The Council on Chiropractic Guidelines and Practice Parameters' Clinical Compass has published a new clinical practice guideline: "The Role of Chiropractic Care in Providing Health Promotion and Clinical Preventive Services for Adult Patients with Musculoskeletal Pain."1 The guideline, which makes detailed recommendations for primary, secondary, tertiary and quaternary prevention of MSK pain, is the latest guideline from the Clinical Compass, which previously published "Manipulative Therapy of Lower Extremity Conditions," "Chiropractic Management of Low Back Pain and Low Back Related Leg Complaints," "Chiropractic Management of Tendinopathy," and "Management of Chronic Spine-Related Conditions," among others.
Here are the recommendations from the "Phases of Prevention for Chiropractic Management of Musculoskeletal Pain" section of the new guideline:
"Primary prevention of pain: Chiropractic management that includes counseling on exercises or safety measures to decrease the risk of acute injury addresses primary prevention of pain. However, clinical evidence does not currently exist to support the use of spinal manipulation alone for direct primary prevention of any condition or disease.
"Secondary prevention of pain: Chiropractic management that includes spinal manipulation, lifestyle counseling and other non-pharmaceutical approaches may contribute to secondary prevention of pain by shortening the duration of acute pain but little evidence supports spinal manipulation alone in preventing the transition from acute to chronic pain.
"Tertiary prevention of pain: Substantial evidence supports chiropractic management that includes spinal manipulation, lifestyle counseling, and other non-pharmaceutical approaches for tertiary prevention of pain."
The comprehensive guideline also includes recommendations relative to general health promotion and clinical prevention; informed consent, risks and benefits; and screening and counseling for primary, secondary, tertiary and quaternary prevention of disease and disability, providing clinical recommendations on tobacco cessation, weight management, diet / nutrition, physical activity, fall prevention, suicide prevention, firearm safety, infection control and osteoarthritis.
A 65-member Delphi panel approved the guideline during a January-February 2021 consensus process, approving a draft set of recommendations by "a multidisciplinary steering committee with training and experience in health promotion, clinical prevention, and/or evidence-based chiropractic practice." The steering committee "[synthesized] the results of a literature search for relevant clinical practice guidelines and systematic reviews" relative to "appropriate application of clinical preventive services for screening and health promotion counseling within the chiropractic scope of practice."
The complete guideline appears in the Journal of Complementary and Alternative Medicine and can be accessed free of charge by clicking here.
Reference
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
