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One in four US adults have chronic low back pain, which is defined as any type of pain in the low back or radiating down to the legs (sciatica) that lasts for three or more months. Chronic low back pain can make it difficult to do daily activities such as walking, sitting, or climbing stairs.

Chronic pain is typically managed with extended use of opioid analgesics, despite an absence of data on their long-term efficacy and clear evidence of significant health risks. Prolonged opioid use dysregulates the endogenous opioid system, disrupting hedonic homeostasis in the brain and resulting in hyperalgesia, stress reactivity...

The co-occurrence of chronic pain, psychological distress, and misuse of prescription opioids undermines the mission of the U.S. Military and inflicts suffering upon Veterans and their families. Approximately one-half of service members have chronic pain following deployment, and nearly one-fifth engage in opioid misusing...

Prescription opioid misuse is a public health threat that is being addressed with heightened urgency at both clinical and policy levels. In primary care settings, where chronic pain is commonly treated with long-term opioid therapy, as many as one-in-three chronic pain patients misuse opioids, evidenced by aberrant...

Chronic pain is a ubiquitous problem and growing concern for the Military Health System (MHS). Low back pain (LBP) is the most common condition that leads to chronic pain. Numerous recommendations have been made to improve care for LBP and chronic pain in the MHS, including implementation of a Stepped Care approach.