The Fraser Health Rapid Access Clinic for Low Back Pain (RAC for LBP) is a Pilot that is running until March 31, 2025.
For Providers

Want To Refer Your Patients To RAC For LBP?

The Rapid Access Clinics (RACs) for Low Back Pain help improve the quality, access and appropriateness of care for people with low back pain.

How to Refer

Did you know...

LBP has an estimated global prevalence rate of 9% at any given point in time.

Opioid overdose rates are highest among occupations with the greatest physical work demands and least access to paid sick leave.

Young and middle-aged men working in construction with mechanical low back pain account for more than 50% of musculoskeletal injuries.

More than 50% of toxic illicit drug overdose deaths of those employed worked in construction, other trades, and transport industries.

What is the RAC for LBP Pilot?

The RAC for LBP Pilot is a new, upstream service based on a successful care model developed in Ontario that led to a province-wide funded Rapid Access Clinic for Low Back Pain Program.

Patients referred to the RAC for LBP Pilot will receive an in-depth assessment based on the Center for Effective Practice stratified Clinically Organized Relevant Exam (CORE) Back Tool within 3-4 weeks of referral. A personalized self-management plan by an Advanced Practice Provider (physiotherapist) is provided within 3-4 weeks of referral.

  • Patients will be screened for risk of substance use-related harm, chronic pain, and mental health conditions. Primary Care Providers will be notified if the patient screens positive.
  • Complex patients will receive a coordinated consult with multiple program team members (a Spine Surgeon, Pain Specialist, and the Physiotherapist Practice Lead) and timely access to interventional procedures and surgery consultations, as needed.
  • Pilot enrollment is capped at 500 patients.
  • We hope to duplicate the success of the Ontario RAC for LBP, so the Pilot becomes a funded service for all British Columbians.

What is our target population?

  • The general population with lower back pain duration of more than 6 weeks and less than 52 weeks or those with episodic low back pain.
  • A particular emphasis will be on targeting those who have worked in the past 12 months in construction, other trades, and/or transport industries.  Lower back pain in the construction trade represents 51.1% of total musculoskeletal injuries. In addition, 52% of the total provincial overdose deaths in 2022 were employed in the trades and transport industries.

Inclusion and exclusion criteria

Inclusion Criteria:

  • Patients with persistent low back pain and/or related symptoms (e.g., sciatica, neurogenic claudication) that are not improving 6 weeks to 12 months from onset or patients with unmanageable recurrent/episodic low back pain and/or related symptoms of less than 12 months duration post-recurrence.

Exclusion Criteria:

  • Patients with specific red flags* (see below)
  • Initial low back-related symptoms < 6 weeks post onset
  • Constant/persistent low back-related symptoms > 12 months post onset
  • < 18 years of age
  • Unmanaged established chronic multisite pain disorder
  • Active low back pain related to WorkSafeBC and ICBC claim
  • Active low back pain-related MVA claim
  • Active low back pain-related legal claim
  • Pregnant or post-partum (<1 year)
  • Known fractures
  • Known oncologic condition

Patients with the following emergent red flags should be referred directly to the closest Emergency Department:

  • Possible Cauda Equina Syndrome (saddle anesthesia about anus, perineum, or genitals; urinary retention with overflow incontinence; loss of anal sphincter tone/fecal incontinence)
  • Progressive neurologic deficit
  • Significant trauma

FAQ

Frequently asked questions

What is The Rapid Access Clinic (RAC) for Low Back Pain (LBP) Pilot?

The RAC for LBP Pilot is an initiative funded by Health Canada’s Substance Use and Addiction Program (SUAP). It supports primary care providers to improve low back pain management and screen for risk of substance use, chronic pain, and mental health conditions in the general population and particularly for those who work in the construction, trades and transport sectors

It will replicate and enhance a successful care model developed in Ontario that led to a province-wide funded Rapid Access Clinic - Low Back Pain Pilot.

What types of patients can I refer to the pilot?

Patients who meet specific referral criteria (outlined below) and whose lower back pain cannot be managed through primary care can be referred to the RAC for LBP Pilot.

Inclusion criteria for the RAC for LBP Pilot:

  • Patients with persistent low back pain and/or related symptoms (e.g., sciatica, neurogenic claudication) that are not improving 6 weeks to 12 months from onset, or
  • Patients with unmanageable recurrent/episodic low back pain and/or related symptoms of less than 12 months duration post-recurrence.

In addition, it is recommended to consider referral in the scenarios mentioned above before initiating an opioid prescription, imaging referral, or specialist referral.

Exclusion criteria for the RAC for LBP Pilot:

  • Patients with specific red flags* (see below)
  • Initial low back-related symptoms < 6 weeks post onset
  • Constant/persistent low back-related symptoms > 12 months post onset
  • < 18 years of age
  • Unmanaged established chronic multisite pain disorder
  • Active low back pain related to WorkSafeBC and ICBC claim
  • Active low back pain-related MVA claim
  • Active low back pain-related legal claim
  • Pregnant or post-partum (<1 year)
  • Known fractures
  • Known oncologic condition

*Patients with the following emergent red flags should be referred directly to the closest Emergency Department:

  • Possible Cauda Equina Syndrome (saddle anesthesia about anus, perineum, or genitals; urinary retention with overflow incontinence; loss of anal sphincter tone/fecal incontinence)
  • Progressive neurologic deficit
  • Significant trauma 

How can a primary care provider obtain referring privileges to the RAC for LBP Pilot?
  • Primary Care Providers must be enrolled in the RAC for LBP Pilot to refer patients.
  • If you are a physician or nurse practitioner interested in enrolling in the RAC for LBP Pilot, please click below to register for the online training module:
obtaining referral privileges
  • You can access the online training module once you have completed the online registration. This 15-minute training module is a mandatory part of the primary care provider enrollment process and is required to obtain referral privileges.
  • Upon completing the online training module, you will receive a confirmation of registration via email within 1-2 business days and may begin referring patients to the RAC for LBP Pilot.
How will referrals be handled?
  • Referred patients will be offered an assessment within 4 weeks of referral. They will be matched with an advanced practice provider based on proximity to 4 physiotherapy clinics located in Fraser North (1), Fraser East (1) and Fraser South (2). The advance practice provider’s clinic will contact the patients directly to schedule an appointment.
  • The advanced practice provider will provide patients with a thorough standardized assessment and develop a personalized self-management plan with the patient and their primary care provider, based on stratification of presenting mechanical low-back symptoms. The self-management plan (based on the Center for Effective Practice stratified CORE Back Tool) emphasizes education and health promotion strategies to help patients better self-manage their low back pain. Patients identified by the advance practice provders as requiring more advanced assessment and management are referred to a physiotherapy practice leader.
  • Patients will be screened for risk of substance use-related harm, chronic pain and mental health conditions. Primary care providers will be notified if the patient screens positive. 
  • The practice leader will review complex patients for diagnostic imaging and referral to the Interdisciplinary Consult Clinic for a coordinated review by a spine surgeon, pain specialist, and the physiotherapist practice lead for timely access to interventional procedures, surgical consultation or other specialty interventions as needed. 
  • Three spinal surgeons (affiliated with the Pilot) and 2 pain specialists will provide ongoing clinical leadership to the practice leader and advanced practice providers, supporting continuous knowledge transfer and evidence-informed practice.
Who will be responsible for the ongoing care of patients referred to The Rapid Access Clinic for Low Back Pain?
  • The Pilot utilizes a shared-care management approach for referred patients, as no one provider can do it all.
  • The RAC for LBP includes the patient’s one-hour initial assessment with an advanced practice provider and up to four follow-up appointments for patients at risk of chronic low back pain.
  • The one-hour follow-up appointments typically occur in 6–12-week intervals. This will be arranged directly with the patient and shared with the primary care provider.
Will my patients be referred to the specialist other than spine surgeons?
  • The advanced practice providers and practice leader may recommend that patients see a non-spine specialist (e.g., for possible inflammatory or pain disorder issues). This recommendation will be communicated to the primary care provider responsible for arranging the necessary referral.
  • If your patient screens for a mental health or substance use condition, the screening scores of these assessments will be forwarded to you for referral management as you deem appropriate.
Will The Rapid Access Clinic for Low Back Pain provide patients with pharmacological or non-pharmacological therapy to support their low back pain self-management plans?
  • The Pilot will not provide patients with adjunct pharmacological or non-pharmacological therapy. It is an interprofessional shared-care model that provides evidence-informed assessment, education and personalized self-management plans. The self-management plan is to help your patient better manage their low back pain, mobility and overall physical function. Self-management plans include advice on staying active and instruction on exercises and modified activities as needed.
  • While the advanced practice providers will not provide patients with treatments, they will educate them on their condition. They may recommend evidence-informed adjunctive hands-on or other available non-pharmacological treatments as indicated to enable self-management.
What type of communications will the referring primary care provider receive from the program about their patient?
  • As part of the shared-care model, primary care providers will be informed of the recommended course of treatment for management of low back pain for each patient.
  • The patient’s referring primary care provider will receive a consultation note post-assessment outlining the patient’s clinical presentation, risk/prognostic factors, individual self-management plan (including activity/work modifications) and next steps, including recommended follow-ups or additional referral recommendations.
  • For complex patients, the advanced practice provider, practice leader, and primary care provider are encouraged to initiate further discussions regarding the consultation and any items needing clarification and to address identified concerns.
How to manage patients who request diagnostic imaging?
Where do I find Pilot information and resources?
  • Please refer to the RAC for LBP Pilot website for program information and patient and provider resources at www.fhraclbp.org.

If you have any questions concerning the RAC for LBP Pilot, contact the Central Intake Office by calling 778-757-1302 or Mark Joe, operations manager, Initium Centre for Pain Medicine, [email protected].

Mark will ensure that you are connected to the FH Clinical Pain Lead (Brenda Poulton) and the RAC for LBP Pilot Coordinator (Gerry O'Hanley) as required.

Resources

Pain Self-Management Tool

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Community Pain Program & Jim Pattison Chronic Pain Clinic

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Fraser Health’s Mental Health and Substance Use Resource page

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CEP CORE Back Tool

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How to Manage Patients Who Request Diagnostic Imaging?

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Imaging Tests for Low Back Pain: When you need them – and when you don’t

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PEER Simplified Chronic Pain Guideline

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BC Chronic Pain Guidelines

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Risk of chronicity - Start Back Tool

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Chronic Pain – suggest referral to the FH Community Chronic Pain Program

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Level of Disability - Oswestry Low Back Pain Disability (ODI) Tool

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Suggestion of Anxiety and Depression - PHQ-4

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Screening for alcohol and drugs – CAGE-AID Questionnaire

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Use of Street Opioids or Other Substances – further screening

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CAMH Canadian Guidelines Cannabis

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Canada’s Guidance on Alcohol and Health

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Link for FH Mental Health and Substance Use Resources page

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Canada Guidance Alcohol and Health

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Also, see Pathways BC resources within your community for MHSU.