Transforming low back pain care delivery in the United States

Abstract

Low back pain (LBP) continues to be a challenging condition to manage effectively. Recent guideline recommendations stress providing non-pharmacological care early, limiting diagnostic testing, and reducing exposure to opioid pain medications. However, there has been little uptake of these guideline recommendations by providers, patients or health systems, resulting in care that is neither effective nor safe. This paper describes the framework for an evidence-based pathway that would transform service delivery for LBP in the United States by creating changes that facilitate the delivery of guideline adherent care. An evidence informed clinical service pathway would be intentionally structured to include; a) direct linkages to community and population based resources that facilitate self-management, b) foundational LBP care that is appropriate for all seeking care, c) individualized LBP care for those who have persistent symptoms, and d) specialized LBP care for instances when advanced diagnostics and intensive treatments are indicated. There is an urgent need to transform LBP care by optimizing clinical care pathways focused on multiple opportunities for non-pharmacological treatments, carefully considering escalation of care, and facilitating self-management. Such approaches have the potential to increase patient access to guideline adherent LBP care as an alternative to opioids, unwarranted diagnostic tests, and unnecessary surgery.

Figure 1.. Framework for a Transformed Low Back Pain Clinical Care Pathway

This framework is structured to support guideline adherent care for LBP by aligning the needs of the patient at different phases of care with the type of care received. The pathway is designed to avoid unwarranted care variation by embedding elements of a stepped progression through each phase. Each phase of the pathway includes an aspect of risk stratification and tailoring to a patient’s individual needs. This framework is not designed for a specific provider setting and meant to be tailored based on available resources.