Low back pain is a common problem that affects the base, or lumbar segment, of the spine and is usually caused by a strain on the muscles, ligaments and bones of the spine. Low back pain is one of most common reasons for workers under age 45 to be on disability or workers' compensation. Almost two-thirds of all adults will have a problem with low back pain at some point. It is often hard to find the specific cause of the low back pain and there is rarely a treatment that will cause the pain to go away quickly. In most cases, however, the pain will go away or lessen within four to six weeks without medical attention. But patients often receive "imaging" (X-rays, MRIs or CT scans) or even surgery that they do not need in an effort to find or fix the problem.

Low back pain is the most costly ailment in the workplace, averaging of $8,000 per claim. Medical costs connected with low back pain are more than $25 billion per year in the U.S. When adding to that lost wages, disability payments, and retraining costs, total costs associated with back pain range between an estimated $50 billion and $100 billion per year. Source: HEDIS

Patients and Caregivers

For low back pain that does not improve in a few days, work with a health care provider to:

• Rule out any "red flags" for conditions that might suggest rare but serious underlying problems.
• If there are no "red flags," wait at least 6 weeks before having an X-ray, MRI or CT scan or even considering more aggressive actions such as injections or surgery.
• Learn about the benefits and risks of different approaches for treating low back pain.
• Work with your doctor to create a plan to gradually get back to normal activity; consider changes you can make in your activities to avoid low back pain in the future.

To cut your risk of low back pain returning:

• Avoid bed rest; stay as physically active as possible.
• Take steps to address work-life concerns and reduce stress.
• Stop smoking, as smoking actually delays healing and recovery.

Doctors and Other Health Care Professionals

• Screen patients for any serious condition that requires prompt medical attention.
• Use an imaging checklist to talk with patients about whether x-rays, MRIs or CT scans are needed.
• Talk with patients about the expected or common course of low back pain and the importance of staying active.
• Encourage patients to use helpful exercises, heat and ice, and over-the-counter medications to help reduce pain.
• Consider using a return-to-activity form to develop a plan with the patient to gradually return to normal activities.

Employers and Other Health Care Purchasers

• Communicate with employees and their families about the recommended conservative treatment of acute low back pain.
• Encourage employees with low back pain to progress back to normal work and activity levels.
• Sponsor a peer-to-peer educational program about low back pain, appropriate treatments, expectations for recovery, self-management, etc.
• Make back pain self-management resources readily available to employees and dependents.

Health Plans

• Provide access to a health risk assessment to identify possible work-life emotional issues that may impact low back pain and the member's response to treatment.
• Encourage providers to use an imaging checklist to determine whether or when imaging is appropriate for individual patients with acute low back pain.

Park Nicollet Institute: Low Back Pain
Joint Clinical Practice Guidelines of the American College of Physicians and the American Pain Society
( Annals of Internal Medicine, October 2007, Volume 147 )
Puget Sound Health Alliance Clinical Improvement Team Report on Low Back Pain