Chronic back pain management is complex and is often challenging for Primary Care Providers (PCPs). Rural PCPs are managing chronic back pain despite limited training and availability of pain management specialists. Pharmacological interventions are often used to treat chronic back pain despite current evidence suggesting physical therapy and aquatic therapy are first-line treatments. A directory of local therapy facilities offering physical and aquatic therapy and a review of clinical practice guidelines (CPG) were provided to three PCPs in a rural clinic in the Midwest. Use of the directory and the CPG was intended to help decrease reliance on pharmacological options and increase reliance on non-pharmacologic options when treating chronic back pain. There were 595 encounters pre-implementation and 641 post implementation for the complaint of chronic back pain reflecting the six most frequent diagnoses. Comparison of pre and post physical and aquatic therapy referrals for chronic back pain indicated that there was not a statistically significant increase in therapy referrals but rather a clinically relevant increase of post implementation referrals (5.88 to 8.58%, an additional 20 referrals). This project impacted the clinic by heightening awareness of the use of non-pharmacological interventions, such as physical and aquatic therapy, for chronic back pain management. Barriers to adaption included patient-oriented reasons, insurance limitations, and provider reluctance
