American College of Physicians Guidelines on Treatment of Low-Back Pain Recommend Complementary Health Approaches

American College of Physicians Guidelines on Treatment of Low-Back Pain Recommend Complementary Health Approaches

Information Resources

By Evelyn Cunico, MS/LIS
Posted May 27, 2017

In February 2017, the American College of Physicians (ACP) released new clinical practice guidelines on treatments for low-back pain. The title is, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.

The ACP Guidelines on Treatment of Low-Back Pain recommend that physicians should consider turning first to non-medication and non-surgical treatments for patients with low-back pain.

For example, the ACP Guidelines include recommendations for  physicians to consider unconventional interventions, such as, complementary health approaches, including tai chi or acupuncture, before considering current treatments, such as overuse of drugs or surgery.

In general, clinical practice guidelines identify and describe recommended courses of treatment. Guidelines are not statements that must be followed, but are meant for physicians and other primary care providers to consider.

The ACP Guidelines are clear that the evidence for the benefit of complementary practices for back pain is a work in progress.

Still, the ACP Guidelines are very important, because ACP is suggesting major changes in the treatment of a common and costly clinical problem.

Low back pain is one of the most common reasons for physician visits in the United States, according to the ACP Guidelines. Most Americans have experienced low-back pain. The total costs of low-back pain in the United States exceed $100 billion per year. Two-thirds of these costs are indirect, due to lost wages and reduced productivity.

The ACP Guidelines relied in part on research conducted by the National Center for Complementary and Integrative Health (NCCIH), which is the National Institute of Health (NIH) agency with primary responsibility for research on promising health approaches that already are in use by the American public.

For information from NCCIH on health care guidelines, visit the March 02, 2017 NCCIH Research Blog, titled, New ACP Clinical Practice Guidelines on Non-pharmacologic Treatment of Low-Back Pain, by NCCIH Director Josephine P. Briggs, M.D.

For more information on low-back pain, see the Selected Information Resources following this blog post.

Editorial note: By definition, Acute back pain lasts less than four weeks. Subacute back pain lasts four to twelve weeks. Chronic back pain lasts more than twelve weeks.

Disclaimer: The information presented in this blog should not replace the medical advice of your medical doctor. You should not use this information to diagnose or treat any disease, illness, or other health condition without first consulting with your medical doctor.

Selected Information Resources

American College of Physicians. Annals of Internal Medicine. Clinical Guidelines. April 04, 2017. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians
Summary Note: Published: Annals of Internal Medicine. 2017;166(7):514-530. DOI:10.7326/M16-2367. Published at www dot annals dot org on 14 February 2017.
(Accessed 06 Ma7 2017)

Devo, RA, Mirza, SK, Martin, BI. Back Pain Prevalence, and Visit Rates: Estimates from U.S. National Surveys, 2002. Spine. 2006 Nov. 1;31(23):2724-7.
Summary Note: Summary of published data from the 2002 National Health Interview Survey (NHIS) on the prevalence of back pain, and comparison with earlier surveys. Results show that about one-quarter of U.S. adults report low-back pain in the past three months.
(Accessed Abstract 24 May 2017)

Katz, JN. Lumbar Disc Disorders and Low-Back Pain: Socioeconomic Factors and Consequences. The Journal of Bone and Joint Surgery. American volume. 2006 April;88 Suppl. 2:21-4.
Summary Note: Discusses socioeconomic risk factors for low-back pain in the United States. Examines total costs of low-back pain, including indirect costs due to lost wages and reduced productivity. As costs exceed $100 billion per year, underscores importance of identifying strategies to prevent low-back pain disorders.
(Accessed Abstract 24 May 2017)

Mayo Clinic. Healthy Lifestyle. Adult Health. Back Pain at Work: Preventing Pain and Injury.
Summary Note: Discusses factors that contribute to back pain in various types of work environments. Suggests ideas on how to help prevent pain at work.
(Accessed 22 May 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Five Things to Know about Chronic Low-Back Pain and Complementary Health Practices
Summary Note: Discusses what the science says about various complementary treatment options for chronic low-back pain.
(Accessed 06 May 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. NCCIH Research Blog. March 02, 2017. New ACP Clinical Practice Guidelines on Non-pharmacologic Treatment for Low-Back Pain.
Summary Note: Josephine P. Briggs, M.D., Director, National Center for Complementary and Integrative Health, discusses the Guideline titled, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians, published online on 14 February, 2017.
(Accessed 06 May 2017)

National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Handout on Health: Back Pain.
Summary Note: The National Institute of Arthritis and Musculoskeletal Diseases is the primary NIH organization for research on back pain. Consumer Handout describes back pain causes, diagnosis, treatments, and research efforts.
(Accessed 23 May 2017)

National Institutes of Health. U.S. National Library of Medicine. MedlinePlus Back Pain.
Summary Note: Resource includes links to more than 100 reliable websites. Subheadings include Diagnosis, Prevention, Treatments, Videos, Statistics, Clinical Trials, Journal Articles, Women, and Children. Sections also include, Find an Expert, Patient Handouts, and Medical Encyclopedia.
(Accessed 24 May 2017)

National Institutes of Health. U.S. National Library of Medicine. MedlinePlus. Medical Encyclopedia. Taking Care of Your Back at Home
Summary Note: Article offers tips on how to handle back pain, including lists of activities that should be practiced or avoided during back pain recovery at home.
(Accessed 12 March 2017)

 

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Tips on Selecting a Complementary Health Practitioner

Tips on Selecting a Complementary Health Practitioner

Information Resources

By Evelyn Cunico, MA, MS/LIS
Posted April 25, 2017

Background

More than 30 percent of adults and about 12 percent of children use complementary health care approaches, according to the National Health Interview Survey (NHIS) for 2012.

However, there is evidence that persons who use complementary health approaches often do not discuss their use with their medical doctors. Instead, persons often rely on other sources, including family and friends, practitioners of complementary health approaches, the Internet, popular magazines, and advertising.

The National Center for Complementary and Integrative Health (NCCIH), which is the Federal Government lead agency for scientific research on complementary health approaches, reminds you that, if you are considering going to a complementary health practitioner, you should tell your medical doctor and other health care providers.

Talking with all of your health care providers will help you to select a complementary health practitioner that is appropriate for your specific medical condition.

Selecting a Complementary Health Practitioner

NCCIH has published a fact sheet titled, Six Things to Know When Selecting a Complementary Health Practitioner

One of the six things in the fact sheet is: Tell all of your health care providers (for example, medical doctor, registered dietitian, pharmacist) about all of the complementary approaches you use.

The reason that you need to tell all of your health care providers about your complementary care is that health conditions can affect the safety of complementary approaches. For example, if you have glaucoma, some yoga poses may not be safe for you.

Keeping your health care providers fully informed helps you to stay in control and to manage your health.

For more information, see the Selected Information Resources at the end of this blog post.

Disclaimer: The information presented in this blog should not replace the medical advice of your medical doctor. You should not use this information to diagnose or treat any disease, illness, or other health condition without first consulting with your medical doctor.

Selected Information Resources

National Institutes of Health. National Center for Complementary and Integrative Health. Complementary, Alternative, or Integrative Health: What’s in a Name?
Summary Note: Fact sheet defines terms. Bar graph shows the ten most common complementary health approaches among adults, based on the 2012 National Health Interview Survey (NHIS).
(Accessed 17 April 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Credentialing, Licensing, and Education
Summary Note: Fact sheet provides an overview of the credentialing of practitioners. One section gives examples of how Licensing Requirements for Complementary Health Practitioners vary from state to state and different practices.
(Accessed 17 April 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Four Tips: Start Talking with Your Health Care Providers about Complementary Health Approaches
Summary Note: Tips on how you can begin a conversation with your health care provider about complementary health approaches.
(Accessed 17 April 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Six Things to Know When Selecting a Complementary Health Practitioner
Summary Note: Tips help to guide your search for a complementary health practitioner.
(Accessed 17 April 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Tips on Complementary Health Practices
Summary Note: Tips help you to understand a therapy’s potential benefits, risks, and scientific evidence, so that you can make informed decisions about health care approaches that are best for your own medical condition.
(Accessed 17 April 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. National Health Interview Survey (NHIS) for 2012. Use of Complementary Health Approaches in the U.S.
Summary Note: Highlights key facts about the use of Natural Products and Mind and Body Approaches by American adults and children. One section includes NHIS findings about consumer spending and insurance for complementary health approaches.
(Accessed 24 April 2017)

 

Use Dietary Supplements Wisely

Use Dietary Supplements Wisely

Information Resources

By Evelyn Cunico, MA, MS/LIS
Posted March 08, 2017

Background

Many Americans take dietary supplements in an effort to stay healthy. Although high-quality clinical trials (studies in people) have confirmed the benefits of some dietary supplements, key questions remain about the safety and usefulness of others.

Some supplements can play an important role in health. For example, Calcium and Vitamin D are important for keeping bones strong. Pregnant women can take the Vitamin Folic Acid to prevent certain birth defects in their babies.

Some other dietary supplements have been shown to cause serious harm. For example, the herbs Comfrey and Kava can cause severe damage to the liver.

Still other dietary supplements have not gone through high-quality clinical trials, so there is not enough scientific evidence to support their use.

One reason for limited clinical trials is that large carefully controlled medical studies are costly. Clinical trials for conventional drugs are often funded by large companies that develop and sell prescription drugs. Fewer resources are available to support scientific research on many dietary supplements.

Federal Regulation of Dietary Supplements

The Federal Government regulates dietary supplements through the U.S. Food and Drug Administration (FDA). However, the regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs.

A manufacturer of a dietary supplement does not have to provide the FDA with data that demonstrate the safety of the product before it is marketed. In contrast, manufacturers of drugs have to provide the FDA with evidence that their products are both safe and effective before the drugs can be sold.

Unlike drugs, supplements are not intended to cure, diagnosis, prevent, or treat diseases. This means that supplements should not make claims, such as, reduces pain, or treats heart disease. Claims like these can be made legitimately only for drugs, not dietary supplements.

How to Take a Dietary Supplement as Safely as Possible

A reliable, free, and up-to-date consumer source for information about health issues is the website of MedlinePlus, produced by the National Library of Medicine, the world’s largest medical library.

MedlinePlus publishes health topic pages that you can visit to learn about conditions, diseases, and wellness issues.

For example, the MedlinePlus topic page for Dietary Supplements explains how to take a supplement as safely as possible.

  • Tell your health care provider about any dietary supplements you use.
  • If you are going to have surgery, it is particularly important that you talk with your medical doctor about the dietary supplements that you take.
  • Do not take a bigger dose than the label recommends.
  • Read trustworthy information about the supplement.

National Center for Complementary and Integrative Health

The National Center for Complementary and Integrative Health (NCCIH) was established to conduct research on the usefulness and safety of complementary and integrative interventions, including dietary supplements, and to make the findings available to the public.

The NCCIH has published a free online fact sheet, called Using Dietary Supplements Wisely. The fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

If you are considering taking a dietary supplement, talk first with your conventional medical doctor. He or she can access information to help you to understand possible risks and benefits before you buy and use a dietary supplement.

Disclaimer: The information presented in this blog should not replace the medical advice of your conventional medical doctor. You should not use this information to diagnose or treat any disease, illness, or other health condition without first consulting with your conventional medical doctor.

Selected Information Resources

National Health Interview Survey 2012. Use of Complementary Health Approaches in the U.S.
Summary Note: The 2012 National Health Interview Survey provides the most comprehensive information on the use of complementary health approaches in the United States.
(Accessed 06 March 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Five Myths about Popular Natural Products Marketed for Disease Prevention and Wellness
Summary Note: Fact sheet with brief statements about popular beliefs that are myths, related to specific Natural Products.
(Accessed 04 March 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Herbs at a Glance.
Summary Note: Series of fact sheets providing evidence-based information on 50 herbs and botanicals. Fact sheets include common names, potential side effects, what the science says, and resources for more information
(Accessed 04 March 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Understanding Drug-Supplement Interactions
Summary Note: Series of 13 slides asks you true or false questions, followed by correct answers, about your understanding of interactions between dietary supplements and prescription or over-the-counter drugs.
(Accessed 04 March 2017)

National Institutes of Health. National Center for Complementary and Integrative Health. Using Dietary Supplements Wisely.
Summary Note: Fact sheet written in plain language to help you to decide whether a dietary supplement is safe or useful. Nine subheadings include Key Points, Safety Considerations, and References. Emphasis is on the need to talk with your doctor before you buy a dietary supplement.
(Accessed 05 March 2017)

National Institutes of Health. National Institute on Aging. Health and Aging. AgePage. Beware of Health Scams.
Summary Note: Explains why people fall for false sales pitches. Advises how to protect yourself from health scams. Lists helpful resources with addresses and phone numbers. Topic focus is on health and aging, but relevant for adults of any age.
(Accessed 04 March 2017)

National Institutes of Health. U.S. National Library of Medicine. MedlinePlus. Dietary Supplements.
Summary Note: Good place to begin learning about the benefits and risks of dietary supplements, with subheadings on Definitions, What You Need to Know, and Specifics on various types of dietary supplements. Includes separate sections on Children, Teenagers, Seniors, and Women.
(Accessed 08 March 2017)

National Institutes of Health. Office of Dietary Supplements.  Botanical Dietary Supplements.
Summary Note: Explains that the word, natural, on a product label does not necessarily mean, safe. And, the word, standardized, on a label does not necessarily indicate product quality. Encourages you to talk with your healthcare providers (medical doctor, registered dietician, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health.

U.S. Food and Drug Administration. Dietary Supplements: What You Need to Know.
Summary Note: Explains benefits and risks of dietary supplements. Suggests how to be a Smart Supplement Shopper. Steps on how to Report Problems to the FDA.
(Accessed 08 March 2017)