Telehealth Outreach for Chronic Back Pain

Inclusion Criteria: 1. Ages 18-75 inclusive; 2. chronic musculoskeletal low back pain (pain "on a daily basis" for at least six months) as the primary pain problem; 3. not eligible for back surgery; 4. presently lives in the San Diego area and will do so six months after baseline examination; 5. English-speaking, literate, with stable residence and phone. Exclusion Criteria: 1. Major medical illness (e.g., insulin-dependent diabetes mellitus with neuropathy or "poor control", heart disease with New York Heart Association Functional Class III or IV, or chronic obstructive pulmonary disease requiring supplemental oxygen which might confound effects of pain on function); 2. candidate for spine surgery; 3. back pain associated with pregnancy, rheumatoid arthritis, neoplastic disease, osteomyelitis, or neural arch lesions, since their treatment and prognosis differs from the usual back pain population, or spinal stenosis, since increased physical activity would be contraindicated; 4. history of Diagnostic and Statistical Manual (DSM)-IV bipolar disorder, dementia, or schizophrenia; 5. current active DSM-IV diagnosed alcohol or non-prescribed substance dependence; 6. current active DSM-IV major depressive episode or post-traumatic stress disorder since specialty mental health care would be indicated; 7. non-opioid and opioid analgesics are permitted, except we will exclude patients on a hospital-initiated opioid treatment "contract," since at this medical center "contracting" identifies patients with history of opioid diversion, multiple VA and non-VA opioid prescribers, and repeated dose escalation in the absence of evidence of disease progression.