Low Back Pain Clinical Improvement Team Final Report

Low back pain is a leading cause of work-related disability and workers’ compensation for people under age 45, affecting about two-thirds of all adults at some point in time.  Medical costs associated with back pain are in excess of $25 billion per year and employers face huge costs in lost productivity and disability payments. 

Report Summary

The Low Back Pain Clinical Improvement Team, made up of community members, representing clinical specialists, complementary and alternative medicine practitioners, patients, employers, health plans, and clinical researchers, has completed and summarized its recommendations in a final report. 

The report includes recommendations for the treatment of low back pain during the first six weeks, including:

1. All patients with low back pain should have a complete exam to determine whether there are any red flag conditions, for example, pain lasting more than six weeks, bowel incontinence or history of cancer;

2. In the absence of red flag conditions, patients should be thoroughly assessed for history of back pain and whether previous therapy was effective;

3. In the absence of red flag conditions, imaging such as X-ray or MRI should not be done during the first six weeks following the onset of low back pain that occurs in a single location;

4. Surgery during the first six weeks in the absence of red flag conditions or symptoms that worsen over time is not recommended; and

5. Generally, doctors and other health care providers should follow a conservative approach to treatment of low back pain during the first six weeks when red flag conditions are not present, with the goal of preventing re-injury. 

The report also includes recommendations for preventing acute back pain from becoming chronic, including:

1. Doctors and other providers should assess all patients with low back pain for emotional status and work-life issues, provide reassurance to reduce fear and anxiety and promote things that the patient can do to manage their condition;

2. In the absence of red flag conditions, bed rest is not recommended and patients with low back pain should be advised to remain active, returning to normal levels of activity as soon as possible;

3. Patients with low back pain who smoke should be assisted with smoking cessation; and

4. Patients with low back pain should be assessed for functional status, using commonly available tests such as the SF-36 or SF-12 Health Survey. 

The report also includes recommendations for clinical performance measures to determine rates of unnecessary surgery and unnecessary imaging within the first six weeks after an initial provider visit.

To Order This Report    

Alliance Participants: download this report from the secure Participant-only section of this website.

All Others: contact the Alliance and enter "Low Back Pain Clinical Improvement Team Report" in the Comments section of the contact us form.  A .pdf file of this report will be sent via return email.

Other Clinical Improvement Team Reports

• Asthma
• Depression
• Diabetes
• Heart Disease
• Prescription Drugs
• Prevention

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