New guideline on Low back pain released by Veterans Affairs and Department of Defense

The US Department of Veterans Affairs and Department of Defense have released a joint Clinical Practice Guideline (CPG) for the diagnosis and treatment of low back pain (LBP).

This CPG was intended to provide healthcare providers with a framework by which to evaluate, treat, and manage patients with LBP.

The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practising 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 (Grading 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.

Also Read: FDA clears laser for chronic low back pain for first time

Key recommendations include:

• The CPG strongly recommends against initiating long-term opioid therapy, and that any opioid therapy be low dose and short in duration.


• The CPG also strongly recommends against the use of benzodiazepines, oral/intramuscular steroid medications, and chronic use of oral acetaminophen.


• Imaging is not recommended for LBP lasting <3 months and centred within the lumbar spine, not extending beyond the lower back.


• Physical activity, self-care, and cognitive behavioural therapy are strongly recommended.


• Spinal epidural steroid injections are not recommended for long-term reduction of radicular low back pain, nonradicular low back pain, or spinal stenosis.


• NSAIDs are recommended for acute or chronic LBP; duloxetine is also an option for chronic LBP.

Also Read: Low Back Pain mistreated globally against treatment guidelines : Lancet

"The 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 the treatment of low back pain," wrote the authors.

To read the full recommendations log on to https://doi.org/10.1007/s11606-019-05086-4