Clinical practice guidelines recommend a conservative approach to managemen
t of acute low back pain (LBP). The present study sought to determine wheth
er health care utilization and the physician's initial managetment of work-
related LBP were associated with disability duration. Clinical management i
nformation was obtained for Bg randomly selected, workers' compensation cla
imants with acute, uncomplicated, disabling work-related LBP. Length of dis
ability tons based on indemnity (wage replacement) payments. Disability was
significantly associated With increased utilization of specialty referrals
(P = 0.013) and provider visits (P < 0.001), use of magnetic resonance ima
ging (P 0.003), and use of opioids for more than 7 days (P = 0013). Effects
of early diagnostic imaging (first 30 days of care) on length of disabilit
y were observed (P = 0.001). Patients whose treatment course did not involv
e Extended opioid use and early diagnostic testing were 3.78 tines more lik
ely (95% confidence interval, 1.6 to 8.9) to have gone off disability statu
s by the end of the study. The nature of the association between these init
ial clinical management aspects and LBP disability duration merits further
exploration.