide a strong case for Member States to consider integrating chiropractic within health systems at high-, middle- and low-income levels.”
To access the full Guideline, Executive Summary and recommendations, go to
https://www.who.int/publications/i/item/9789240081789