Management Options for Patients with Chronic Back Pain without an Etiology

The treatment and management of low back pain is complex when there is no specific etiology such as cancer, fracture, or herniated disc. An organized approach to management that follows evidence based guidelines will facilitate care in a problem that reflects a lifetime prevalence of over 70 percent. The purpose of this review is to present a guideline to care for a common disabling process with a very heterogeneous etiology.

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Will publishing evidence-based guidelines for low back pain imaging decrease imaging use?

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2018.07.039 ◽

2019 ◽

Vol 37 (3) ◽

pp. 545-546 ◽

Cited By ~ 1

Author(s):

Ali S. Raja ◽

Ivan K. Ip ◽

Laila Cochon ◽

Sarvenaz Pourjabbar ◽

Brian J. Yun ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Evidence Based ◽

Low Back ◽

Evidence Based Guidelines

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Evidence-based guidelines for managing acute low back pain

Focus on Alternative and Complementary Therapies ◽

10.1211/fact.1997.00025 ◽

2010 ◽

Vol 2 (1) ◽

pp. 24-24

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Evidence Based ◽

Low Back ◽

Acute Low Back Pain ◽

Evidence Based Guidelines

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Safety, Efficacy, and Cost Effectiveness of Evidence-Based Guidelines for the Management of Acute Low Back Pain in Primary Care

Spine ◽

10.1097/00007632-200112010-00017 ◽

2001 ◽

Vol 26 (23) ◽

pp. 2615-2622 ◽

Cited By ~ 120

Author(s):

Brian McGuirk ◽

Wade King ◽

Jayantilal Govind ◽

John Lowry ◽

Nikolai Bogduk

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

Cost Effectiveness ◽

Evidence Based ◽

Low Back ◽

Acute Low Back Pain ◽

Evidence Based Guidelines

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Effects of implementing evidence-based appropriateness guidelines for epidural steroid injection in chronic low back pain: the EAGER (Esi Appropriateness GuidElines pRotocol) study

BMJ Open Quality ◽

10.1136/bmjoq-2019-000772 ◽

2019 ◽

Vol 8 (4) ◽

pp. e000772

Author(s):

Scott M Johnson ◽

Troy Hutchins ◽

Miriam Peckham ◽

Yoshimi Anzai ◽

Elizabeth Ryals ◽

...

Keyword(s):

Body Mass Index ◽

Low Back Pain ◽

Back Pain ◽

Body Mass ◽

Chronic Low Back Pain ◽

Evidence Based ◽

Low Back ◽

Patient Level ◽

Epidural Steroid ◽

Evidence Based Guidelines

ObjectiveChronic low back pain is very common and often treated with epidural steroid injections (ESIs). As ESI referrals had been rapidly increasing at our Veterans’ Administration hospital, we were concerned that they were supplanting more comprehensive care. The objective was to determine how referral patterns and multidisciplinary care might change with the implementation of evidence-based guidelines.MethodsIn this retrospective observational study, multidisciplinary evidence-based guidelines were implemented in 2014 (EAGER: Esi Appropriateness GuidElines pRotocol) as part of the ordering process for an ESI. Time series analysis was performed to assess the primary outcome of subspecialty referral pattern, that is, the number of patients receiving referrals to ancillary services which might serve to provide a more comprehensive approach to their back pain. Secondary outcomes included patient-level changes (ie, body mass index, number of injections, opioid use), which were compared before and after protocol implementation.ResultsComparing preimplementation and postimplementation protocol periods, referrals to physical medicine/rehabilitation increased 11.7% (p=0.003) per year and integrative health increased 2.1% (p<0.001) per year among the 2294 individual patients who received ESI through the neurointerventional radiology service. Of 100 randomly selected patients for patient-level analysis, the median body mass index decreased from 31.57 to 30.22 (p=<0.001) and the mean number of injections decreased from 1.76 to 0.73 (p<0.001). The percentage of patients using oral opioid analgesics decreased from 72% to 49% (p=<0.001).ConclusionImplementation of evidence-based guidelines for ESI referral helps guide patients into a more comprehensive care pathway for chronic low back pain and is correlated with patient-level changes such as decreased body mass index and decreased opioid usage.

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McKenzie Therapists Adhere More to Evidence-Based Guidelines and Have a More Biopsychosocial Perspective on the Management of Patients with Low Back Pain than General Physical Therapists in Japan

Open Journal of Therapy and Rehabilitation ◽

10.4236/ojtr.2014.24023 ◽

2014 ◽

Vol 02 (04) ◽

pp. 173-181 ◽

Cited By ~ 12

Author(s):

Hiroshi Takasaki ◽

Takeshi Saiki ◽

Yoshihiro Iwasada

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Physical Therapists ◽

Evidence Based ◽

Low Back ◽

Biopsychosocial Perspective ◽

General Physical ◽

Evidence Based Guidelines

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Management of non-specific low back pain in primary care – A systematic overview of recommendations from international evidence-based guidelines

Primary Health Care Research & Development ◽

10.1017/s1463423620000626 ◽

2020 ◽

Vol 21 ◽

Author(s):

Cornelia Krenn ◽

Karl Horvath ◽

Klaus Jeitler ◽

Carolin Zipp ◽

Andrea Siebenhofer-Kroitzsch ◽

...

Keyword(s):

Primary Care ◽

Low Back Pain ◽

Back Pain ◽

High Income ◽

Current Evidence ◽

Evidence Based ◽

Low Back ◽

Pharmacological Interventions ◽

International Evidence ◽

Evidence Based Guidelines

Abstract Aim: Systematic identification, characterization and analysis of recommendations concerning the diagnosis and treatment of non-specific low back pain (LBP) in primary care provided in international evidence-based guidelines from high-income countries. Background: LBP is one of the most common reasons for consulting a primary care physician and its prevalence is higher in high-income than in middle- or low-income countries. The majority of LBP is non-specific and treatment recommendations are not often based on high-quality and patient-oriented evidence. Methods: We systematically searched PubMed and major guideline databases from 2013 to 2020. Two independent reviewers performed literature selection and the quality assessment of included guidelines using the AGREE II tool. We extracted all relevant recommendations including the corresponding Grade of Recommendation. We grouped all included recommendations by topic and compared them to each other. Findings: This overview includes 10 current guidelines and overall 549 relevant recommendations. Recommendations covered aspects of assessment and diagnosis (15%), non-pharmacological interventions (46%), pharmacological interventions (26%), invasive treatments (8%) and multimodal pain management (5%). In total, 30% of all recommendations were strong and 57% weak or very weak. The proportion of recommendations for and against an intervention was 45% and 38%, respectively. The recommendations from the different guidelines were largely in good agreement. We identify only a small number of contradictory recommendations, mostly dealing with very specific interventions. Conclusion: In conclusion, current evidence-based guidelines published in high-income countries provide recommendations for all major aspects of the management of people with LBP in primary care. Recommendations from different guidelines were largely consistent. More than 50% of these recommendations were weak or very weak and a high proportion of recommendation advised against an intervention.

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