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Low back pain is one of the most common causes of disability in the country—more than 80 percent of Americans will experience low back pain in their lifetime. Imaging tests–including CT scans, MRIs, and X-rays–are commonly performed to diagnose the seriousness of the condition. However, most patients do not benefit from imaging studies and may be unnecessarily exposed to harmful radiation. Unnecessary imaging can also lead to surgeries that may not improve pain, or that may even cause further injury and disability. Additionally, overprescribing of opioids for low back pain contributes to the worsening of the opioid epidemic. There is a compelling need to reduce over-imaging and ensure evidence-based treatment for low back pain. Links to key resources collected by the Workgroup are included below.



Patients, families, and caregivers

Easy-to-read information on the prevention and treatment of low back pain. Key resources include fact sheets and patient support materials on common mistakes in the treatment of back pain, including the use of imaging, and when to seek medical treatment. Providers, payers, and purchasers can distribute these resources to patients and consumers.

Imaging tests for lower-back pain: You probably don’t need an X-ray, CT scan, or MRI (Consumer Reports)

Consumer Report’s Guide to Treating Back Pain (Consumer Reports)         

Low back pain – acute (US National Library of Medicine)


Evidence-based guidelines, clinical decision support, and training materials for physicians and physical therapists on the diagnosis, management, and treatment of low back pain. Practical tools such as screening questionnaires are referenced.

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (American College of Physicians [published by Annals of Internal Medicine])

Oswestry Low Back Pain Disability Questionnaire (American Academy of Orthopedic Surgeons)

The Bree Collaborative Spine and Low Back Pain Report and Recommendations (Bree Collaborative)      

Payers and purchasers

Concrete actions for payers and purchasers seeking to improve treatment of low back pain. Key resources include information on innovative benefit designs such as rapid access to physical therapy, as well as information on first- and second-line therapies for acute and chronic low back pain.

Chronic Low Back and Neck Pain: Final Report (Institute for Clinical and Economic Review [ICER])

Health Evidence Review Commission (HERC) Coverage Guidance: Lower Back Pain: Non-Pharmacological/Non-Invasive Interventions (Oregon Health Authority [OHA])        

Does Unrestricted Direct Access to Physical Therapy Reduce Utilization and Health Spending? (Health Care Cost Institute)


Spine Pain & Opioids: A Tale of Two Epidemics (Eugene Hsu, MD, MBA, Stanford CERC, Smart Care California Meeting, January 2017)

Pain Center of Excellence (Tobias Moeller-Bertram, MD, PhD, MAS, Desert Clinic Pain Institute & Jennifer Sayles, MD, MPH, Inland Empire Health Plan, Smart Care California Meeting, January 2017)

Reducing Low Back Pain Imaging – Implementing Choosing Wisely (Parag Agnihotri, MD, Sharp Rees-Stealy Medical Group, Smart Care California Meeting, October 2015)

Right Study, Right Patient, Right Time: Reducing Inappropriate Imaging for Low Back Pain (Jennifer Sayles, MD, MPH, LA County Department of Health Services, Smart Care California Meeting, October 2015)


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