Pain: Low Back Pain

[2010 update]

Introduction to this self-study CME activity


Acute low back pain occurs in about 80% of adults.  Acute low back pain is the second most common symptomatic reason for office visits to primary care physicians.  Recurrence is common: with 60-80% of patients experiencing reoccurrence within two years.  A great majority of persons with non-radiating low back pain will have symptoms resolved within 6 weeks. Half of all persons with radiating back pain recover spontaneously within 6 weeks.  As time passes without resolution, the prognosis worsens.  This self-study activity provides practical guidance to clinicians with key aspects of care.

New with this update:

  • Updated medications (Table 7).
  • Assess GI risk prior to prescribing NSAIDs (Table 8).
  • Early opioid use is associated with prolonged length of disability and increased cost of care.
  • Multidisciplinary rehabilitation is effective for patients disabled by low back pain.
  • Lumbo-pelvic pain in pregnancy is associated with increased risk of post-partum depression.


Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for providing care for low back pain in adults.


This self-study activity is appropriate for primary care clinicians and other health care providers providing care for low back pain in adults.


Team Leaders

  • Anthony Chiodo, MD
    Physical Medicine & Rehabilitation

Team Members

  • David Alvarez, DO
    Family Medicine
  • Gregory Graziano, MD
    Orthopedic Surgery
  • Paul Park, MD
  • Andrew Haig, MD
    Physical Medicine & Rehabilitation
  • Connie Standiford, MD
    General Internal Medicine
  • Van Harrison, PhD
    Medical Education

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
David Alvarez, DO
Anthony Chiodo, MD
Advisory Board
Gregory Graziano, MD
Andrew Haig, MD
Rehabilitation Team Assessments, LLC
Van Harrison, PhD
Paul Park, MD
Connie Standiford, MD

Other Acknowledgements

UMHS Guidelines Oversight Team

  • William E. Chavey, MD
  • R. Van Harrison
  • PhD Connie J. Standiford, MD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in January 2010, with credit available through January 2016. The  activity was reviewed for currency of content in April 2016 and availability of credit extended through January 2019.  Continuation of credit from that date depends on a thorough review of the content currency and accuracy.  

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.