Introduction With the rapid rise in arthroscopy rates for the management of Femoroacetabular Impingement (FAI) Syndrome, it is important to understand current surgical rates and the impact of these surgeries within the Military Health System (MHS). The purpose of this study was to provide an epidemiological descriptive summary of hip arthroscopy for FAI Syndrome in the MHS and describe perioperative healthcare utilization variables. Methods Eligible beneficiaries ages 18–50, undergoing hip arthroscopy with 2-year follow-up after surgery were included. Healthcare utilization data were abstracted from the MHS Data Repository (MDR) from June 2003 to July 2015, and included all visits, costs, procedures, and prescriptions taking place in both military and civilian hospitals worldwide. Results 1870 patients were included (mean age 32.2 years; 55.5% male). 51.7% of the procedures took place in military versus 48.3% in civilian hospitals. Mean hip-related healthcare costs in the 2-year following surgery were $15,434 per patient. Patients had a median of 3 opioid prescriptions and 72% had a comorbidity present after surgery. Generally, rates of surgery grew annually from 66 cases in 2004 to 422 cases in 2013. Overall complication rates were comparable to other published reports. Procedures in both military and civilian hospitals had the same rates of femoroplasty and labral repairs, however acetabuloplasty procedures occurred at a higher rate in military (18.9%) vs civilian (14.7%) hospitals. Only 58.8% of patients had physical therapy in the year prior to surgery, while 82.7% had it after surgery. Additionally, 50% of patients had received opioid prescriptions in the 1 year prior to surgery, while 38.9% had 3 or greater opioid prescriptions beyond the initial perioperative fill within the 2-year follow-up. Conclusion Rates of arthroscopy have grown in the MHS over the last decade. Complication rates are similar to those reported in other populations and settings. Utilization of physical therapy was much more likely after surgery than prior to it. Opioid use was high prior to surgery and many individuals continued to receive opioid prescriptions beyond the initial perioperative period.

Chronic non-cancer pain (CNCP) is significant global health issue, accounting for a substantial increase in prescription analgesics worldwide, in recent decades. This clinical burden is evident in the UK prison population, where the prevalence of CNCP has never previously been determined. This study, conducted in June/July 2013, used prescribing data and a systematic review of clinical records from two UK prison establishments to derive a figure for point-prevalence of CNCP. Results showed that 20% of the total aggregated prisoner rolls (N = 1944) described CNCP and had been in receipt of treatment with daily analgesia, for a period of at least 3 months prior to observation date. This prevalence of CNCP was related to increasing age group (Spearman's rank correlation 0.94). Of those on continuous analgesic therapy (CAT), 44% were taking continuous opioid therapy (COT) of any sort. Prisoners with a diagnosis of opioidtype drug dependence (OTDD) were more than twice as likely to complain of CNCP and be on continuous medication for it (odds ratio 2.3). The issues relating to CNCP in prisons are discussed. Further research is recommended, identifying factors influencing CNCP prevalence in prisons, and enabling comparisons to CNCP prevalence in the UK general population.

Background The prevalence of chronic pain conditions is growing. Low back pain was the primary cause of disability worldwide out of 156 conditions assessed between 1990 and 2016, according to the Global Burden of Disease Study. Conventional medical approaches have failed to identify effective and long-lasting approaches for the management of chronic pain, and often fail to consider the multiple domains that influence overall health and can contribute to the pain experience. Leading international organizations that focus on pain research have stated the importance of considering these other domains within holistic and multidisciplinary frameworks for treating pain. While the research behind the theoretical link between these domains and chronic pain outcomes has expanded greatly over the last decade, there have been few practical and feasible methods to implement this type of care in normal clinical practice. Methods The purpose of this manuscript is to describe an implementation protocol that is being used to deliver a complex holistic health intervention at multiple sites within a large government health system, as part of a larger multisite trial for patients with chronic low back pain. The Move to Health program developed by the US Army Medical Command was tailored for specific application to patients with low back pain and begins by providing an empirical link between eight different health domains (that include physical, emotional, social, and psychological constructs) and chronic low back pain. Through a six-step process, a health coach leverages motivational interviewing and information from a personal health inventory to guide the patient through a series of conversations about behavioral lifestyle choices. The patient chooses which domains they want to prioritize, and the health coach helps implement the plan with the use of SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goals and a series of resources for every domain, triaged from self-management to specialist referral. Discussion Complex interventions described in clinical trials are often challenging to implement because they lack sufficient details. Implementation protocols can improve the ability to properly deliver trial interventions into regular clinical practice with increased fidelity. Trial registration Implementation of this intervention protocol was developed for a clinical trial that was registered a priori (clinicaltrials.gov #NCT04172038).

Background Adherence to guidelines for back pain continues to be a challenge, prompting strategies focused on improving education around biopsychosocial frameworks. Objective Assess the influence of an interactive educational mobile app for patients on initial care decisions made for low back pain by the primary care provider. The secondary aim was to compare changes in self-reported pain and function between groups. Methods This was a randomized controlled trial involving patients consulting for an initial episode of low back pain. The intervention was a mobile video-based education session (Truth About Low Back Pain) compared to usual care. The app focused on addressing maladaptive beliefs typically associated with higher risk of receiving low-value care options. The primary outcome was initial medical utilization decisions made by primary care practitioners (x-rays, MRIs, opioid prescriptions, injections, procedures) and secondary outcomes included PROMIS pain interference and physical function subscales at 1 and 6 months, and total medical costs. Results Of 208 participants (71.2% male; mean age 35.4 years), rates of opioid prescriptions, advanced imaging, analgesic patches, spine injections, and physical therapy use were lower in the education group, but the differences were not significant. Total back-related medical costs for 1 year (mean diff = $132; P = 0.63) and none of the 6-month PROMIS subscales were significantly different between groups. Results were no different in opioid-naïve subjects. Instead, prior opioid use and high-risk of poor prognosis on the STarT Back Screening Tool predicted 1-year back pain-related costs and healthcare utilization, regardless of intervention. Conclusion Factors that influence medical treatment decisions and guideline-concordant care are complex. This particular patient education approach directed at patients did not appear to influence healthcare decisions made by primary care providers. Future studies should focus on high-risk populations and/or the impact of including the medical provider as an active part of the educational process. Trial Registration clinicaltrials.gov NCT02777983.