We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Why Don’t Physicians (and Patients) Consistently Follow Clinical Practice Guidelines?  Comment on “Worsening Trends in the Management and Treatment of Back Pain”

Donald E. Casey Jr, MD, MPH, MBA1,2
[+] Author Affiliations
1NYUPN Clinically Integrated Network, Network Integration, New York University Langone Medical Center, New York
2Department of Population Health, New York University School of Medicine, New York
JAMA Intern Med. 2013;173(17):1581-1583. doi:10.1001/jamainternmed.2013.7672.
Text Size: A A A
Published online


In this issue of JAMA Internal Medicine, Mafi and colleagues1 effectively describe national trends in the management of neck and back pain between 1999 and 2010. Using a large representative sample of patient encounters associated with International Classification of Diseases, Ninth Revision (ICD-9) codes for the chief symptoms of acute back and neck pain extracted from the National Hospital Ambulatory Medical Care Survey, the authors describe patterns of care that seem discordant with well-established clinical practice guidelines for these conditions. Whereas these guidelines promote use of nonopioid analgesics, avoidance of imaging tests, use of physical therapy–based exercises, and primary care for this population,2 the results of this analysis demonstrate recent significant decreases for these recommendations. So, in the words of Saturday Night Live character DeAndre Cole played by Kenan Thompson, “What’s up with that?”

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Barriers to Physician Adherence to Practice Guidelines in Relation to Behavior Change

Reprinted from JAMA.5

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

8 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Low Back Pain

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Low Back Pain, Disabling