Denmark Produces Low Back Pain Guidelines - Chiropractic Recommended

By Editorial Staff

The Danish Institute for Health Technology Assessment (DIHTA) has published low back pain guidelines "to manifest today's knowledge on the problem and the most rational way to handle it." The Danish National Board of Health is not only dedicated to establishing guidelines, but serious about seeing them applied, as indicated by this published statement:

Denmark will ensure that international HTA (health technology assessment) initiatives are monitored and the results applied to the Danish National Health Services."

The guidelines, Low-Back Pain: Frequency, Management and Prevention from an HTA Perspective, were produced by a 14-member multidisciplinary panel, which included Peter Kryger-Baggesen,DC, representing the Danish Chiropractors' Association (DCA).

Chiropractic, which received it authorization in Denmark in 1992, is flourishing. According to Henrik Laugesen,DC, president of the DCA, the chiropractic profession in Denmark cannot meet the demand for chiropractic.

The guidelines are divided in two volumes. The first volume gives a thorough discussion of back pain, its risks and diagnosis. The second volume deals with the treatment parameters and identifies the health professions that treat patients with low back pain.

Under the section "The chiropractor in the primary health care sector," the scope of chiropractic practice is delineated: "diagnosis, treatment and prevention of biomechanical functional lesions for patients suffering from low back pain." The Danish guidelines stratify their recommendations into three areas:

treatment that can be generally recommended
treatment methods that can be recommended in certain conditions
treatment that cannot be recommended

Those treatments not recommended include: corsets, traction, ultra sound, laser and short-wave therapy.

Treatments recommended only for certain conditions include: injections; trigger point injections; facet joint injections; epidural injections; acupuncture; massage; heat/cold therapy; back surgery; bed rest; and transcutaneous nerve stimulation.
Under "treatments which can generally be recommended," manual therapy (which includes chiropractic) is the first listed. It is cited as having "moderate costs" with the following recommendations:

Manual treatment can be recommended for patients suffering from acute low back symptoms and functional limitations of more than 2-3 days duration.
Manual treatment can be recommended as an initial treatment for acute exacerbations of recurrent or chronic low back pain and functional limitation.
Manual treatment can be considered as an element of a broader strategy for chronic low back trouble.
Manual treatment can be considered as an element of a conservative treatment regime in patients suffering from nerve root irritation, taking into account the previously mentioned contradictions.

The only other generally recommended treatments were: back school; ergonomics; McKenzie exercise therapy; exercise therapy; and pain relieving medication.

Denmark joins a growing list of countries that have examined the scientific literature and found sufficient evidence to recommend chiropractic for low back pain. While it is understood chiropractic is effective for more than just back pain, this is an important step in establishing chiropractic's value and place in each country's health care system.