Recommendations

Document Overview

Design and created by Guideline Central in participation with the North American Spine Society.

Diagnosis And Treatment Of Low Back Pain

North American Spine Society

Publication Date: Jan 1, 2020

Page Last Updated: May 6, 2026

North American Spine Society Grades of Recommendation

Recommendation Grade
Grade	Recommendation	Quality of Evidence
A	Recommended	Good evidence (Level I studies with consistent findings) for or against recommending intervention
B	Suggested	Fair evidence (Level II or III studies with consistent findings) for or against recommending intervention
C	May be considered	Poor quality evidence (Level IV or V studies) for or against recommending intervention
I	Insufficient, Inadequate or Conflicting Evidence	Insufficient, inadequate or conflicting evidence not allowing a recommendation for or against intervention

Document Overview

Document Title: Diagnosis And Treatment Of Low Back Pain

Authoring Society: North American Spine Society

Document Publication Date: Jan 1, 2020

Page Last Reviewed/Updated: May 6, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf

Source Citation: Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC 3rd, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL Jr, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020 Jul;20(7):998-1024. doi: 10.1016/j.spinee.2020.04.006. Epub 2020 Apr 22. Erratum in: Spine J. 2021 Feb 24;: PMID: 32333996.

Document Scope, Criteria, and Use Cases

Scope: Assessment and Screening, Diagnosis, Management, Rehabilitation, Treatment

Diseases/Conditions (MeSH)

D017116 - Low Back Pain

Keywords: chronic low back pain, low back pain (LBP), pain

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Hospital

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resources: Technical Review Data Supplement

Number of Source Documents: 337

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Diagnosis And Treatment Of Low Back Pain

Recommendations

Diagnosis

Work Group Consensus Statement:

Imaging

Medical and Psychological Treatment

Physical Medicine and Rehabilitation

North American Spine Society Grades of Recommendation

Document Overview

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology