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. 2019 Nov;34(11):2620-2629.
doi: 10.1007/s11606-019-05086-4. Epub 2019 Sep 16.

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

Sanjog S Pangarkar  1   2 , Daniel G Kang  3 , Friedhelm Sandbrink  4 , Adam Bevevino  3 , Kirsten Tillisch  4 , Lisa Konitzer  3 , James Sall  3
Affiliations

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

Sanjog S Pangarkar et al. J Gen Intern Med. 2019 Nov.

Abstract

Description: In September 2017, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) approved the joint Clinical Practice Guideline (CPG) for Diagnosis and Management of Low Back Pain. This CPG was intended to provide healthcare providers a framework by which to evaluate, treat, and manage patients with low back pain (LBP).

Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through September 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. A patient focus group was also convened to ensure patient values and perspectives were considered when formulating preferences and shared decision making in the guideline.

Recommendations: The VA/DOD LBP CPG provides evidence-based recommendations for the diagnostic approach, education and self-care, non-pharmacologic and non-invasive therapy, pharmacologic therapy, dietary supplements, non-surgical invasive therapy, and team approach to treatment of low back pain.

Keywords: Veteran; acute low back pain; chronic back pain; lumbago; military; radiculopathy; sciatica.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Module A: Initial Evaluation of Low Back Pain. Provides clinical algorithm incorporating clinical practice guidelines for initial evaluation of low back pain. Reference Table 2 for suggested diagnostic workup recommendations, and reference module B (Fig. 2) for clinical algorithm for management of low back pain. LBP low back pain.
Figure 2
Figure 2
Module B: Management of Low Back Pain. Provides clinical algorithm incorporating clinical practice guidelines for management of low back pain. Reference Table 2 for suggested diagnostic workup recommendations, and reference Table 3 for intervention recommendations. LBP low back pain.
See this image and copyright information in PMC

References

    1. Chou R, Deyo R, Friedly J, et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016. - PubMed
    1. Murray CJ, Atkinson C, Bhalla K, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama. 2013;310(6):591–608. doi: 10.1001/jama.2013.13805. - DOI - PMC - PubMed
    1. Centers for Disease Control and Prevention. Severe headache or migraine, low back pain, and neck pain among adults aged 18 and over, by selected characteristics: United States, selected years 1997–2012. National Health Survey. 2012.
    1. Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015(9):CD001139. - PMC - PubMed
    1. Dieleman JL, Baral R, Birger M, et al. US Spending on Personal Health Care and Public Health, 1996-2013. JAMA. 2016;316(24):2627–46. doi: 10.1001/jama.2016.16885. - DOI - PMC - PubMed

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