In its first three years, LG Health’s low back pain protocol has successfully reduced opioid prescriptions and increased referrals to physical therapy.

Tony T. Ton-That, M.D.

Tony T. Ton-That, M.D., LG Health Medical Director of Spine and Low Back Pain, said that many patients with acute low back pain previously were given narcotics and asked to follow up with their primary-care provider. Those patients now see a physical therapist to learn an exercise program to implement at home.
Phase 2 of the protocol is now in place, establishing a care pathway for patients who don’t improve after physical therapy. The pathway calls for those patients to be referred back to their primary-care provider or to a physiatrist, rather than a surgeon.
“We created this pathway to ensure that our patients see the right provider at the right time,” Dr. Ton-That said. “We want to be sure patients exhaust all conservative options before they talk to a surgeon, if appropriate.”
Dr. Ton-That indicated more than 60 percent of low back pain patients were first referred to a surgeon, instead of a physiatrist or pain management physician.  Within that population, less than 25 percent required surgery. The new pathway leads to positive patient outcomes, while ensuring more efficient use of surgical resources, he said.
In many cases, primary-care providers can manage patients with medications, education, stress reduction techniques, lifestyle modifications and appropriate further diagnostic studies, if required. If the patient’s condition does not improve after a reasonable amount of time, referral to a pain specialist is appropriate, he said.
LG Health providers now have more options for referrals. LGHP Pain Management has two new physicians, J. Tobias Musser, M.D., and Daniel S. Sandusky, M.D. Additionally, Lancaster NeuroScience & Spine Associates, which recently joined LGHP, includes two physiatrists, Jessica Mack, M.D., and Robert Roberts III, M.D.
If these approaches are not successful, referral to a surgeon is appropriate, Dr. Ton-That said. (Cases of a medical emergency or progressive neurological deficit should be referred directly to surgery, he said.)
There is now one order in Epic for referral to LNSA. Providers making a pain-management referral to LNSA should be sure to select physiatry, not neurosurgery.  
“Our goal is to educate providers that surgery should be seen as a last resort,” Dr. Ton-That said. “This care pathway ensures that we provide a high-quality, cost-effective, evidence-based standard of care to our patients.”

  • The Acute Low Back Pain Care Pathway is available on the Physician Portal on StarNet.

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