VA/DOD Cinical Practice Guideline for Diagnosis and Treatment of Low Back Pain Guideline Summary

This Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the recommendation. 

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I. Introduction..................................................................................................................................... 5

II. Recommendations........................................................................................................................... 6

III. Background...................................................................................................................................... 9

A. Description of Low Back Pain .............................................................................................................. 9

B. Epidemiology and Impact..................................................................................................................10

a. General Population................................................................................................................................... 10

b. Veterans Affairs Population ..................................................................................................................... 11

c. Department of Defense Population ......................................................................................................... 11

IV. About this Clinical Practice Guideline ............................................................................................. 12

A. Scope of this Clinical Practice Guideline ...........................................................................................12

B. Methods.............................................................................................................................................13

a. Grading Recommendations...................................................................................................................... 14

b. Reconciling 2007 Clinical Practice Guideline Recommendations............................................................ 15

c. Peer Review Process................................................................................................................................. 16

C. Summary of Patient Focus Group Methods and Findings................................................................16

D. Conflict of Interest.............................................................................................................................17

E. Highlighted Features of this Clinical Practice Guideline...................................................................18

F. Patient-centered Care .......................................................................................................................18

G. Shared Decision Making ....................................................................................................................18

H. Implementation................................................................................................................................. 19

V. Guideline Work Group ................................................................................................................... 20

VI. Algorithm ...................................................................................................................................... 21

Module A: Initial Evaluation of Low Back Pain..........................................................................................22

Module B: Management of Low Back Pain...............................................................................................24

VII. Discussion of Recommendations.................................................................................................... 26

A. Diagnostic Approach..........................................................................................................................26

B. Education and Self-care.....................................................................................................................31

C. Non-pharmacologic and Non-invasive Therapy ...............................................................................33

D. Pharmacologic Therapy.....................................................................................................................39

E. Dietary Supplements.........................................................................................................................46

F. Non-surgical Invasive Therapy ..........................................................................................................48

G. Team Approach to Treatment of Chronic Low Back Pain ................................................................50

VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain

September 2017 Page 4 of 110

Members of the medical profession engaged in treatment for back pain and the multi-facted forms thereof including, acupuncturists, chiropractors, suregoens, spinal chord practitioners, health facilities serving military veterans, helath care providers, health care insurers, federal officials concerned and engaged in military veteran rules and regulations, private sector and NGO veteran organizations.