Low Back Pain Care in Hilo & Across Hawaiʻi — Medicaid (QUEST) Accepted

Low back pain is one of the most common reasons adults see a primary care provider, and the great majority of cases improve over time, often without imaging or strong medications. The key is sorting the common, self-limited kind from the rare warning signs and choosing treatments that actually work. At Ohana Care Clinic in Hilo, we take an evidence-based, whole-person approach.

What causes low back pain

Most low back pain is “nonspecific,” meaning it comes from the muscles, ligaments, joints, and discs of the back rather than a single serious cause, and it tends to improve within weeks. Sometimes pain radiates down a leg from an irritated nerve. A small number of cases have warning signs, such as pain after a major injury, fever, unexplained weight loss, or new bladder or bowel problems, that call for prompt evaluation. We screen for those first.

How we treat it

The American College of Physicians’ guideline recommends starting with non-drug treatments for most low back pain, such as staying active, heat, massage, physical therapy, acupuncture, or spinal manipulation. When medication is needed, anti-inflammatory drugs or muscle relaxants are preferred, and we are deliberately cautious with opioids given their risks. Imaging is usually not helpful early on unless there are warning signs. We tailor the plan to you and add referrals when appropriate.

The mind-body connection

Back pain and emotional health are closely tied. Stress, depression, poor sleep, and fear of movement can all prolong pain, while pain itself disrupts mood and sleep. Because we integrate primary care and behavioral health, we can treat the pain and these factors together, which improves recovery and reduces the chance of pain becoming chronic.

Culturally grounded care

We care for the whole person, in the spirit of lōkahi — balance and harmony among the connected parts of life: the body, the mind and emotions, the spirit, the ʻohana (family), and our relationship with the ʻāina (land) and community. In a Native Hawaiian understanding of health, these are not separate, and neither is our care. To mālama (care for and protect) your wellbeing and to live pono (in balance and rightness), we listen to your whole story, welcome your ʻohana into the process, and honor the values and traditions that ground you. Offering kōkua (help given freely, with aloha) in a way that respects who you are is at the heart of how we practice.

Insurance and how we see you

We accept Medicare and Medicaid, including the Hawaiʻi QUEST Integration plans (AlohaCare, the Hawaiʻi Medical Service Association (HMSA), ʻOhana Health Plan, and UnitedHealthcare Community Plan), along with most commercial insurance, and we are accepting new patients in Hilo. Primary care works best as a partnership. Your first visit is in person at our Hilo clinic. We see patients in person for physical exams, vitals, and lab work, and we use telehealth for follow-up visits, medication management, and chronic-disease check-ins whenever it is clinically appropriate.

Common questions about low back pain

Do I need an MRI or X-ray for low back pain?

Usually not early on. For most low back pain without warning signs, imaging does not improve outcomes and can lead to unnecessary tests. We reserve imaging for situations with red flags or pain that is not improving as expected.

What is the best treatment for low back pain?

The American College of Physicians recommends starting with non-drug options like staying active, heat, physical therapy, massage, acupuncture, or spinal manipulation, with anti-inflammatory medicines or muscle relaxants if needed. Opioids are avoided when possible.

When should back pain be evaluated urgently?

Seek prompt care for back pain after a major injury, or with fever, unexplained weight loss, severe or progressive leg weakness, or new bladder or bowel problems. These can signal a more serious cause.

What insurance do you accept?

We accept Medicare and Medicaid, including the Hawaii QUEST Integration plans (AlohaCare, HMSA, Ohana Health Plan, and UnitedHealthcare Community Plan), along with most commercial insurance. We are accepting new patients in Hilo.

References

Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://www.acpjournals.org/doi/10.7326/M16-2367

Papa Ola Lōkahi. (n.d.). Native Hawaiian health. Retrieved June 29, 2026, from https://www.papaolalokahi.org/

This page is general health education from Ohana Care Clinic, written by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have a medical condition, reach out to us or another licensed provider. In an emergency, call 911.

George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner