Low Back Pain Clinical Management Guidelines

As a clinician are you following best-evidence guidelines for managing your patients with low back pain?
As a patient, how is you doctor managing your low back pain?

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Preventing progression of low back pain to surgical intervention is extremely important, especially as a recent study in the Journal of the American Medical Association (April 2010) showed that complex surgical procedures (spinal fusions) have increased over the last five years, and yet these complex procedures is associated with significantly higher risk of major complications, 30-day mortality, and uses a lot more medical resources (increased costs). Many of these surgeries do not need to occur.

The care patients receive for low back pain from their general practitioners "may not provide the best outcomes" for them according to a recent study in the Archives of Internal Medicine, a leading medical journal (Williams, February 2010). It appears some doctors are not following evidence-based recommendations for treating low back pain. These guidelines have been established and proposed for the full spectrum of patient management for low back pain by the American College of Physicians (2007). This recent study (Williams, 2010) however shows that these guidelines are poorly followed leading to high costs of healthcare and increased risk of adverse effects.

Did you know that studies have shown it is extremely difficult to determine a specific disease or spinal abnormality that can reliably be shown to be the cause of nonspecific low back pain? In fact in over 85% of patients that present to primary care clinics, reliably attributing the symptoms as being caused by a herniated disc, facet joint, or pinched nerve, etc has not been able to be done. The methods vary amont providers and different doctors disagree as to the cause of the pain, but regardless of the diagnosis, most patients with nonspecific low back pain tend to have similar outcomes.

Guidance from this application can answer some questions to include: When to order xrays? When to order MRIs?
What are some quick and easy questions that let you be certain that the following conditions are not present (including sensitivity, specificity, and likelihood ratios)?:
- Cancer?
- Cauda equina syndrome?
- Vertebral fracture?
- Infection (i.e. osteomyelitis)?
- Spinal stenosis?
- Ankylosing spondylitis?

What is the latest evidence regarding the association of psychosocial risk factors and low back pain? How strong is the evidence for acupuncture, herbal supplements, proper mattress use, narcotics, non-steroidal anti-inflammatory medications, etc (among many other reviewed interventions)?
(See the comparison tables under Recommendations #6 and #7 in the app)

This application is based on the American College of Physicians and American Pain Societys Low Back Pain Management Guidelines (Chou, 2007). It provides recommendations for management and evidence-based screening strategies to include weighing the evidence for interventions, providing diagnostic utility of pertinent components of the patient history and physical exam, and a decision-guiding algorithm. All information is referenced by link to applicable PUBMed abstracts.


** This applications and CRTech, LLC are in no way affiliated with the American College of Physicians or the American Pain Society.