Organizational and Nursing Issues Related to Spine Pain Care

  • Paul ArnsteinEmail author


People with back and neck pain are high utilizers of healthcare, despite having comorbidities, disability, and limited financial resources that impede access. Globally, these conditions have been ranked the most burdensome cause of disability for decades, yet real-world reduction in the prevalence, cost, and suffering attributed to spine pain has been elusive. Back and neck pain accounts for tens of millions of office visits in the USA and a million surgical procedures each year. When pain is complex and persists despite first-, second-, and third-line therapies, interprofessional collaboration can develop a thoughtfully tailored multimodal treatment plan. In this collaborative model, healthcare professionals share their different understandings, assessments, and critical thinking about pain to best serve patients. Nurses comprise the largest segment of the healthcare workforce and may be an underutilized resource to strengthen coordination of team-based care. The role and scope of practice are delineated for nurses and other healthcare professionals. The role organizations play in supporting the best possible patient-centered care, professional practices, in a financially responsible way is reviewed. Given the imperative to address pain, professionals and organizations must balance concerns for helping without hurting, advising without dictating, and doing what is best for both the individual and community served.


Low back pain Neck pain Patient-centered care Interprofessional collaboration Pain management nursing role Organizational improvement Electronic health record decision support 


  1. 1.
    Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC: The National Academies Press; 2011. Scholar
  2. 2.
    DiMaggio C, Ayoung-Chee P, Shinseki M, Wilson C, Marshall G, Lee DC, et al. Traumatic injury in the United States: in-patient epidemiology 2000–2011. Injury. 2016;47(7):1393–403.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Hall MJ, Schwartzman A, Zhang J, Liu X. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report. 2017;102:1–15.Google Scholar
  4. 4.
    Nahin RL. Estimates of pain prevalence and severity in adults: United States, 2012. J Pain. 2015;16(8):769–80.PubMedPubMedCentralGoogle Scholar
  5. 5.
    U.S. Department of Health and Human Services. National pain strategy: a comprehensive population health-level strategy for pain. March 2016. Washington, DC: Accessed on line at: Accessed 12 March 2018.
  6. 6.
    GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–1259.Google Scholar
  7. 7.
    MacDonald J, Stuart E, Rodenberg R. Musculoskeletal low back pain in school-aged children: a review. JAMA Pediatr. 2017;171(3):280–7.PubMedGoogle Scholar
  8. 8.
    Nitta A, Sakai T, Goda Y, Takata Y, Higashino K, Sakamaki T, et al. Prevalence of symptomatic lumbar spondylolysis in pediatric patients. Orthopedics. 2016;39(3):e434–7.PubMedGoogle Scholar
  9. 9.
    Foundation for Health Care Quality. Spine/low back pain: report & recommendations. Bree Collaborative. Bree Collaborative, for the Washington State Health Care Authority. Contract No. K529, 2013. Accessed on line 3 March 2018 at
  10. 10.
    Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation. 2014;17(Suppl 2):3–10.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Hoy DG, Protani M, De R, Buchbinder R. The epidemiology of neck pain. Best Pract Res Clin Rheumatol. 2010;24(6):783–92.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Shmagel A, Foley R, Ibrahim H. Epidemiology of chronic low back pain in US adults: data from the 2009-2010 National Health and Nutrition Examination Survey. Arthritis Care Res (Hoboken). 2016;68(11):1688–94.Google Scholar
  13. 13.
    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545–602.Google Scholar
  14. 14.
    Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine. 2006;31(23):2724–7.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Bishop A, Foster NE, Thomas E, Hay EM. How does the self-reported clinical management of patients with low back pain related to the attitudes and beliefs of health practitioners? A survey of UK general practitioners and physiotherapists. Pain. 2008;135:187–95.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain. 2012;16:3–17.PubMedGoogle Scholar
  17. 17.
    Deyo RA, Mirza SK, Terner JA, Martin BI. Overtreating chronic pain: time to back off? J Am Board Fam Med. 2009;22:62–8.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Schers H, Wensing M, Juijsmans Z, van Tulder M, Grol R. Implementation barriers for general practice guidelines on low back pain. Spine. 2001;26(15):E349–53.Google Scholar
  19. 19.
    Barth J, Schafroth L, Witt CM. Overlap and differences between patient and provider expectations for treatment outcomes: the case of acupuncture. J Pain. 2016;17(6):685–93.PubMedGoogle Scholar
  20. 20.
    Cagle J, Bunting M. Patient reluctance to discuss pain: understanding stoicism, stigma, and other contributing factors. J Soc Work End Life Palliat Care. 2017;13(1):27–43.PubMedGoogle Scholar
  21. 21.
    Dasgupta N, Funk MJ, Proescholdbell S, et al. Cohort study of the impact of high-dose opioid analgesics on overdose mortality. Pain Med. 2016;17(1):85–98.PubMedGoogle Scholar
  22. 22.
    Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, and use disorders in U.S. adults: 2015 National Survey on drug use and health. Ann Intern Med. 2017;167(5):293–301.PubMedGoogle Scholar
  23. 23.
    Tang NK, Crane C. Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links. Psychol Med. 2006;36:575–86.PubMedGoogle Scholar
  24. 24.
    Tang NK, Beckwith P, Ashworth P. Mental defeat is associated with suicide intent in patients with chronic pain. Clin J Pain. 2016;32(5):411–9.PubMedGoogle Scholar
  25. 25.
    Alford DP, German JS, Samet JH, Cheng DM, Lloyd-Travaglini CA, Saitz R. Primary care patients with drug use report chronic pain and self-medicate with alcohol and other drugs. J Gen Intern Med. 2016;31(5):486–91.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Ann Rheum Dis. 2017;76(7):1269–78.PubMedGoogle Scholar
  27. 27.
    Shanthanna H, Gilron I, Rajarathinam M, AlAmri R, Kamath S, Thabane L, et al. Benefits and safety of gabapentinoids in chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2017;14:e1002369.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database Syst Rev. 2016;6:CD012230.Google Scholar
  29. 29.
    Mathieson S, Maher CG, McLachlan AJ, Latimer J, Koes BW, Hancock MJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med. 2017;376:1111–20.PubMedPubMedCentralGoogle Scholar
  30. 30.
    De Ruddere L, Craig KD. Understanding stigma and chronic pain: a state of the art review. Pain. 2016;157:1605–8.Google Scholar
  31. 31.
    Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, et al. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;10:CD012509.PubMedGoogle Scholar
  32. 32.
    Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493–505.Google Scholar
  33. 33.
    Daly C, Griffin E, Ashcroft DM, Webb RT, Perry IJ, Arensman E. Intentional drug overdose involving pregabalin and gabapentin: findings from the National Self-Harm Registry Ireland, 2007-2015. Clin Drug Investig. 2018;38(4):373–80.PubMedGoogle Scholar
  34. 34.
    Gomes T, Juurlink DN, Antoniou T, Mamdani MM, Paterson JM, van den Brink W. Gabapentin, opioids, and the risk of opioid-related death: a population-based nested case-control study. PLoS Med. 2017;14(10):e1002396.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Goodman CW, Brett AS. Gabapentin and pregabalin for pain - is increased prescribing a cause for concern? N Engl J Med. 2017;377:411–4.PubMedGoogle Scholar
  36. 36.
    Donkor J, Armenian P, Hartman IN, Vohra R. Analysis of gastric lavage reported to a statewide poison control system. J Emerg Med. 2016;51(4):394–400.PubMedGoogle Scholar
  37. 37.
    Nelson JC, Spyker DA. Morbidity and mortality associated with medications used in the treatment of depression: an analysis of cases reported to U.S. Poison Control Centers, 2000-2014. Am J Psychiatry. 2017;174(5):438–50.PubMedGoogle Scholar
  38. 38.
    Solomon DH, Husni ME, Libby PA, Yeomans ND, Lincoff AM, Lϋscher TF, et al. The risk of major NSAID toxicity with celecoxib, ibuprofen, or naproxen: a secondary analysis of the PRECISION trial. Am J Med. 2017;130(12):1415–22.PubMedGoogle Scholar
  39. 39.
    Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Sondergaard KB, Weeke P, Wissenberg M, Schjerning Olsen AM, Fosbol EL, Lippert FK, et al. Non-steroidal anti-inflammatory drug use is associated with increased risk of out-of-hospital cardiac arrest: a nationwide case–time–control study. Eur Heart J Cardiovasc Pharmacother. 2017;3(2):100–7.PubMedGoogle Scholar
  41. 41.
    Quan M. The cardiovascular safety of nonsteroidal anti-inflammatory drugs: putting the evidence in perspective. Clin Rev. 2017;Suppl(1):S1–6.Google Scholar
  42. 42.
    Doyon S, Klein-Schwartz W, Lee S, Beuhler MC. Fatalities involving acetaminophen combination products reported to United States poison centers. Clin Toxicol (Phila). 2013;51(10):941–8.Google Scholar
  43. 43.
    Blieden M, Paramore LC, Shah D, Ben-Joseph R. A perspective on the epidemiology of acetaminophen exposure and toxicity in the United States. Expert Rev Clin Pharmacol. 2014;7(3):341–8.PubMedGoogle Scholar
  44. 44.
    Tabibian BE, Kuhn EN, Davis MC, Pritchard PR. Patient expectations and preferences in the spinal surgery clinic. World Neurosurg. 2017;106:595–601.PubMedGoogle Scholar
  45. 45.
    Weiss PF, Colbert RA, Xiao R, Feudtner C, Beukelman T, DeWitt EM, et al. Development and retrospective validation of the juvenile spondyloarthritis disease activity index. Arthritis Care Res (Hoboken). 2014;66(12):1775–82.Google Scholar
  46. 46.
    Saifi C, Fein AW, Cazzulino A, Lehman RA, Phillips FM, An HS, et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J. 2017. pii: S1529-9430(17)31149-X.Google Scholar
  47. 47.
    Ghori A, Konopka JF, Makanji H, Cha TD, Bono CM. Long term societal ccosts of Anterior Discectomy and Fusion (ACDF) versus Cervical Disc Arthroplasty (CDA) for treatment of cervical radiculopathy. Int J Spine Surg. 2016;10:1.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Bigos S, Bowyer O, Braen G, et al. Acute low back problems in adults. Clinical practice guideline No. 14. AHCPR Publication No. 95–0642. Rockville: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services; 1994.Google Scholar
  49. 49.
    Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Clinical efficacy assessment Subcommittee of the American College of physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. 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):478–91.Google Scholar
  50. 50.
    Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–30.PubMedGoogle Scholar
  51. 51.
    Katz J, Rosenbloom BN, Fashler S. Chronic pain, psychopathology, and DSM-5 somatic symptom disorder. Can J Psychiatr. 2015;60(4):160–7.Google Scholar
  52. 52.
    Upshur CC, Luckmann RS, Savageau JA. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006;21(6):652–5.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Fishman SM, Young HM, Lucas Arwood E, Chou R, Herr K, Murinson BB, et al. Core competencies for pain management: results of an interprofessional consensus summit. Pain Med. 2013;14(7):971–81.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Krebs EE, Bergman AA, Coffing JM, Campbell SR, Frankel RM, Matthias MS. Barriers to guideline-concordant opioid management in primary care--a qualitative study. J Pain. 2014;15(11):1148–55.PubMedGoogle Scholar
  55. 55.
    Webster LR, Grabois M. Current regulations related to opioid prescribing. PM R. 2015;7(11 Suppl):S236–47.PubMedGoogle Scholar
  56. 56.
    St. Marie B, Arnstein P. Quality pain care for older adults in an era of suspicion and scrutiny. J Gerontol Nurs. 2016;42(12):31–9.Google Scholar
  57. 57.
    Federation of State Medical Boards (FSMB). Guidelines for the Chronic Use of Opioid Analgesics. Policy adopted April, 2017. Accessed online 2/23/18 at
  58. 58.
    Slade SC, Kent P, Patel S, Bucknall T, Buchbinder R. Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: a systematic review and metasynthesis of qualitative studies. Clin J Pain. 2016;32(9):800–16.PubMedGoogle Scholar
  59. 59.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recommendations and Reports18. 2016;65(1):1–49.Google Scholar
  60. 60.
    Tayeb BO, Barreiro AE, Bradshaw YS, Chui KK, Carr DB. Durations of opioid, nonopioid drug, and behavioral clinical trials for chronic pain: adequate or inadequate? Pain Med. 2016;17(11):2036–46.PubMedGoogle Scholar
  61. 61.
    Pezalla EJ, Rosen D, Erensen JG, Haddox JD, Mayne TJ. Secular trends in opioid prescribing in the USA. J Pain Res. 2017;10:383–7.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Guy GP Jr, Zhang K, Bohm MK, Losby J, Lewis B, Young R, et al. Vital signs: changes in opioid prescribing in the United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66(26):697–704.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Seth P, Scholl L, Rudd RA, Bacon S. Overdose deaths involving opioids, cocaine, and psychostimulants - United States, 2015-2016. MMWR Morb Mortal Wkly Rep. 2018;67(12):349–58. Scholar
  64. 64.
    Varga Z, Sabzwari SRA, Vargova V. Cardiovascular risk of nonsteroidal anti-inflammatory drugs: an under-recognized public health issue. Cureus. 2017;9(4):e1 144.Google Scholar
  65. 65.
    Gunter BR, Butler KA, Wallace RL, Smith SM, Harirforoosh S. Non-steroidal anti-inflammatory drug-induced cardiovascular adverse events: a meta-analysis. J Clin Pharm Ther. 2017;42(1):27–38.PubMedGoogle Scholar
  66. 66.
    Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445–52.Google Scholar
  67. 67.
    Pollak KA, Stephens LS, Posner KL, Rathmell JP, Fitzgibbon DR, Dutton RP, et al. Trends in pain medicine liability. Anesthesiology. 2015;123(5):1133–41.PubMedGoogle Scholar
  68. 68.
    Fitzgibbon DR, Stephens LS, Posner KL, Michna E, Rathmell JP, Pollak KA, et al. Injury and liability associated with implantable devices for chronic pain. Anesthesiology. 2016;124(6):1384–93.Google Scholar
  69. 69.
    Loeser JD, Cahana A. Pain medicine versus pain management: ethical dilemmas created by contemporary medicine and business. Clin J Pain. 2013;29(4):311–6.PubMedGoogle Scholar
  70. 70.
    Blondal K, Halldorsdottir S. The challenge of caring for patients in pain: from the nurse’s perspective. J Clin Nurs. 2009;18(20):2897–906.PubMedGoogle Scholar
  71. 71.
    Giannitrapani KF, Ahluwalia SC, McCaa M, Pisciotta M, Dobscha S, Lorenz KA. Barriers to using nonpharmacologic approaches and reducing opioid use in primary care. Pain Med. 2018;19(7):1357–64.Google Scholar
  72. 72.
    Suman A, Schaafsma FG, Buchbinder R, van Tulder MW, Anema JR. Implementation of a multidisciplinary guideline for low back pain: process-evaluation among health care professionals. J Occup Rehabil. 2017;27(3):422–33. Scholar
  73. 73.
    O’Malley AS, Swankoski K, Peikes D, Crosson J, Duda N, Day T, et al. Patient dismissal by primary care practices. JAMA Intern Med. 2017;177(7):1048–50.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Moore RA, Derry S, Simon LS, Emery P. Nonsteroidal anti-inflammatory drugs, gastroprotection, and benefit-risk. Pain Pract. 2014;14(4):378–95.PubMedGoogle Scholar
  75. 75.
    Jambunathan J, Chappy S, Siebers JJ, Deda A. Patient-centered care for chronic pain in the emergency department: a qualitative study. Int Emerg Nurs. 2016;24:22–7.PubMedGoogle Scholar
  76. 76.
    Doorenbos AZ, Gordon DB, Tauben D, Palisoc J, Drangsholt M, Lindhorst T, et al. A blueprint of pain curriculum across prelicensure health sciences programs: one NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 2013;14(12):1533–8.PubMedGoogle Scholar
  77. 77.
    American Occupational Therapy Association. Occupational therapy practice framework: domain and process. Am J Occup Ther. 2014;68(Suppl 1):S1–S48.Google Scholar
  78. 78.
    Boitor M, Gélinas C, Richard-Lalonde M, Thombs BD. The effect of massage on acute postoperative pain in critically and acutely ill adults post-thoracic surgery: systematic review and meta-analysis of randomized controlled trials. Heart Lung. 2017;46(5):339–46.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Lee SH, Kim JY, Yeo S, Kim SH, Lim S. Meta-analysis of massage therapy on cancer pain. Integr Cancer Ther. 2015;14(4):297–304.PubMedGoogle Scholar
  80. 80.
    Yuan SL, Matsutani LA, Marques AP. Effectiveness of different styles of massage therapy in fibromyalgia: a systematic review and meta-analysis. Man Ther. 2015;20(2):257–64.PubMedGoogle Scholar
  81. 81.
    Cheng YH, Huang GC. Efficacy of massage therapy on pain and dysfunction in patients with neck pain: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2014;2014:204360.PubMedPubMedCentralGoogle Scholar
  82. 82.
    IOM (Institute of Medicine). The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press; 2010.Google Scholar
  83. 83.
    International Council on Nursing. ICN code of ethics for nurses. 3, place Jean-Marteau, 1201 Geneva, Switzerland, 2012. Accessed on line 3/2/18 at
  84. 84.
    IASP interprofessional pain curricula outline. International Association for the Study of Pain Web site. Published 2015. Accessed 29 Dec 2015.
  85. 85.
    American Nurses Association and American Society for Pain Management Nursing. (2016). Pain Management Nursing: Scope and Standards of Practice (2nd Edition). American Nurses Association Silver Spring, MD 20910. ISBN: 9781558106598 PUB# 9781558106598.Google Scholar
  86. 86.
    Jungquist CR, Pasero C, Tripoli NM, Gorodetsky R, Metersky M, Polomano RC. Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients. Worldviews Evid-Based Nurs. 2014;11(6):350–60.PubMedGoogle Scholar
  87. 87.
    Crawford CL, Boller J, Jadalla A, Cuenca E. An integrative review of pain resource nurse programs. Crit Care Nurs Q. 2016;39(1):64–82.PubMedGoogle Scholar
  88. 88.
    Manchikanti L, Pampati V, Hirsch JA. Retrospective cohort study of usage patterns of epidural injections for spinal pain in the US fee-for-service Medicare population from 2000 to 2014. BMJ Open. 2016;6(12):e013042.PubMedPubMedCentralGoogle Scholar
  89. 89.
    Manchikanti L, Abdi S, Atluri S, Benyamin RM, Boswell MV, Buenaventura RM, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013;16:S49–83.Google Scholar
  90. 90.
    The Joint Commission. R3 Report Pain Assessment and management standards for hospitals, 2017. Accessed 3/8/18 at
  91. 91.
    Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009;(2):CD003030.Google Scholar
  92. 92.
    Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment options for failed back surgery syndrome patients with refractory chronic pain: an evidence based approach. Spine (Phila Pa 1976). 2017;42(Suppl 14):S41–52.Google Scholar
  93. 93.
    Sharma AK, Vorobeychik Y, Wasserman R, Jameson J, Moradian M, Duszynski B, et al. Standards Division of the Spine Intervention Society. The effectiveness and risks of fluoroscopically guided lumbar interlaminar epidural steroid injections: a systematic review with comprehensive analysis of the published data. Pain Med. 2017;18(2):239–51.PubMedGoogle Scholar
  94. 94.
    Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018. pii: S0140-6736(18)30489-6.Google Scholar
  95. 95.
    Nuckols TK, Escarce JJ, Asch SM. The effects of quality of care on costs: a conceptual framework. Milbank Q. 2013;91(2):316–53.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Gordon DB, Wrona SK. Implementing and evaluating pain management safety and quality. In: Czarnecki ML, Turner HN, editors. Core curriculum for pain management nursing. 3rd ed. St. Louis: Elsevier; 2017. p. 577–5882. ISBN 978-0-323-46198-6.Google Scholar
  97. 97.
    Roberts ET, Zaslavsky AM, McWilliams JM. The value-based payment modifier: program outcomes and implications for disparities. Ann Intern Med. 2018;168(4):255–65.PubMedPubMedCentralGoogle Scholar
  98. 98.
    Nicolay CR, Purkayastha S, Greenhalgh A, Benn J, Chaturvedi S, Phillips N, et al. Systematic review of the application of quality improvement methodologies from the manufacturing industry to surgical healthcare. Br J Surg. 2012;99(3):324–35.PubMedGoogle Scholar
  99. 99.
    Zaslansky R, Rothaug J, Chapman RC, Backström R, Brill S, Engel C, et al. PAIN OUT: an international acute pain registry supporting clinicians in decision making and in quality improvement activities. J Eval Clin Pract. 2014;20(6):1090–8.Google Scholar
  100. 100.
    Chang V, Schwalb JM, Nerenz DR, Pietrantoni L, Jones S, Jankowski M, et al. The Michigan Spine Surgery Improvement Collaborative: a statewide collaborative quality initiative. Neurosurg Focus. 2015;39(6):E7.PubMedGoogle Scholar
  101. 101.
    Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic Health Record usability issues and potential contribution to patient harm. JAMA. 2018;319(12):1276–8.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Theodore BR, Whittington J, Towle C, Tauben DJ, Endicott-Popovsky B, Cahana A, et al. Transaction cost analysis of in-clinic versus telehealth consultations for chronic pain: preliminary evidence for rapid and affordable access to interdisciplinary collaborative consultation. Pain Med. 2015;16(6):1045–56.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Shelley BM, Katzman JG, Comerci GD Jr, Duhigg DJ, Olivas C, Kalishman S, et al. ECHO Pain Curriculum: balancing mandated continuing education with the needs of rural health care practitioners. J Contin Educ Heal Prof. 2017;37(3):190–4.Google Scholar
  104. 104.
    Jaspers MWM, Smeulers M, Vermeulen H, Peute LW. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. J Am Med Inform Assoc. 2011;18:327–34.PubMedPubMedCentralGoogle Scholar
  105. 105.
    Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. Scholar
  106. 106.
    Ash JS, Chase D, Wiesen JF, Murphy EV, Marovich S. Studying readiness for clinical decision support for worker health using the rapid assessment process and mixed methods interviews. AMIA Annu Symp Proc. 2017 Feb 10;2016:285–294. Accessed on line 3/20/18
  107. 107.
    Forseen SE, Corey AS. Clinical decision support and acute low back pain: evidence-based order sets. J Am Coll Radiol. 2012;9(10):704–12.PubMedGoogle Scholar
  108. 108.
    Blackmore CC, Mecklenburg RD. Taking charge of imaging: implementing a utilization program. Appl Radiol. 2012:18–23.Google Scholar
  109. 109.
    Vartanians VM, Sistrom CL, Weilburg JB, Rosenthal DI, Thrall JH. Increasing the appropriateness of outpatient imaging: effects of a barrier to ordering low-yield examinations. Radiology. 2010;255(3):842–9. Scholar
  110. 110.
    Saunders H. Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice. J Clin Nurs. 2015;24(13–14):2035–51.PubMedGoogle Scholar
  111. 111.
    Sipes C. Project management for the advanced practice nurse. New York: Springer Publishing; 2016. ISBN 978-0-8261-2817-1Google Scholar
  112. 112.
    Jeffery MM, Butler M, Stark A, Kane RL. Multidisciplinary pain programs for chronic noncancer pain. Technical Brief No. 8. AHRQ Publication No. 11-EHC064-EF. Rockville: Agency for Healthcare Research and Quality. September 2011. Accessed online 28 March 2018 @
  113. 113.
    Dorflinger L, Moore B, Goulet J, Becker W, Heapy AA, Sellinger JJ, et al. A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management. J Gen Intern Med. 2014;29(Suppl 4):870–6.PubMedPubMedCentralGoogle Scholar
  114. 114.
    Moore BA, Anderson D, Dorflinger L, Zlateva I, Lee A, Gilliam W, et al. Stepped care model of pain management and quality of pain care in long-term opioid therapy. J Rehabil Res Dev. 2016;53(1):137–46.PubMedGoogle Scholar
  115. 115.
    Nahin RL, Stussman BJ, Herman PM. Out-of-pocket expenditures on complementary health approaches associated with painful health conditions in a nationally representative adult sample. J Pain. 2015;16(11):1147–62.PubMedPubMedCentralGoogle Scholar
  116. 116.
    Huber S, Priebe JA, Baumann KM, Plidschun A, Schiessl C, Tölle TR. Treatment of low back pain with a digital multidisciplinary pain treatment app: short-term results. JMIR Rehabil Assist Technol. 2017;4(2):e11.PubMedPubMedCentralGoogle Scholar
  117. 117.
    Nicholl BI, Sandal LF, Stochkendahl MJ, McCallum M, Suresh N, Vasseljen O, et al. Digital support interventions for the self-management of low back pain: a systematic review. J Med Internet Res. 2017;19(5):e179.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Massachusetts General Hospital, Institute for Patient CareBostonUSA

Personalised recommendations