Enhancing treatment decision-making for low back pain: a novel framework integrating large language models with retrieval-augmented generation technology.

Introduction: Chronic low back pain (CLBP) is a global health problem that seriously affects the quality of life among patients. The etiology of CLBP is complex, with non-specific symptoms and considerable heterogeneity, which poses a great challenge for diagnosis. In addition, the uncertain treatment responses as well as the potential influence of psychological and social factors further increase the difficulty of personalized decision-making in clinical practice. Methods: This study proposed an innovative support framework on clinical decision, which combined large language models (LLMs) with retrieval-augmented generation (RAG) technology. Moreover, the least-to-most (LtM) prompting technology was introduced, aiming to simulate the decision-making process of senior experts thereby improving personalized treatment for CLBP. Additionally, a special CLBP-related dataset was generated to verify effectiveness of the framework, which compared the proposed model CLBP-GPT with GPT-4.0, ERNIE Bot, and DeepSeek in terms of five key indicators: accuracy, relevance, clarity, benefit, and completeness. Results: The results showed that the CLBP-GPT model proposed in this study scored significantly better than other comparison models in all five evaluation dimensions. Specifically, the total score of CLBP-GPT was 4.40 (SD = 0.20), substantially higher than GPT-4.0 (4.03, SD = 0.48), ERNIE Bot (3.54, SD = 0.53), and DeepSeek (3.81, SD = 0.47). In terms of accuracy, the average score of CLBP-GPT was 4.38 (SD = 0.19), while the scores of other models were all below 4, indicating that CLBP-GPT could provide more accurate clinical decision-making recommendations. In addition, CLBP-GPT scored as high as 4.42 (SD = 0.19) in the completeness dimension, further demonstrating that the decision content output by the model was more comprehensive and covered more key information related to CLBP. Discussion: This study not only provides new technical support for clinical decision-making in CLBP, but also introduces a powerful tool for doctors to formulate personalized and efficient treatment strategies. It is expected to improve the diagnosis and treatment of CLBP in the future.