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JAMA talks low back pain

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The Journal of the American Medical Association (JAMA) recently published an article on low back pain on its Patient Page. This article contains a good discussion of the anatomy of the back, the sources of low back pain, and the range of treatments that should be considered.

JAMA notes that low back pain can result from problems with muscles, bones, or nerves, but muscle pain doesn't move down the legs. When the patient has had trauma, imaging studies such as x-rays, MRIs, and CT scans are appropriate. JAMA reports that treatment may include exercise, physical therapy, chiropractic, acupuncture, over-the-counter or prescription medication, and, in rare cases, surgery.

One of the things that we found interesting is that the JAMA article cited a clinical guideline by the American College of Radiology (ACR). This article discusses the appropriateness of several types of imaging studies under different clinical conditions. The ACR guideline states that most uncomplicated low back pain resolves on its own, but that intervention is needed for more complicated cases. The guideline considers low back pain to be "complicated" when it is accompanied by trauma, cumulative trauma, or lasts longer than 6 weeks. The ACR guideline confirms that x-rays are appropriate for evaluating alignment and instability in the low back.  

The ACR guideline was published by the National Guideline Clearinghouse (NGC). The NGC is a governmental organization created in partnership with the American Medical Association and the American Association of Health Plans (now America's Health Insurance Plans [AHIP]). Its mission is to provide health professionals, health plans, and others a mechanism for obtaining objective information on clinical practice guidelines.

We are glad to see JAMA referencing the NGC's Guidelines. As lawyers who deal with health issues for our clients, we like to work with doctors who utilize the latest health guidelines in their practice.