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Anthem Blue Cross : Low Back Pain Tools for Patients and Providers

Low Back Pain Tools for Patients and Providers

Consider this: Two-thirds of all adults will experience low back pain at some time. It is the second most common cause of symptom-related doctor visits and associated with $50 billion to $100 billion annually in medical care costs, and lost wages and retraining costs. There is documented variation of care for key procedures such as imaging and surgery1
We know caring for a patient with low back pain can be complex and time-consuming. We developed this toolkit in conjunction with our external physician expert panel in the hopes that it will help you better manage their care.  
Diagnostic work-up: a checklist
Measuring functional status
Measuring pain status
Snapshot of available interventions
Shared decision-making
The Back Book
Healthy Body, Healthy Mind: Low Back Pain
Please send any questions or feedback to  
Section 1: Guidelines – what science says  
In the majority of cases, x-rays, MRIs, or CT scans in the first four weeks are not necessary. To read more about this recommendation and others, access the guidelines listed below. 

Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society on the diagnosis and treatment of low back pain (Ann Intern Med. 2007;147:478-49)

Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline from the American Pain Society (Spine; 34:10:1066-1077)

Section 2: Treatment flow chart to help you develop the right process  
The following treatment protocol was adapted from the Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.  

Please consider it a model and a starting point for developing a treatment protocol that fits the way you practice. 
The tools referenced within the protocol are: 
Diagnostic Work-Up Checklist
Interventions Table
Degenerative Disc Disease
Additionally, the protocol recommends assessing the patient’s level of pain and ability to function. By doing so, you’ll have a quantitative way to assess your patient’s progress. The National Committee for Quality Assurance (NCQA) offers tools in their Back Pain Recognition Program. Of these, we recommend the following:  
To measure pain status, Numerical Rating Scale: Ask the patient to rate their pain on a scale of 1 to 10, with 1=no pain and 10=worst pain imaginable.  
To measure functional status:  
Oswestry Low Back Pain Questionnaire
Roland-Morris Disability Questionnaire
Section 3: Educating your patients and considering their treatment preferences  
Shared decision-making tools help people become involved in decision making by providing information about options and outcomes and by clarifying personal values. They are designed to complement, rather than replace, counseling from a health practitioner.  
The Ottawa Health Research Institute has developed a comprehensive website to explain the value of patient decision aids. They have also evaluated several of the available SDM tools focused on low back pain which include tools to help patients understand whether they should consider procedures such as MRI, surgery, or spinal manipulation. Access a complete list of topics here.  

The Back Book
The Back Book, written by a multi-disciplinary team of researchers, offers evidence-based self care advice on coping with back pain and leading a normal life. 
The books are sold in packs of 10 and can be purchased from The Stationary Office.  
Healthy Body, Healthy Mind: Low Back Pain  
This 30 minute episode focuses on the causes, treatments, and self-management options for persons suffering from low back pain. [etc.]  
Section 4: Articles & other resources for low back pain  

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