Back Pain Choices

About Back Pain Choices

The low back pain management algorithm, Back Pain Choices, is a distillation of the recommendations from evidence-based clinical practice guidelines produced by Australia’s National Health and Medical Research Council, The United Kingdom’s National Institute for Health and Clinical Excellence, and the guideline jointly produced by the American Pain Society and American College of Physicians.

Back Pain Choices was jointly developed by The George Institute for Global Health and NPS Better choices, Better health to assist with the diagnosis and management of lower back pain in primary care to achieve two keys aims:

  1. To support primary care clinicians to diagnose and manage LBP in line with best practice.
  2. To provide a communication mechanism that can be used to engage patients in discussion of LBP treatment options.

Clinical Validation

Clinical validation was conducted in 3 phases:

  1. Key authors of the 3 major international guidelines used in the algorithm and an expert GP musculoskeletal researcher reviewed the first draft of the LBP tool to judge that it fairly reflects these guidelines. Written comments were collated and changes made to the algorithm and the LBP tool.
  2. 16 hypothetical cases representing the different permutations of the 4 diagnostic classification variables were created. A programming code was written independently in two 2 statistical software packages to generate the diagnostic classification for each case. The resultant output was compared and, if there was not 100% agreement, the codes were checked for sources of error and resolved.
  3. The hypothetical cases were then manually entered into the LBP tool and the output of the LBP tool compared to that from the 2 statistical software packages outlined above. If there was not 100% agreement, the source of disagreement was explored and resolved.


Back Pain Choices will be evaluated by NPS Better choices, Better health and the George Institute for Global Health.