THE DIAGNOSIS AND TREATMENT OF LOW BACK PAIN: Synopsis of the 2021 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

Abstract

Low back pain (LBP) is a significant issue in the VA and DoD populations, and the general U.S. population at large. According to the Centers for Disease Control and Prevention, 25% of U.S. adults reported having low back pain in the prior 3 months.1 A survey of U.S Veterans published in 2017 revealed 33% of Veterans reported having significant back pain within the last three months.2 Within the DoD, LBP was the primary diagnosis for more than 1 million medical encounters in 2020 affecting 213,331 service members.3 In 2022, leadership within the U.S. Department of Veterans Affairs and U.S. Department of Defense approved a joint clinical practice guideline for the management of low back pain. Development of the guideline included a systematic evidence review which was guided by 12 key questions. A multidisciplinary team, that included clinical stakeholders, reviewed the evidence that was retrieved and developed 39 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The scope of the CPG is broad; however, the authors have focused on key recommendations that are important for clinicians in the evaluation and non-operative treatment of low back pain, including pharmacologic therapies, and both non-invasive and invasive non-pharmacologic treatments.