To view this page ensure that Adobe Flash Player version 11.1.0 or greater is installed.
I N T E RV I E W Addressing Back Pain in the Primary-Care Setting Approximately 80 percent of U.S. adults experience low-back pain at some point in their lifetimes, and one-in-four report struggling with low-back pain within the last three months. Low-back pain is the most common cause of job-related disability and a leading contributor to lost work time. But treatment often is ineffective, costly, and even dangerous. UCLA Health has established an initiative designed to ensure a standard, evidence-based approach to managing back pain in primary-care settings. The initiative is being spearheaded by O. Kenrik Duru, MD, MSHS, associate professor of medicine at the David Geffen School of Medicine at UCLA. What is the impetus behind the UCLA Back Pain Initiative? This really goes beyond back pain. UCLA Health has moved toward patient-centered care that is value-based, and part of that involves improving communication and coordination among primary-care doctors and specialists. We want a system in which all healthcare providers know their role and everything moves seamlessly. Back pain is a good place to start with that. Why is that? For one thing, it’s very common, and it involves treatment by both primary-care providers and specialists. And we saw that our UCLA Spine Center was getting many referrals from primary-care physicians of patients who didn’t necessarily need to be seen by a specialist. Most acute-back-pain cases — not just the first-time cases but also the ones that flare up every so often — will get better on their own. For those patients, time is the best medicine, and referring them doesn’t make sense for the health system or for the patient, who has UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) to take time off work, make a copayment and then is told to go home, rest and wait. So we wanted to communicate to patients and to their primary-care physicians that once the doctor has carefully screened you for more serious conditions, you don’t need a referral to a specialist right away. Our other concern is that patients should not be getting X-rays or MRIs on uncomplicated back pain in the first four-to-six weeks. It doesn’t help, and it often will turn up abnormalities that aren’t related to the back pain. These false positives can lead to unnecessary treatment that puts the patient at greater risk. So there is a danger to overtreatment? Yes, and unfortunately, in too many cases, patients end up going on opiates, which can lead to long-term addiction and other problems. So we do have to be careful about overtreatment. About 85 percent of patients with back pain who visit a primary-care doctor have “nonspecific” back pain, meaning that a cause is never found; an additional 10 percent have herniated discs or spinal stenosis, which may require treatment at some point but are not medical emergencies. Of patients with back pain who seek care, 70-to-90 percent improve within seven weeks with conservative