Updated guidelines for low back disorders
Here are key changes in updated evidence-based guidelines for low back disorders from the American College of Occupational and Environmental Medicine (ACOEM):
- Inclusion of numerous disorders including acute, subacute, and chronic low back pain, radicular pain syndromes, spinal stenosis, spinal fractures, sacroilitis, and spondylolisthesis.
- Detailed recommendations regarding the use of appliances such as lumbar supports and magnets, skilled non-medical therapies of massage and manipulation, ultrasound, low level laser therapy, electrical therapies, and acupuncture.
- An in-depth review of medications and injection therapies to treat low back disorders.
- A review of surgical procedures on the low back, including discectomy, spinal fusion, disc replacement, and implantable spinal cord stimulators.
- For the new guidelines, a more meticulous, strength-of-evidence rating methodology was used, with nearly 1,400 references, compared to 150 references in the previous version.
If a particular state mandates that the ACOEM guidelines are presumptive correct treatment for workers' compensation patients, the guidelines fully acknowledge that in some cases alternative treatments outside the recommended course of action may be warranted, says James B. Talmage, MD, chair of the ACOEM's spine panel and a physician at the Occupational Health Center in Cookeville, TN. Currently, California and Nevada have adopted the practice guidelines, and Michigan, New York, Kentucky, and Tennessee are considering adopting them.
ACOEM's position is that the guidelines should not be used as absolute mandates, says Patrick O'Connor, director of government affairs. "Any time a provider has reason to vary from the guidelines and recommend a treatment that goes outside the guidelines, that should be given every consideration. There should be an opportunity for that provider to make his or case in support of that treatment."
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For more information on the updated low back guidelines, contact:
- James B. Talmage, MD, Occupational Health Center, Cookeville, TN. Phone: (931) 526-1604. Fax: (931) 526-7378 E-mail: [email protected].
- Single copies of the chapter on low back disorders contained in Occupational Medicine Practice Guidelines: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, Second Edition may be pre-ordered for $49.95 for members of the American College of Occupational & Environmental Medicine and $59.95 for non-members. To order a subscription to the online version, call (800) 441-9674.
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