Overview
Vertebrogenic low back pain (LBP) is a common and distressing condition affecting a significant portion of the population 1. It is characterized by recurrent and fluctuating pain that can persist from childhood through young adulthood 2.Diagnosis
Clinical evaluation includes history and examination 3.
Screening for red flags is recommended 3.
Diagnostic imaging recommendations are addressed in care pathways 3.Management
Management includes pharmacologic therapies and nonpharmacologic treatments (both noninvasive and invasive) 1.
Integrated care pathways guide chiropractic management and collaborative care for veterans with LBP 3.
Care pathways address informed consent, documentation, patient-reported outcomes, and adverse event reporting 3.
Standards for chiropractic treatment frequency and duration are established 3.
Tailored approaches to chiropractic care in veteran populations are considered 3.Special Populations
The natural course of LBP from childhood to young adulthood shows patterns of no LBP, fluctuating LBP, and persistent LBP 2.
Specific care pathways are developed for veterans with LBP, including those with mental health comorbidities 3.Key Recommendations
A joint clinical practice guideline for the management of low back pain has been approved by the US Department of Veterans Affairs and US Department of Defense, providing evidence-based recommendations for assessment and management 1. (Evidence: Expert opinion)
Integrated care pathways for low back pain in veterans have been developed through a Delphi consensus process, involving doctors of chiropractic, primary care providers, and mental health professionals 3. (Evidence: Expert opinion)
The natural course of low back pain in the general population from childhood through adolescence to young adulthood has been assessed, identifying common patterns of LBP 2. (Evidence: Moderate)References
1 Macedo F, Annaswamy T, Coller R, Buelt A, Glotfelter MA, Heideman PW et al.. Diagnosis and Treatment of Low Back Pain: Synopsis of the 2021 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline. American journal of physical medicine & rehabilitation 2024. link
2 Junge T, Wedderkopp N, Boyle E, Kjaer P. The natural course of low back pain from childhood to young adulthood - a systematic review. Chiropractic & manual therapies 2019. link
3 Lisi AJ, Salsbury SA, Hawk C, Vining RD, Wallace RB, Branson R et al.. Chiropractic Integrated Care Pathway for Low Back Pain in Veterans: Results of a Delphi Consensus Process. Journal of manipulative and physiological therapeutics 2018. link