Affiliations: University of Washington, and Seattle Veterans Affairs Medical Center, Seattle, WA
Note: [1] Supported in part by grant no. HS-06344 from the Agency for Health Care Policy and Research (the Back Pain Outcome Assessment Team) and by the Health Services Research and Development Field Program, Seattle VA Medical Center.
Abstract: Back pain is a pervasive problem which ranks only behind cold symptoms as a reason for all physician visits. Among persons with back pain lasting at least two weeks, 85% will seek the care of a health professional. These patients obtain care from primary care physicians (Family Medicine, Internal Medicine, and Osteopathic physicians), but also see a variety of specialists, including physiatrists, rheumatologists, orthopedic surgeons, and neurosurgeons. Since any of these specialties may evaluate patients early in their course, it is important to adopt a systematic and rational early approach to back pain. This discussion emphasizes recent data suggesting that such an approach would include a parsimonious diagnostic evaluation, careful attention to patients' concerns, and careful choice of proven effective treatments. Specifically, we propose five strategies that may help to reduce costs of care while maintaining quality: 1. Avoid premature or unnecessary diagnostic tests. 2. Avoid patient deactivation. 3. Avoid ineffective or unproven remedies. 4. Prescribe effective therapy in a cost-conscious manner, and 5. Emphasize lifestyle changes and patient self-efficacy.
Keywords: Back pain, diagnosis back pain, lifestyle change, strategies for back pain
