BMJ released a clinical practice guideline highlighting what should NOT be done for chronic low back pain. The list includes: - Injection of local anesthetic, steroids, or their combination into the cervical or lumbar facet joint or sacroiliac joint - epidural injections of local anesthetic, steroids, or their combination - radiofrequency of dorsal root ganglion - radiofrequency denervation of cervical or lumbar facet joints or the sacroiliac joint - paravertebral intramuscular injections of local anesthetic, steroids, or their combination Benefits and risks must be transparent. Small improvements in pain are meaningful to patients (1.5 out of 10 pain scale) and they are willing to accept some risk, provided they know the interventions are efficacious and are likely to succeed.

Medicare advantage plans are one of the biggest drivers of wasted healthcare dollars and high administrative burden.