THE DIAGNOSIS AND TREATMENT OF LOW BACK PAIN: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Author: Franz Macedo1, Thiru Annaswamy2, Rachael Coller3, Andrew Buelt4, Michael A Glotfelter5, Paul W Heideman6, Daniel Kang7, Lisa Konitzer8, Casey Okamoto9, Juli Olson10, Sanjog Pangarkar11, James Sall12, Lance C Spacek13, Evan Steil14, Rebecca Vogsland15, Friedhelm Sandbrink16
1 Medical Director, Headache Center of Excellence, VA Health Care System, Minneapolis, MN.
2 Spine and Electrodiagnostic Section Chief, PM&R Service, VA North Texas Health Care System, Dallas, TX.
3 Clinical Pharmacy Specialist - Pain & Psychiatry, Naval Medical Center (NMCSD), San Diego, CA.
4 Hospitalist, VA Medical Center, Bay Pines, FL.
5 Director of Psychological Health, Eielson Medical Treatment Facility, Fairbanks, AK.
6 Clinical Psychology, Comprehensive Pain Center, VA Medical Center, Minneapolis, MN.
7 Program Director, Orthopedic Surgery Residency, Madigan Army Medical Center, Tacoma, WA.
8 Chief, Department of Rehabilitation Medicine, Madigan Army Medical Center, Tacoma, WA.
9 Chiropractic Care, VA Healthcare System (HCS), Minneapolis, MN.
10 Acupuncture, Chinese Medicine, and Chiropractic Care, Pain Clinic, VA Central Iowa HCS, Des Moines, IA.
11 Health Sciences Clinical Professor, David Geffen School of Medicine at UCLA, Los Angeles, CA.
12 Director Office of Evidence-Based Practice, Quality and Patient Safety, Veterans Administration Central Office, Washington, DC, 830.515.8153.
13 Internal Medicine and Sports Medicine, South Texas Veterans HCS.
14 Defense Health Agency, Healthcare Risk Management, Regional Health Command Europe, Primary Care Service Line, Sembach, Germany.
15 Director, Headache Center of Excellence VA Healthcare System, Minneapolis, MN.
16 Pain Management, Department of Neurology, VA Medical Center' Washington, DC.
Conference/Journal: Am J Phys Med Rehabil
Date published: 2023 Oct 26
Other: Special Notes: doi: 10.1097/PHM.0000000000002356. , Word Count: 197

Low back pain (LBP) is a significant issue in the VA and DoD populations, and the general U.S. population at large. According to the Centers for Disease Control and Prevention, 25% of U.S. adults reported having low back pain in the prior 3 months.1 A survey of U.S Veterans published in 2017 revealed 33% of Veterans reported having significant back pain within the last three months.2 Within the DoD, LBP was the primary diagnosis for more than 1 million medical encounters in 2020 affecting 213,331 service members.3 In 2022, leadership within the U.S. Department of Veterans Affairs and U.S. Department of Defense approved a joint clinical practice guideline for the management of low back pain. Development of the guideline included a systematic evidence review which was guided by 12 key questions. A multidisciplinary team, that included clinical stakeholders, reviewed the evidence that was retrieved and developed 39 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The scope of the CPG is broad; however, the authors have focused on key recommendations that are important for clinicians in the evaluation and non-operative treatment of low back pain, including pharmacologic therapies, and both non-invasive and invasive non-pharmacologic treatments.

PMID: 37903622 DOI: 10.1097/PHM.0000000000002356