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

AbstractDescriptionIn 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).MethodsThe 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 (Gra ding 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.RecommendationsThe 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.
Source: Journal of General Internal Medicine - Category: Internal Medicine Source Type: research

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Conclusion. Higher pain intensity and disability predicted higher pain-related HCU in the year following a LBP self-management class. The presence of a sleep disorder diagnosis, as recorded in medical records, had a significant independent effect on LBP-related health care visits and costs beyond the influences of pain intensity, disability, and other key demographic and health-related characteristics, but did not moderate these relationships. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: CLINICAL CASE SERIES Source Type: research
Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsyc...
Source: BMC Musculoskeletal Disorders - Category: Orthopaedics Authors: Tags: Research article Source Type: research
CONCLUSIONS: There was low concordance of perifacet signal change and FDG activity with clinically implicated facet joints. This could indicate either the potential to change patient management or a lack of biomarker accuracy. Therefore, additional larger randomized studies with the use of comparative medial branch blocks would be useful to further investigate the clinical utility of these findings.
Source: American Journal of Neuroradiology - Category: Radiology Authors: Tags: SPINE Source Type: research
Once you begin to dip your toes into psychological therapies, it doesn’t take long before you begin to see TLAs all over the place. So today I’m going to post on two things: some of the TLAs, and why or how we might consider using these approaches in pain rehabilitation. The first one is CBT, or cognitive behavioural therapy. CBT grew out of two movements: behaviour therapy (Skinner and the pigeons, rats and all that behaviour modification stuff), and cognitive therapy (Ellis and Beck and the “cognitive triad” – more on this later). When the two approaches to therapy are combined, we have c...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: ACT - Acceptance & Commitment Therapy Clinical reasoning Cognitive behavioral therapy Coping strategies Interdisciplinary teams Occupational therapy Physiotherapy Professional topics Psychology Research Science in practice Source Type: blogs
ConclusionsT12 DRG ‐S can be an effective treatment for chronic axial low back pain. Stimulation results in reduced pain and disability, while improving quality of life. These outcomes can be achieved without paresthesias.
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Case Series Source Type: research
Conclusions: The present study evaluated the anti-inflammatory and regenerative efficiencies of Nar and NG in degenerated human NP cells. Altered gene expressions of cytokines, metalloproteases, extracellular proteins, apoptotic genes were dose responsive. The molecular docking (in silico) studies showed effective binding of these native ligands (Nar and NG) with genes identified as potent inhibitors of inflammation. Thus, these natural flavonoids could serve as anti-inflammatory agents in the treatment of low back pain and sciatica. PMID: 31575107 [PubMed - as supplied by publisher]
Source: Asian Spine Journal - Category: Orthopaedics Tags: Asian Spine J Source Type: research
Conclusions: Among older adults with CLBPR, pain provocation drives increases in the energy cost of walking. Because high energy cost of walking is predictive of mobility decline, clinicians may focus on effective pain management strategies during walking, which may potentially decrease the risk of mobility decline.
Source: Journal of Geriatric Physical Therapy - Category: Physiotherapy Tags: Research Reports Source Type: research
CONCLUSIONS: Sacral laminoplasty with titanium mesh is a safe and effective procedure for treating progressive sacral dural ectasia and refractory pseudomeningocele, preventing CSF leakage as well as relieving local symptoms that may occur years after previous surgery for spina bifida. PMID: 31574475 [PubMed - in process]
Source: Neurosurgical Focus - Category: Neurosurgery Authors: Tags: Neurosurg Focus Source Type: research
If you live with persistent pain of any kind, you’ll know what a flare-up is. Periods of time when pain is exacerbated and sustained at a higher than average level over at least a few days, often longer. Flare-ups always settle down – but oh my, it can feel like they’re going on forever! Handling a flare-up is not quite the same as handling everyday pain. Everyday pain, for those of us who manage it independently of healthcare professionals, usually needs a generally steady routine, not too many surprises. A regimen of movement, relaxation, fun, mindfulness, plodding on and managing stress. A little bo...
Source: HealthSkills Weblog - Category: Anesthesiology Authors: Tags: Chronic pain Coping Skills Coping strategies Pain conditions Professional topics Resilience/Health exacerbation flare-up management flare-ups Source Type: blogs
lesen Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Sl...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Article Source Type: research
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