JAMA’s Low Back Pain Patient Page

To chiropractic students today, it may seem altogether ordinary (and certainly evidence-based) to recommend chiropractic care for low back pain. The evidence supporting this has been quite strong since at least the mid-1990s. Yet for those of us who remember the days of the boycott and the ethical proscriptions against medical physicians who cooperated in any way with chiropractors, seeing this recommendation in the pages of the Journal of the American Medical Association is a milestone moment.

From my editorial in the current issue of Health Insights Today: 

So why is this news? Ask any chiropractor who’s been in the field for more than a decade or two and they’ll know. When we became chiropractors, and in some cases for long after that, it was taken for granted that JAMA, the official voice of the medical profession, would never publish a handout recommending chiropractic care for any condition. Long after research had demonstrated the effectiveness of spinal adjustments for low back pain (as recognized, for example, by the federal Agency for Healthcare Policy and Research report in 1994), such a recommendation never appeared in the pages of JAMA.

Why now? It’s hard for an outsider to say with certainty, but after a certain point, the consistent  conclusions of all major practice guidelines (including the influential 2007 Low Back Pain Guidelines jointly prepared by the American College of Physicians and American Pain Society) probably became impossible to ignore while seeking to maintain an aura of integrity. In addition, this likely represents a generational change in the medical profession. More and more medical doctors in leadership positions came of age professionally at a time when a fair reading of available research clearly led to the conclusion that spinal manual care (what the new JAMA Patient Page calls “chiropractic therapy”) is in fact helpful for acute, subacute and chronic low back pain.