Background context: The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE: The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. Study design: This is a guideline summary review. Methods: This guideline is the product of the Low Back Pain Work Group of NASS’ Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. Results: Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. Conclusions: The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx
Bibliographical noteFunding Information:
Development of this guideline was funded in its entirety by the North American Spine Society (NASS) with the exception that stakeholder societies provided representatives and paid for the travel and accommodation of their representatives to recommendation meetings. The NASS Evidence-Based Guideline Development Committee developed this guideline. All participating authors have disclosed potential conflicts of interest consistent with NASS? disclosure policy (http://www.spine.org/DisclosurePolicy). The Technical Report associated with this document includes the disclosures of all authors and contributors along with a description of participating and contributing societies. The following approach was applied for sequencing the complete author list: Evidence-Based Guideline Development Committee Co-Chairs (alphabetically), Section Chairs (alphabetically), Work Group Members and NASS staff (alphabetically). With the exception of the Evidence-Based Guideline Development Committee Co-Chairs, who reviewed the entire document, each author affirmed authorship only for the section under which he or she is listed. Authors: Evidence-Based Guideline Development Committee Co-Chairs: D. Scott Kreiner, MD; Paul Matz, MD Diagnosis Section: Daniel K. Resnick, MD, MS (Section Chair); Norman B. Chutkan, MD, FACS; Adam C. Lipson, MD; Anthony J. Lisi, DC; Tom E. Reinsel, MD; Robert L. Rich, Jr. MD, FAAFP [Stakeholder Representative, American Academy of Family Physicians (AAFP)]. Imaging Section: Charles H. Cho, MD, MBA (Section Co-Chair); Gary Ghiselli, MD (Section Co-Chair); Walter S. Bartynski, MD [Stakeholder Representative, American Society of Spine Radiology (ASSR)]; Sean D. Christie, MD; Bernard A. Cohen, PhD, FASNM, FACNS; S. Raymond Golish, MD, PhD, MBA; Murat Pekmezci, MD Medical & Psychological Treatment Section: Christopher M. Bono, MD (Section Chair); Randall P. Brewer, MD [Stakeholder Representative, American Academy of Pain Medicine (AAPM)]; Paul Dougherty, DC; Ravi Prasad, PhD [Stakeholder Representative, American Academy of Pain Medicine (AAPM)]; Gazanfar Rahmathulla, MD, MBBS; Christopher K. Taleghani, MD; Terry Trammell, MD Physical Medicine & Rehabilitation Section: Charles A. Reitman, MD (Section Chair); R. Carter Cassidy, MD; Dennis E. Enix, DC, MBA; Daniel S. Robbins, MD; Alison A. Stout, DO; Ryan A. Tauzell, PT, MA, MDT Interventional Treatment Section: John E. Easa, MD, FIPP (Section Chair); Jamie Baisden, MD, FACS; Shay Bess, MD; David S. Cheng, MD; David A. Provenzano, MD [Stakeholder Representative, American Society of Regional Anesthesia and Pain Medicine (ASRA)]; Yakov Vorobeychik, MD, PhD [Stakeholder Representative, Spine Intervention Society (SIS)] Surgical Treatment Section: William C. Watters III, MD, MS (Section Chair); Thiru M. Annaswamy, MD; Steven W. Hwang, MD; Cumhur Kilincer, MD, PhD; RJ. Meagher, MD; Kris E. Radcliff, MD [Stakeholder Representative, American Academy of Orthopaedic Surgeons (AAOS)]; Anil K. Sharma, MD Cost-Utility Section: Zoher Ghogawala, MD, FACS (Section Chair); Simon Dagenais, PhD, MSc, DC; Padma Gulur, MD [Stakeholder Representative, American Society of Anesthesiologists (ASA)]; Jeffrey A. King, DC, MS; Paul Park, MD; John E. O'Toole, MD, MS [Stakeholder Representative, American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS)]; Daniel R. Perry, MPT, MDT; Jonathan N. Sembrano, MD Contributors: John P. Birkedal, MD; Michael P. Dohm, MD; Thomas J. Gilbert, MD; Joseph Gjolaj, MD; Jordan Gliedt, DC; Darren R. Lebl, MD; Robert C. Nucci, MD; Alex Seldomridge, MD, MBA; Matthew Smuck, MD [Stakeholder Representative, American Academy of Physical Medicine and Rehabilitation (AAPM&R)]; William L. Tontz, Jr. MD Participating Societies (does not necessarily imply endorsement): American Academy of Family Physicians (AAFP); American Academy of Orthopaedic Surgeons (AAOS); American Academy of Pain Medicine (AAPM); American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS); American Society of Anesthesiologists (ASA); American Society of Regional Anesthesia and Pain Medicine (ASRA); American Society of Spine Radiology (ASSR); Spine Intervention Society (SIS) Contributing Societies (does not necessarily imply endorsement): American Academy of Physical Medicine and Rehabilitation (AAPM&R); American Physical Therapy Association (APTA) North American Spine Society Staff: Karie A. Rosolowski, MPH; Amy M. Yahiro, MS.
- Cost utility
- Evidence-based guideline
- Low back pain
- Lumbar pain