SMART Stepped Care Management for Low Back Pain in the Military Health System

Inclusion Criteria:

1. Active duty military member (Army, Navy, Air Force, Marines) or member of Reservesor National Guard on active duty, a family member of active duty personnel, orTricare beneficiary receiving care in a participating Military Treatment Facility.

2. Age 18 - 65 years at the time of enrollment.

3. Receiving Step 1 chronic LBP care based on VA Stepped Care Pain Management modeldefined as: a. Seen by a health care provider for chief complaint of LBP with or withoutsymptoms into the buttocks or legs within past the 30 days.

• Chief complaint of LBP which may be self-reported or identified by primaryInternational Classification of Disease (ICD), 10th edition codes of LBP (M54.5, M54.9, S33.012), lumbar degenerative change (M51.36, M51.37, M48.06,M47.817), lumbar disc herniation/radiculitis (M54.16, M54.17, M51.26, M51.27,M54.3).

4. Meets NIH Task Force145 definition of chronic LBP based on two questions: How long has LBP has been an ongoing problem for you? and How often has LBP been anongoing problem for you over the past 6 months? A response of greater than 3 monthsto question 1, and "at least half the days in the past 6 months" to question 2 isrequired to satisfy the NIH definition of chronic LBP.

5. Anticipates ability to attend treatment sessions over a 16 week period followingenrollment with no planned absence of 2 weeks or more for training, vacation or anypurpose.

Exclusion Criteria:

1. Signs of serious or systemic pathology as a cause of LBP including spine fracture,neoplasm, inflammatory disease (e.g., ankylosing spondylitis), vertebralosteomyelitis, etc.

2. Knowingly pregnant

3. Has received interventions for LBP that involves providers other than primary carein the past 6 months. This includes physical therapy or behavioral pain managementor counseling as well as specialist physician consultations, chiropractic, etc.

4. Has received any interventional pain procedures (e.g., spinal injections),inter-disciplinary pain management, integrated chronic pain and substance usetreatment programs, etc. in the past 6 months

5. Has received any lumbar spine surgery in the past year.

6. Retiring from active duty within 12 months, pending a medical evaluation board,discharge from the military for medical reasons, or pending or undergoing anylitigation for an injury.

7. At elevated acute risk for suicide (i.e., risk is below the level requiring eitherconsultation or urgent action based on Veterans Affairs-Department of DefenseClinical Practice Guideline for Assessment and Management of Patients at Risk forSuicide)