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F4CP Applauds World Health Organization Recommending Spinal Manipulation Over Drugs or Surgery for Low Back Pain

WHO: Manage Low Back Pain With Non-Pharmaceutical Interventions While Avoiding Opioids, Spinal Injections, and Surgery

In mid-June, the Foundation for Chiropractic Progress (F4CP), the not-for-profit organization dedicated to educating the public about the value of chiropractic care, applauded the recently published recommendations by the World Health Organization (WHO) to manage low back pain initially with non-pharmaceutical interventions, such as spinal manipulation, while avoiding opioids, spinal injections and surgery.

In an article called “Care for Low Back Pain: Can Health Systems Deliver?” and printed in the Bulletin of the World Health Organization, researchers review six sets of updated international guidelines for managing low back pain, pointing out that all recommend avoiding medication, if possible, as a first step. They also highlight that after educating patients about low back pain and urging them to remain active, the second-step care options generally include: therapies such as spinal manipulation, most often performed by a doctor of chiropractic (DC), as well as massage and exercise. International guidelines also prioritize psychological and complementary therapies, such as mindfulness-based stress reduction, yoga, acupuncture and tai chi, over medical and surgical interventions.

“This report confirms what doctors of chiropractic around the world continue to witness in their practices on a daily basis: non-pharmaceutical, non-surgical care approaches to managing general low back pain, such as spinal manipulation and exercise, are vastly superior methods,” said Sherry McAllister, DC, executive vice president of F4CP. “This is an important study that we hope will help continue to expand the worldwide consensus toward managing low back pain patients with safer, more effective and longer-lasting pain relief methods that drive increased mobility.”

Changing the Culture

The article’s authors point out, however, that reaching a worldwide low back pain consensus among all healthcare providers and payers will require a system-wide change involving governments, employers, consumers, professional organizations and other stakeholders. F4CP recommends helping usher in this cultural change by implementing the following steps:

  1. Reduce co-pays for evidence-based, effective treatments such as chiropractic care, acupuncture, and occupational therapy
  2. Decrease unnecessary administrative obstacles, such as medical necessity reviews for these conservative, cost-effective treatments
  3. Refine visit limits to encourage members to make such therapies part of their long-term, chronic pain management strategy, preventing the need for pharmacologic intervention
  4. As authors also note, attempts to reduce opioid prescriptions should be accompanied by adequate access to substance-use disorder services, social programs and evidence-based non-pharmacological approaches to relieve psychological and physical pain.

As patients take advantage of non-pharmacological care approaches and experience better outcomes, cultural expectations and beliefs around managing low back pain will change. Continued research on the efficacy of non-pharmacological approaches to low back pain would also help advance this cultural shift.

For example, a study published in The Journal of Alternative and Complimentary Medicine concluded that adults receiving chiropractic care for low back pain were 55% less likely to fill a prescription for an opioid analgesic in comparison to adults who did not receive chiropractic care. The object of the investigation was to evaluate the association between utilization of chiropractic services and the use of prescription opioid medications. Based on the findings, the F4CP notes that pain management services provided by DCs may allow patients to use lower or less frequent doses of opioids, leading to reduced costs and risk of adverse effects.

DCs Lead in Safe, Effective Low Back Pain Management

DCs are front-line providers for spinal health and well-being, specifically as it relates to the management of back, neck, and headache pain. In addition, DCs are required to receive a minimum of seven years of higher-level education – similar to other healthcare providers. DCs are specifically trained to diagnose, evaluate and provide non-pharmaceutical care and rehabilitation to individuals suffering from acute, subacute and chronic low back and neck pain, headaches, neuro-musculoskeletal and other related conditions.

“It is exciting to be a part of this monumental shift toward evidence-based, safer care for the millions of patients worldwide suffering from low back pain,” said Dr. McAllister. “We urge the WHO to move forward in establishing international guidelines for the condition that advises against ineffective pharmacological and surgical care approaches and embraces drug-free pain management methods, such as spinal manipulation delivered by a doctor of chiropractic.”


F4CP Press Release, “F4CP Applauds World Health Organization Highlighting Spinal Manipulation for Low Back Pain Over Drugs or Surgery,” June 11, 2019

Bulletin of the World Health Organization 2019;97:423-433. doi:

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