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Clinical Standard for Low Back Pain in Adults
Core Document
TITLE: MADIGAN ARMY MEDICAL CENTER CLINICAL STANDARD FOR LOW BACK PAIN IN ADULTS
INDICATIONS FOR THE CLINICAL STANDARD: Low back problems in adults rank high among the reasons for physician office visits and are costly in terms of medical treatment, time lost from work, and diminished quality of life. Acute low back problems are defined as activity intolerance due to lower back or back-related leg symptoms of less than 3 months duration. This clinical standard for Low Back Pain in Adults outlines the new paradigm shift away from care focused exclusively on pain but toward helping patients improve activity tolerance. The standard provides Primary Care Managers with a plan to determine non-serious versus serious spinal pathology causing limitations due to low back symptoms.
METRICS: THE KEY ELEMENTS OF THE CLINICAL STANDARD THAT
WILL BE USED TO MONITOR PROVIDER ADHERENCE TO THE CLINICAL
STANDARD:
1. Documentation of initial history (Algorithm
page 1) includes description of mechanism of injury.
2. Documentation of physical examination (Algorithm
page 1) includes palpation of the lumbar back.
3. Documentation of Referral to Physical Therapy (Algorithm
Page 3) at 2 weeks if patient not improving.
DATE: Published: October 1998, Revised: May 2003.
AUTHORS:
Please contact the administrator for information regarding the authors of
this clinical standard.
AREAS OF DISAGREEMENT: No areas of significant disagreement were noted by the committee.
PUBLISHED STANDARDS OF CARE AND OTHER REFERENCES UPON WHICH THE
CLINICAL STANDARD IS BASED:
1. Adult Patients With Low Back Pain/Sciatica (ACUTE), American Academy
of Orthopedic Surgeons and North American Spine Society, published 1997.
2. Health Care Guideline: Adult Low Back Pain, Institute for Clinical
Systems Integration, October, 1997.
3. National Low Back Pain Clinical Guidelines, The Royal College of
General Practitioners, published 1997.
4. Clinical Practice Guideline: Number 14. Acute Low Back Problems in
Adults. Rockville Md., U.S. Dept. of Health and Human Services, Public
Health Service, Agency for Health Care Policy and Research. AHCPR
Publication No. 95-0642. December 1994.
CLINICAL PRACTICE RECOMMENDATIONS: Please refer to the attached treatment algorithm on Low Back Pain, to be used as the standard of care.
IMPACT STATEMENT TO THE INSTITUTION: This standard of care will impact all providers who care for adult patients with back pain: all Primary Care managers, Orthopedists, Neurologists, Neurosurgeons, Radiologists, Physical Therapists, Physical Medicine and Rehabilitation, nursing personnel, laboratory personnel, and Pharmacy personnel. It will impact physical therapy with an initial increase in referrals, balanced later by a decrease in chronic low back pain patients referred. It may impact family practice or other providers privileged to perform osteopathic manipulation, with an increase in patients receiving osteopathic manipulation.
KEY POINTS: There are no key points for this clinical standard.
LINKS WITHIN THE MAMC INTRANET: The Low Back Pain in Adults clinical standard will be published on the MAMC Intranet on the Clinical Standards Webpage. It will be hypertexted to the related Referral Guidelines on the Intranet, and referenced on the CHCS bulletin board within the appropriate Acute Low Back Pain referral guideline. Electronic notice of the approved Low Back Pain clinical standard will be sent to all providers using current electronic mail systems on CHCS and CC: Mail.
METHODS OF PROVIDER EDUCATION:
1. Department Chiefs will notify their departments of the standard and
emphasize the use of the guideline.
2. Inservices will be given by the authors to all primary care providers
encompassing the care standard for low back pain and the referral
guidelines to specialty care.
3. The treatment algorithm for Low Back Pain will be listed on the MAMC
intranet site.
4. Copies of the practice recommendation for treatment of low back pain
will be made available at appropriate patient care sites.
5. Publish the practice recommendation to providers at our Regional care
facilities for reference.
6. Send automated reminders via CHCS when providers order pharmaceuticals
for the treatment of low back pain.
METHODS OF PATIENT EDUCATION: Link to a DOD/VA patient brochure.
REVISION FREQUENCY: This standard of care for Low Back Pain will be reviewed by the Clinical Standards Committee annually. Revisions deemed necessary by the authors, based on data such as updated treatment guidelines or outcomes of metric audits, will be incorporated into the care standard for low back pain, and will be forwarded to the Clinical Standards Committee for approval on an annual basis or earlier if the need is determined.