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Dynamic Chiropractic – November 4, 2010, Vol. 28, Issue 23

How to Manage Chronic Pain

CCGPP issues guideline to help direct case management.

By Editorial Staff

The Council on Chiropractic Guidelines and Practice Parameters (CCGPP) has released "Management of Chronic Spine-Related Conditions: Consensus Recommendations of a Multidisciplinary Panel," which the council says "is the first of its kind to truly define chiropractic case management for this specific population of patients." The chronic pain guideline appears in its entirety in the September 2010 issue of the Journal of Manipulative and Physiological Therapeutics.

A press release from the CCGPP underscored the importance of the new guideline: "It provides very clear direction on how to manage and document chronic spine pain care. This paper will also help reduce the administrative and legal issues caused by the historical random and diverse opinions of consultants and treating doctors. Now the entire industry will have access to an evidence-based consensus document developed with strict adherence to guideline development processes."

In reaching consensus on the guideline, a multidisciplinary panel consisting of 24 doctors of chiropractic and five non-DCs (one acupuncturist, two massage therapists, a physical therapist and a medical physician specializing in pain management) reviewed background materials and seed documents such as the CCGPP's "Chiropractic Management of Low Back Disorders," Bronfort, et al.'s "Evidence-Informed Management of Chronic Low Back Pain With Spinal Manipulation and Mobilization," Dehen, et al.'s "Consensus Terminology for Stages of Care: Acute, Chronic, Recurrent and Wellness," and various other materials.

CCGPP Executive Committee members developed 29 seed statements based on these background materials, and RAND/UCLA consensus methodology was utilized to reach consensus on the statements. Consensus was considered achieved for each statement if at least 80 percent of panelists rated the statement "7" or higher based on the scientific evidence and their clinical experience.

According to the council, the guideline provides clear direction on various issues related to the management of chronic pain including treatment options, yellow and red flags (including contraindications for manipulation), complicating factors, comorbidities, and benefits and goals of ongoing care. Maximum therapeutic improvement, prognostic factors, risk factors for transition from the acute phase to chronicity, clinical re-evaluation information, and recommendations regarding treatment, frequency and duration are also presented in detail.

"Management of Chronic Spine-Related Conditions: Consensus Recommendations of a Multidisciplinary Panel" is available online at; access the September 2010 issue contents.

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