To increase the relevance of this extensive literature for emergency physicians, we imposed in our review, in addition to the requirement that patients present with non-chronic, non-radicular low back pain, two important stipulations: 1) Chiropractic manipulation needed to be contrasted with an intervention that was clearly of no benefit. While the efficacy/harm ratio of opioids was beyond the scope of our review, we agree that in general, adding an opioid to a non-steroidal anti-inflammatory drug does not improve pain or functional outcomes one week after an ED visit for acute, non-radicular low back pain and does not prevent the transition from acute to chronic low back pain 4. 1 S. Rothberg, B.W. Friedman, Complementary therapies in addition to medication for patients with nonchronic, nonradicular low back pain: a systematic review, Am J Emerg Med, Vol. 35, Iss. 1, 2017, 55-61 2 A. Qaseem, T.J. Wilt, R.M. McLean, M.A. Forciea, Clinical Guidelines Committee of the American College of Physicians, Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians, Ann Intern Med, Vol. 166, Iss. 7, 2017, 514-530 3 B.W. Friedman, M. Chilstrom, P.E. Bijur, E.J. Gallagher, Diagnostic testing and treatment of low back pain in United States emergency departments: a national perspective, Spine, Vol. 35, Iss. 24, 2010, E1406-E1411 4 B.W. Friedman, A.A. Dym, M. Davitt, L. Holden, C. Solorzano, D. Esses, JAMA, Vol. 314, Iss. 15, 2015, 1572-1580 5 B.W. Friedman, S. Gensler, A. Yoon, R. Nerenberg, L. Holden, P.E. Bijur, Predicting three-month functional outcomes after an ED visit for acute low back pain, Am J Emerg Med, Vol. 35, Iss. 2, 2017, 299-305