Learning Objectives


All learners will be able to describe the principles of evaluation and conservative management of low  back pain.

The nine objectives of the core case listed are appropriate for learners in all disciplines.

Explanatory subsections are associated with specific objectives for that particular learning material. (e.g., Principles of Pain Processing)


  1. Identify the elements of a focused clinical history needed to assess a patient with pain symptoms, and the potential diagnostic significance of common physical findings.
  2. Discuss the major social, emotional, and financial consequences associated with decreasing  functional ability, and techniques to elicit relevant information from the patient.
  3. Identify the rationale for use of appropriate imaging or alternative diagnostic approaches.
  4. Explain the pathogenesis of degenerative changes in the lower spinal cord.
  5. Describe the pharmacological, physical therapy, occupational therapy, and behavioral strategies used to manage low back pain, and possible contraindications.
  6. Describe the role of chiropractic medicine and acupuncture in the 
  7. assessment and management of low back pain, and the mechanisms of action of these treatments.
  8. Communicate knowledge and opinions to the entire patient care team with confidence, clarity, and respect, to ensure common understanding of the patient’s needs and care decisions.
  9. Clearly explain to the patient her condition and treatment options, and negotiate a self-management plan that meets her personal and health care needs.
  10. Describe how an individual’s experience of pain relates to the larger population of similar patients, and discuss implications for society and the health care system of managing care of this population.
  11. Discriminate and interpret the unique and important aspects of a history and physical examination in older adults.   
  12. Identify appropriate patient-centered treatment methods while applying best practice and evidenced based care.
  13. Identify appropriate outcome measures by using and demonstrating appropriate referral and/or co management plans.
  14. Define  “meaningful use” and its relationship to electronic medical records, population health, and provider reimbursement. 
  15. Define “population based healthcare.”
  16. Identify determinants of health and their impact on health care.
  17. Understand the social and economic imperatives of “health promotion.” 
  18. Define “disease management” and understand the business case.
  19. Describe four models of provider-patient relationship.
  20. Discriminate between compliance and adherence. 
  21. List factors that define the degree of adherence.
  22. Define health literacy and explain how it affects patient adherence and outcomes. 
  23. List the “Ask Me 3” questions that patients should ask you.  
  24. Apply health literacy concepts to a patient case and make recommendations to improve adherence.
  25. List 5 health behavior models.  
  26. Describe in detail the stages of the Transtheoretical Model of Change.
  27. Identify concepts of the TMC model in 2 videos of pharmacist-patient communication.


Principal Investigator

O.J. Sahler, MD, Professor of Pediatrics, Psychiatry, Medical Humanities, & Oncology, University of Rochester School of Medicine

Co-Principal Investigator

Jill Lavigne, PhD, MS, MPH, Associate Professor, Pharmacy Practice and Administration, Wegmans School of Pharmacy, St. John Fisher College

Co-Leaders of Case Development

Joel Kent, MD, Associate Professor of Anesthesiology, Director of Pain Treatment Center, University of Rochester School of Medicine

Katherine Juba, PharmD, BCPS, Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher College

Janet Pennella-Vaughan, MS, FNP, Sr. Nurse Practitioner, Anesthesia Pain Service
Associate Professor of Nursing, University of Rochester School of Nursing

Contributors to Case Development

Constance D. Baldwin, PhD, Professor Department of Pediatrics, University of Rochester School of  Medicine (Curriculum Consultant)

Jean M. Bidlack, PhD, Paul Stark Professor of  Pharmacology, Department of Pharmacology and Physiology, University of Rochester School of  Medicine  (Pharmacokinetics, Drug Addiction)

Christine Boev, PhD, RN, CCRN, Assistant Professor, Wegmans School of Nursing
St. John Fisher College (Pain Assessment and Quality of Life)

Paul Dougherty, DC, DABCO, Professor, New York Chiropractic College, Adjunct Assistant Professor, Physical Medicine and Rehabilitation, University of  Rochester School of Medicine (Chiropractic Medicine)

Kevin Ergil, MA, MS, LAc, Professor, New York Chiropractic College, Finger Lakes School of Acupuncture & Oriental Medicine, (Chiropractic/Principles of Integrative Medicine Consultant)

Jill Lavigne, PhD, MPH, Associate Professor, Wegmans School of Pharmacy, St. John Fisher College, (Population Based Healthcare, Healthcare Delivery)

Laura Markwick, DNP, FNP-C, Assistant Professor, FNP Track Coordinator, Wegmans School of Nursing, St. John Fisher College (Pain Assessment and Quality of Life)

Jennifer L. Mathews, PhD, Assistant Professor, Wegmans School of Pharmacy, St. John Fisher College (Principles of Pain Processing)

Katie McDonald, MS, Educational Technologist, Wegmans School of Pharmacy, St. John Fisher College (Technical Consultant)

Jason G. Napuli, DC, MBA, Associate Professor, Clinic Systems, New York Chiropractic College (Chiropractic/Principles of Integrative Medicine Consultant)

Kristina L. Petrocco-Napuli, DC, MS, Associate Professor, Chiropractic Technique, New York Chiropractic College (Instructional Design Consultant)

Karen M. Parker, DNP, FNP-C, RN, Assistant Professor, Wegmans School of Nursing, St. John Fisher College (Pain Assessment and Quality of Life)

Ellen L. Poleshuck, PhD, Associate Professor, Psychiatry and Obstetrics & Gynecology, University of Rochester School of  Medicine (Communication and Behavioral/Treatment)

Jeanmarie R. Burke, PhD, Dean of Research, New York Chiropractic College,  Finger School of Acupuncture & Oriental Medicine (Project Administrator)

Marta Brewer, Center for Experiential Learning, University of Rochester School of Medicine (Standardized Patient Educator)

Geneva Robinson,  Center for Experiential Learning, University of Rochester School of Medicine (Standardized Patient)

Next: Event 1: Meet Mrs. Johnson

University of Rochester logo
University of Rochester