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Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence).For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs.Owens, MD, MS; for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel* From Oregon Health & Science University, Portland, Oregon; the American College of Physicians, Philadelphia, Pennsylvania; Atlantic Health, Morristown, New Jersey; Medstudy, Colorado Springs, Colorado; and Veterans Affairs Health Care System and RAND, Santa Monica, Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, California.From Oregon Health & Science University, Portland, Oregon; the American College of Physicians, Philadelphia, Pennsylvania; Atlantic Health, Morristown, New Jersey; Medstudy, Colorado Springs, Colorado; and Veterans Affairs Health Care System and RAND, Santa Monica, Veterans Affairs Palo Alto Health Care System, Palo Alto, and Stanford University, Stanford, California.For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).* This paper, written by Roger Chou, MD; Amir Qaseem, MD, Ph D, MHA; Vincenza Snow, MD; Donald Casey, MD, MPH, MBA; J.Thomas Cross Jr., MD, MPH; Paul Shekelle, MD, Ph D; and Douglas K.



The evidence in this guideline was first evaluated by the ACP/APS panel by using a system adopted from the U. Preventive Services Task Force for grading strength of evidence, estimating magnitude of benefits, and assigning summary ratings (Appendix Tables 2, 3, and 4) (19).Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence).For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care.Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).

Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence).

The target patient population is adults with acute and chronic low back pain not associated with major trauma.



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