Management of Low Back Pain: Getting From Evidence-Based Recommendations to High-Value Care
Authors: Steven J. Atlas
Journal: Annals of Internal Medicine (2017)

Editorials4 April 2017Management of Low Back Pain: Getting From Evidence-Based Recommendations to High-Value CareSteven J. Atlas, MD, MPHSteven J. Atlas, MD, MPHFrom Massachusetts General Hospital, Boston, Massachusetts.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0293 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This issue of Annals includes updated systematic reviews of noninvasive pharmacologic and nonpharmacologic therapies for low back pain and accompanying practice recommendations from the American College of Physicians (ACP) (1–3). Low back pain is common, and its management may be a good example of low-value health care—expensive tests and therapies that deliver limited benefits in terms of reduced pain and increased function (4). Greater use of effective treatments, whether for acute symptoms managed in the primary care setting or chronic, disabling pain that typically involves a range of specialists, might help patients who are suffering, clinicians who are frustrated with ...References1. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:493-505. doi:10.7326/M16-2459 LinkGoogle Scholar2. Chou R, Deyo R, Friedly J, Skelly A, Weimer M, Fu W, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American College of Physicians clinical practice guideline. Ann Intern Med. 2017;166:480-92. doi:10.7326/M16-2458 LinkGoogle Scholar3. Qaseem A, Wilt TJ, McLean RM, Forciea MA; 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. 2017;166:514-30. doi:10.7326/M16-2367 LinkGoogle Scholar4. Martin BI, Turner JA, Mirza SK, Lee MJ, Comstock BA, Deyo RA. Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006. Spine (Phila Pa 1976). 2009;34:2077-84. [PMID: 19675510] doi:10.1097/BRS.0b013e3181b1fad1 CrossrefMedlineGoogle Scholar5. Chou R, Huffman LH; American Pain Society. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492-504. [PMID: 17909210] LinkGoogle Scholar6. Chou R, Huffman LH; American Pain Society. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505-14. [PMID: 17909211] LinkGoogle Scholar7. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Noninvasive treatments for low back pain. Comparative effectiveness review no. 169. (Prepared by the Pacific Northwest Evidence-based Practice Center under contract no. 290-2012-00014-I.). Rockville, MD: Agency for Healthcare Research and Quality; 2016. Google Scholar8. Hill JC, Whitehurst DG, Lewis M, Bryan S, Dunn KM, Foster NE, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011;378:1560-71. [PMID: 21963002] doi:10.1016/S0140-6736(11)60937-9 CrossrefMedlineGoogle Scholar9. Bigos S, Bowyer O, Braen G, Brown K, Deyo R, MD, Haldeman S, et al. Acute low back problems in adults. Clinical practice guideline no. 14. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994. AHCPR publication no. 95-0642. Google Scholar10. Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med. 2013;173:1573-81. [PMID: 23896698] doi:10.1001/jamainternmed.2013.8992 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Massachusetts General Hospital, Boston, Massachusetts.Disclosures: Dr. Atlas reports royalty payments from UpToDate and personal fees from Healthwise. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0293.Corresponding Author: Steven J. Atlas, MD, MPH, Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114; e-mail, [email protected]harvard.edu.This article was published at Annals.org on 14 February 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline Roger Chou , Richard Deyo , Janna Friedly , Andrea Skelly , Melissa Weimer , Rochelle Fu , Tracy Dana , Paul Kraegel , Jessica Griffin , and Sara Grusing Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline Roger Chou , Richard Deyo , Janna Friedly , Andrea Skelly , Robin Hashimoto , Melissa Weimer , Rochelle Fu , Tracy Dana , Paul Kraegel , Jessica Griffin , Sara Grusing , and Erika D. Brodt Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Timothy J. Wilt , Robert M. McLean , Mary Ann Forciea , and Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain Metrics Cited byInitial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care ProvidersWhich Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled TrialRisk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary CareDoctors of chiropractic working with or within integrated healthcare delivery systems: a scoping review protocolDrug delivery in intervertebral disc degeneration and osteoarthritis: Selecting the optimal platform for the delivery of disease-modifying agentsThe OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back painPrediction of Persistent Musculoskeletal Pain at 12 Months: A Secondary Analysis of the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Validation Cohort StudyImproving Physical Therapy Pain Care, Quality, and Cost Through Effectiveness-Implementation ResearchTime to Revamp "Usual Back Care" and Include a Broad Range of Nontraditional OptionsStart with nondrug therapies for low back pain, guideline saysBold Attempt to Transform Back Care in the United States—But Can It Succeed? 4 April 2017Volume 166, Issue 7Page: 533-534KeywordsDrug therapyDrugsExercise therapyHospital medicineLower back painOpiatesPatientsRandomized trialsSkeletal musclesSystematic reviews ePublished: 14 February 2017 Issue Published: 4 April 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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