text: Background 
  Musculoskeletal pain is a prevalent and costly health 
  condition with far-reaching public health consequences 
  including chronic pain, disability and opioid-related ad- 
  diction [1]. Clinical practice guidelines now recom- 
  frontline 
  mend non-pharmacological 
  management for musculoskeletal pain, which will lead 
  
  to increased utilization of services such as physical 
  therapy [1–3]. Physical therapy is effective for improving 
  disability and reducing costs associated with many muscu- 
  loskeletal pain conditions [4–9]. However, pain-related 
  healthcare utilization beyond the physical therapy episode 
  (e.g. subsequent use of surgery, injection, opioids, etc.) 
  may indicate suboptimal treatment response, the presence 
  of more complex needs, or unwarranted escalation of care. 
  Downstream healthcare utilization is not often considered 
  as an outcome of care or indication of treatment effective- 
  ness for musculoskeletal pain. But the importance of 
  
  treatment  as 
  
  *Correspondence: trevor.lentz@duke.edu 
  1Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, 
  NC 27705, USA 
  Full list of author information is available at the end of the article 
  
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