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Low Back Pain Appropriate Use Criteria

UC Low Back Pain AUC (pdf)

Priority Clinical Area Coverage

This AUC reasonably addresses common and important clinical scenarios within the "Low back pain" Priority Clinical Area (PCA) and thus meets the minimum requirement for qCDSM to cover that PCA. However, by CMS definition of relevancy, it is not considered relevant to that PCA, as further described (See AUC Overview).

Search Strategy and Sources - Completed 2023-04-26

  • Limits:  English, 15 years publication, and adult, 19+
  • Extensive PubMed (Medline), Supplemental: EMBase, Web of Science, and Cochrane Database of Systematic Reviews.

( (Low Back Pain AND diagnostic imaging(major) AND investigative technique(major) ) OR
(Low Back Pain AND diagnostic imaging AND investigative technique AND review/document type)) OR

( (Low Back Pain AND diagnostic imaging  OR lumbar spine/diagnostic imaging (major) )
AND 
(practice guidelines as topic OR decision support techniques OR sensitivity and specificity OR predictive value of tests OR evidence based medicine) )

Results

171 publications were examined.  Initially 29 out of 94 references were determined to be relevant to the question of appropriateness of imaging of low back pain in the acute care setting. An expanded search based on specific terms (listed above) yielded an additional 77 related articles.   The result are 4 references for the AUC.

Low Back Pain AUC References and OCEBM Level of Evidence

  1. Bell, D.A., D. Collie, and P.F. Statham, Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning? Br J Neurosurg, 2007. 21(2): p. 201-3. Level 1
  2. Chou, R., et al., Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med, 2011. 154(3): p. 181-9. Level 1
  3. Chou, R., et al., Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med, 2007. 147(7): p. 478-91. Level 1
  4. Jarvik, J.G. and R.A. Deyo, Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med, 2002. 137(7): p. 586-97. Level 1