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  1. For patients with acute or chronic neck pain, consider recommending soft tissue techniques and manipulation therapies (eg, high velocity/low amplitude) combined with a home exercise program, as these therapies may improve pain and function in the short and moderate term.

  2. For patients with chronic low back pain or osteoarthritis-related knee pain, consider recommending acupuncture for management.

  3. Ask patients who take over-the-counter or prescription drugs about use of herbal supplements.

  4. When an herbal supplement-related adverse event is suspected, report the suspected adverse event to the Food and Drug Administration via the MedWatch reporting system.

  5. For patients who use marijuana, monitor their use and adverse effects.


  1. Strength of Evidence: SORT B

    Sources: J Back Musculoskelet Rehabil, Spine J, references 21 and 20

  2. Websites:;

  3. Strength of Evidence: SORT B

    Source: Australian Acupuncture and Chinese Medicine Association, reference 36

  4. Website:

  5. Strength of Evidence: SORT C

    Source: Am Fam Physician, reference 87

  6. Website:

  7. Strength of Evidence: SORT C

    Sources: Pharmacoepidemiol Drug Saf, Food and Drug Administration, references 86 and 93

  8. Websites:;

  9. Strength of Evidence: SORT C

    Source: Federation of State Medical Boards, reference 148

  10. Website:

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