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Complementary Care: When Is It Appropriate? Who Will Provide It?

Marc S. Micozzi, MD, PhD
[+] Article and Author Information

College of Physicians of Philadelphia; Philadelphia, PA 19103. Requests for Reprints: Marc S. Micozzi, MD, PhD, College of Physicians, 19 South 22nd Street, Philadelphia, PA 19103.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(1):65-66. doi:10.7326/0003-4819-129-1-199807010-00014
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The Agency for Health Care Policy and Research (AHCPR) recently made history when it concluded that spinal manipulative therapy is the most effective and cost-effective treatment for acute low back pain [1]. The 1994 guidelines for acute low back pain developed by AHCPR concluded that spinal manipulation hastens recovery from acute low back pain and recommended that this therapy be used in combination with or as an alternative to nonsteroidial anti-inflammatory drugs [1]. At the same time, AHCPR concluded that various traditional methods, such as bed rest, traction, and other physical and pharmaceutical therapies were less effective than spinal manipulation and cautioned against lumbar surgery except in the most severe cases. Perhaps most significantly, the guidelines state that unlike nonsurgical interventions, spinal manipulation offers both pain relief and functional improvement. One might conclude that for acute low back pain not caused by fracture, tumor, infection, or the cauda equina syndrome, spinal manipulation is the treatment of choice.

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