Back pain is a common source of disability, both from work-related injuries and from injuries that
occur outside the workplace. Annually in the United States, over $15 billion is spent for the treatment of low back
pain and disorders, and approximately 15 percent of the costs in workers’ compensation medical care are for low
back pain cases. This study focuses on care provided or directed by physicians and addresses the following
questions: What are the patterns of medical care for workers with common low back conditions in the 16 states
studied? How do these patterns vary across states? How do the patterns of medical practice in the study states
compare with evidence-based treatment guideline recommendations? Overall, we found that workers with similar
low back conditions received very different care, depending on the state. These interstate differences were most
noticeable for cases with nonspecific low back pain in the areas of diagnostic services and pain management
injections. For disc cases, the interstate differences were most notable in the utilization of nerve testing, pain
management injections, back surgery, and physical medicine. Large interstate differences in the timing of care
were also seen for both types of low back conditions.