Haldeman, Scott; Bracher, Eduardo Sawaya Botelho

doi:10.1590/S1808-18512013000100001

EDITORIAL

The Brazilian Orthopedic Society and World Federation of Chiropractic: a new scientific partnership

The recently published multinational Global Burden of Disease 2010 study listed low-back pain (LBP) and neck pain as the first and fourth leading causes of disability worldwide, and as a group musculoskeletal disorders are second only to mental and behavioral disorders as a cause of disability¹. Back and neck pain combined have a greater impact on global health than HIV/AIDs, malaria, lower respiratory infections, stroke, breast and lung cancer combined, Alzheimer's disease or diabetes. Spinal pain now is recognized as imposing an enormous and growing cost to individuals. It is increasing recognition that current models for the management of patients with spinal pain have not been very effective and there have been many calls for improved management.

This has led to a 'revolution' in the management of spinal pain, to use the description of UK orthopedic surgeon and back-pain specialist Gordon Waddell². This revolution began in the 1990s in the USA and the UK with new national evidence-based guidelines for the management of acute LBP, developed by multidisciplinary panels of experts.^3,4 On these panels physicians and surgeons were joined by other healthcare providers including chiropractors and occupational and physical therapists.

The recommendations made have been strengthened by subsequent research and followed by a number of updated guidelines for acute and chronic back⁵ and neck pain⁶. These guidelines recognize that a significant number of patients have genetic, degenerative and traumatic disorders that require surgical intervention, but that the great majority of patients with spinal pain and disability have non-specific mechanical back and neck pain that can be successfully managed by non-surgical methods. Treatment modalities that are most commonly recommended in these guidelines include symptom control through oral medications (acetaminophen and NSAIDS) or spinal manipulative therapy, early return to activity, use of exercises after the acute phase, and patient education and encouragement and education to reduce risk factors that increase associated disability. For many types of back and neck pain where surgery is contemplated, outcomes for non-operative care can be comparable with those from surgery.⁷

In 2013, from the perspectives of patients, healthcare professionals, and third parties who fund healthcare, there is clear value in orthopedists, chiropractors, physiotherapists and others working together in an interdisciplinary evidence-based team approach to the improved management of spinal disorders. Recent studies in Canada, the UK, and the USA report superior results for patients with back and neck pain when skilled spinal manipulation and exercise are added to or compared with usual medical care.^8-10

In these circumstances it is not only an honor for the World Federation of Chiropractic (WFC) to now become one of the sponsoring organizations of Coluna/COLUMNA but also, we believe, appropriate. The WFC, a non-governmental organization or NGO in official relations with the World Health Organization since 1997, is the international organization representing the chiropractic profession. Its members are national associations of chiropractors in 90 countries, including the Associação Brasileira de Quiropraxia (ABQ) in Brazil.

The chiropractic profession was formed in the USA in the 1890s and is now well-established in many countries. However it is relatively new in Brazil, with approximately 500 practicing chiropractors and 700 students at the two faculties of chiropractic, which are at the University Anhembi Morumbi in Sao Paulo and Feevale University in Novo Hamburgo. Chiropractic is a profession that focuses on the diagnosis, prevention, and management of biomechanical disorders of the musculoskeletal system and their impact on health, with an emphasis on manual assessment and treatment techniques including spinal manipulative therapy.

The WFC looks forward to a long and productive partnership with Coluna/COLUMNA, and wishes to thank Professor Helton Defino, Editor, and the Brazilian Spine Society for the kind invitation which made this possible.

More information on the chiropractic profession, the WFC, and its Research Council may be found at www.wfc.org. The WHO guidelines on basic training and safety in chiropractic may be found in Portuguese, Spanish, and English at www.wfc.org under About WFC/WHO.

Scott Haldeman DC, MD, PhD, FRCP(C)

Clinical Professor, Department of Neurology, University of California, Irvine Chairman, Research Council, World Federation of Chiropractic

Eduardo Sawaya Botelho Bracher DC, MD, PhD

Private practice, Sao Paulo, SP, Member, Research Council, World Federation of Chiropractic

REFERENCES

1. Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C,et al. GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet.2012;380(9859):2055-8.
2. Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
3. Bigos SJ, Bowyer O, Brain G, Brown K, Deyo R, Haldeman S, et al. Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14.AHCPR Publication No. 95-0642. Rockville, MD; Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994.
4. Rosen M, Breen A, et al. Management Guidelines for Back Pain. Appendix B In: Report of a Clinical Standards Advisory Group Committee on Back Pain.London, England: Her Majesty's Stationery Office (HMSO); 1994.
5. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.
6. A Best Evidence Synthesis on Neck Pain: Findings From The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976);33(4S):S1-S220.
7. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976). 2009;34(10):1094-109.
8. Bishop PB, Quon JA, Fisher CG, Dvorak MF. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J. 2010;10(12):1055-64.
9. United kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ Online First; 2004:1-8.
10. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1Pt1):1-10.

Publication Dates

Publication in this collection
10 May 2013
Date of issue
2013

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Murray CJ, Ezzati M, Flaxman AD, Lim S, Lozano R, Michaud C,et al. GBD 2010: a multi-investigator collaboration for global comparative descriptive epidemiology. Lancet.2012;380(9859):2055-8.

[2] 2. Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.

[3] 3. Bigos SJ, Bowyer O, Brain G, Brown K, Deyo R, Haldeman S, et al. Acute Low Back Problems in Adults, Clinical Practice Guideline No. 14.AHCPR Publication No. 95-0642. Rockville, MD; Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994.

[4] 4. Rosen M, Breen A, et al. Management Guidelines for Back Pain. Appendix B In: Report of a Clinical Standards Advisory Group Committee on Back Pain.London, England: Her Majesty's Stationery Office (HMSO); 1994.

[5] 5. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.

[6] 6. A Best Evidence Synthesis on Neck Pain: Findings From The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976);33(4S):S1-S220.

[7] 7. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976). 2009;34(10):1094-109.

[8] 8. Bishop PB, Quon JA, Fisher CG, Dvorak MF. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain. Spine J. 2010;10(12):1055-64.

[9] 9. United kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ Online First; 2004:1-8.

[10] 10. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med. 2012;156(1Pt1):1-10.