Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Diagnosis and treatment of low back pain:
Key questions:

1. In patients with low back pain, what are the benefits and harms of identifying risk factors for chronicity and targeting treatment based on assessed risk?
2. In patients with low back pain without signs or symptoms suggesting a specific or serious underlying diagnosis, what are the benefits and harms of routine imaging versus no routine imaging?
3. What are the comparative benefits and harms of self-care advice, education, or other self-care interventions?
4. What are the comparative benefits and harms of different pharmacological therapies for non-radicular low back pain, radicular low back pain, or spinal stenosis? (Including NSAIDs, acetaminophen, opioids, antiseizure medications, antidepressants, corticosteroids)
5. What are the comparative benefits and harms of different non-pharmacological, non-invasive therapies for non-radicular low back pain, radicular low back pain, or spinal stenosis? (Including interdisciplinary rehabilitation, exercise and related therapies, spinal manipulation, acupuncture and related therapies, massage, and various psychological therapies)
6. What is the accuracy and clinical effectiveness of decision tools or other methods for predicting which patients with low back pain are more likely to respond to specific therapies?
7. What are the comparative benefits and harms of various interventional procedures for non-radicular low back pain, radicular low back pain, or spinal stenosis? (Including local injections, epidural steroid injections, facet joint steroid injection, intradiscal methylene blue, intradiscal ozone, injections involving anti-TNF drugs, radiofrequency denervation, IDET/PIRFT)
8. What are the comparative benefits and harms of surgery (and different surgical interventions) vs. non-surgical management for non-radicular low back pain, radicular low back pain, or spinal stenosis?
9. What are the comparative benefits and harms of combinations of therapies (versus single therapies or versus different combinations) for low back pain?
10. What are the comparative benefits and harms of different methods of integrating or coordinating low back pain care?
11. What are the benefits and harms of interventions for secondary prevention of low back pain, or for prevention of flares of low back pain in patients with chronic low back pain?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Functional limitations and disability

AHRQ Priority Populations

None

Federal Health Care Program

None

Importance

Describe why this topic is important.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program