Chronic Low Back Pain: A Widespread and Debilitating Public Health Problem

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Release Date: February 10, 2012
Expiration Date: July 02, 2014

Expected time to complete this activity as designed: 90 minutes
There are no fees for participating in or receiving credit for this online activity.

Program Overview

Low back pain (LBP) has a considerable impact on both the individual sufferer and society at large. The accurate assessment of pain is a prerequisite for its effective management, [1] yet the systematic quantification of this common symptom is rare in clinical practice. [2] Most back pain is simple and self-limiting, but it is important to recognize that which is not.

Assessment should take place before initiation of therapy and continue as a monitoring activity throughout the course of treatment. The treatment regimen, whether pharmacologic, non-pharmacologic, or both, should be individualized accordingly. [4-5]

This three-part program is designed to improve the diagnosis, management, and treatment of patients suffering with chronic low back pain. The presentations include both speaker segments and also patient case vignettes.


  1. Charette SL, Ferrell BA. Rheum Dis Clin North Am. 2007;(33):109-122.
  2. Sokka T. Clin Exp Rheumatol. 2005;(23):S77-S84.
  3. Chou R, et al. Ann Intern Med. 2007;147(7):505-514.
  4. Webster L. Available at:
  5. Ziegler P. Available at:

Target Audience

This activity is designed for nurses who have an interest in enhancing their clinical skills in pain management.

Learning Objectives

Upon completion of this educational activity, participants should be able to:

  • Discuss the differential diagnosis for low back pain and the importance of clinical red flags in evaluation of low back pain
  • Review the pharmacotherapy and interventional approaches to managing chronic low back pain
  • Contrast and compare evidence-based treatments to initiate a patient-centric multimodal approach to the long-term management of chronic low back pain
  • Discuss the differential diagnosis for low back pain and the importance of clinical red flags in evaluation of low back pain
  • Identify assessment tools to differentially diagnose chronic low back pain
  • Identify and select validated tools for use in comprehensive assessment and risk-stratification of patients with chronic low back pain to determine and identify appropriate candidates for chronic opioid therapy
  • Define key risk phenomenon and describe three aberrant behaviors attributed to chronic low back pain patients with addictive disease
  • Identify two benefits that are derived from using a strategic precautionary approach to patient assessment and management for the chronic pain patient


Chronic Low Back Pain Bruce D. Nicholson, MD

Physical Exam: Low Back Pain –Steven P. Stanos, DO

Physical Exam: Low Back Pain Case – Bruce D. Nicholson, MD (Moderator) and Paul Arnstein, RN, PhD, FAAN

Instructions for Participation and Credit

This activity is eligible for credit through February 10, 2013. After this date, this activity will expire and no further credit will be awarded.

  1. Read the target audience, learning objectives, and faculty disclosures.
  2. You may be asked to complete a short pre-test before accessing the educational content. This must be completed in order to move forward in the activity.
  3. Complete the educational content as designed.
  4. Complete the post-test. To receive a certificate, you must receive a passing score of 70%.
  5. Complete the activity evaluation survey to provide feedback and information useful for future programming.
  6. Certificates may be printed immediately after successfully completing the post-test and activity evaluation.

Faculty Biographies

Bruce D. Nicholson, MD
Director, Division of Pain Medicine
Lehigh Valley Health Network
Clinical Associate Professor, Anesthesia
Penn State School of Medicine
Hershey, Pennsylvania

Dr. Bruce Nicholson received his medical degree from Eastern Virginia Medical School in Norfolk, Virginia. He performed his residency in anesthesiology and pain management training at the University of Virginia, Health Sciences Center in Charlottesville. Dr. Nicholson is the director of Pain Specialists of Greater Lehigh Valley. He is the medical director for the Division of Pain Management, Lehigh Valley Hospital and Health Network, and is a clinical associate professor at Penn State's College of Medicine at Hershey Medical Center.

Dr. Nicholson is board certified in anesthesiology and pain management by the American Board of Anesthesiology. His memberships in professional societies include the American Society of Regional Anesthesia, the International Association for the Study of Pain, and the American Pain Society. Dr. Nicholson has authored numerous journal articles, abstracts and book chapters, and has lectured nationally and internationally on the subject of neuropathic pain.

Steven P. Stanos, DO
Medical Director
Center for Pain Management
Rehabilitation Institute of Chicago
Assistant Professor, Department of Physical Medicine and Rehabilitation
Northwestern University Medical School, Feinberg School of Medicine
Chicago, Illinois

Dr. Steven Stanos earned his doctor of osteopathy degree from Nova Southeastern University in Miami, Florida and went on to complete his internship at Chicago Osteopathic Hospitals and Medical Centers, Midwestern University, Chicago, Illinois. He completed both his residency and pain fellowship in the Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Rehabilitation Institute of Chicago (RIC), where he is currently an assistant professor. In addition, Dr. Stanos is the medical director at the RIC Center for Pain Management in Chicago.

Dr. Stanos is board certified by the American Board of Physical Medicine & Rehabilitation, as well as a diplomate of the American Board of Pain Medicine and the American Board of Physical Medicine and Rehabilitation, with subspecialty certification in pain. In addition, he is a member of numerous professional societies, including the American Academy of Pain Medicine, the American Pain Society, and the Midwest Pain Society, among others. Dr. Stanos has lectured and published numerous manuscripts, book chapters and abstracts on the treatment and management of pain.

Paul Arnstein, RN, PhD, FAAN
Clinical Nurse Specialist for Pain Relief
Massachusetts General Hospital
Boston, Massachusetts

Dr. Paul Arnstein earned a doctorate in nursing from Boston College in Chestnut Hill, Massachusetts and completed research training fellowships from the National Institutes of Health. For over 30 years, he has helped thousands of patients in pain. His work with patients, professionals, and policymakers is driven by a desire to ensure that no patient lives or dies with needless pain due to unrealistic fears and mistaken beliefs about pain and its treatment. His research has been referenced in the popular media and supports the value of nurse-led interventions that help chronic pain patients think, feel, and do better.

Dr. Arnstein was a founder and first president of the New Hampshire Cancer Pain Initiative and has served as president of the New England Pain Association and the American Society for Pain Management Nursing (ASPMN). He presided over ASPMN at a time when pain management nursing emerged as a specialty within nursing. Dr. Arnstein helped develop the core curricula, exam, and certification preparation materials that have benefited over 1,000 nurses and the patients they serve. As a liaison to the Joint Commission, and an advisor to legislators through the Pain Care Forum, Dr. Arnstein has expanded nursing’s influence in promoting access to pain relievers and ensuring their safe use.

Dr. Arnstein has participated in the development and dissemination of several position papers to help reduce pain in vulnerable populations. He is a strong spokesperson for nursing’s contributions for interdisciplinary programs and clinical guidelines developed by the American Pain Society, American Pain Foundation, and the Agency for Healthcare Research and Quality. Dr. Arnstein is widely published and frequently speaks at local, regional, and national levels addressing topics that help improve the way pain is managed.


Accreditation Statement: MediCom Worldwide, Inc., 101 Washington Street, Morrisville, PA 19067 is approved by the California Board of Registered Nursing, Provider Number CEP11380. MediCom designates this CNE activity for 1.5 contact hours Program Number: 12-310-279


As an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Pharmacy Education (ACPE) and California State Board of Registered Nursing, MediCom Worldwide, Inc. requires everyone who is a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Accordingly, the following disclosures were made.

Faculty Disclosures

Dr. Bruce Nicholson has received honoraria related to speakers’ bureau activities from AzurPharma Ltd.; Cephalon, Inc.; Johnson & Johnson Services, Inc.; Pfizer Inc.; and Purdue Pharma L.P. He has received consultant fees from Johnson & Johnson, Pfizer, Purdue, and QRxPharma Limited.

Dr. Steven Stanos has disclosed no relevant financial relationships.

Dr. Paul Arnstein has received consultant fees from Covidien and the Nurse Practitioner Healthcare Foundation; he has also received royalties from F.A. Davis Company.

Planning Committee Disclosures

The individuals listed below from MediCom Worldwide, Inc. reported the following for this activity: Joan Meyer, RN, MHA, executive director, Bronwyn Boyes, PharmD, director, and Sheri Sturgis, chief operating officer, have no relevant financial relationships.

Peer Reviewer Disclosure

In accordance with MediCom Worldwide, Inc. policy, all content is reviewed by external independent peer reviewers for balance, objectivity and commercial bias. The peer reviewers have no relevant financial relationships to disclose.

Off-Label Disclosures/Investigational Disclosures

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.

Dr. Nicholson and Dr. Stanos have indicated that they do not intend to discuss off-label uses of drugs, mechanical devices, biologics or diagnostics approved by the US Food and Drug Administration (FDA) for use in the US.

Dr. Arnstein has indicated that he does intend to discuss off-label uses of drugs, mechanical devices, biologics or diagnostics approved by the US Food and Drug Administration (FDA) for use in the US.

Drs. Nicholson, Stanos, and Arnstein have indicated that they do not intend to discuss investigational drugs, mechanical devices, biologics or diagnostics not approved by the FDA for use in the US.

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Provided by MediCom Worldwide, Inc.

This activity is supported by an independent educational grant from Cephalon, Inc.

©2012 MediCom Worldwide, Inc., 101 Washington St., Morrisville, PA 19067, 800-408-4242.
No portion of this material may be copied or duplicated without the expressed permission of MediCom Worldwide, Inc.

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