Low back and radicular pain: a pathway for care developed by the British Pain Society

Abstract

These consensus guidelines aim to provide an overview of best practice for managing chronic spinal pain reflecting the heterogeneity of low back pain. Most guidelines have covered only one aspect of spinal care and thus have been divisive and potentially worsened the quality of care. Additionally, some of the evidence base is subjective and of poor quality. The British Pain Society low back pain pathway has reached across all disciplines and involved input from patients. It is recognized, however, that there is an urgent need for further good-quality clinical research in this area to underpin future guidelines. Considerable work is still needed to clarify the evidence; however, foundations have been laid with this pathway. Key features include: risk stratification; clarification of intensity of psychological interventions; a logical progression for the management of sciatica; and decision points for considering structural interventions such as spinal injections and surgery.

A Nationwide Retrospective Study of Opioid Management Patterns in 2,468 Patients with Spinal Pain in Korea

“…Recommended treatment modalities for spinal pain management can be classified into four categories: interventional pain therapies, complex medication (including opioids and neuropathic pain medications), high-intensity cognitive behavioral therapy-based programs, and spinal surgery [18]. Despite various treatment modalities, there has been very limited systematic research to guide and improve the use of opioid analgesics for managing spinal disorder-associated pain.…”

“…The guidelines state that (1) opioids should not be used as a first-line treatment, (2) patients should be adequately informed about the long-term effects of opioids, including the possibility of adverse events, (3) mental health history should be recorded before treatment to aid exclusion of patients with depression or substance misuse disorders, and (4) whenever possible, modified-release opioid formulations at regular intervals should be used. In addition, the BPS guidelines for low back pain recommend that the lowest dose possible should be used for the shortest time possible [1819]. Other recent guidelines and physician resources for opioid prescription, such as guidelines from the Centers for Disease Control and Prevention and the UK Royal College of Anaesthetists, state that opioids are not effective for long-term use [2021].…”

Key Safety Considerations when Administering Epidural Steroid Injections

“…Percutaneous adhesiolysis also has been shown to have level II evidence in managing post lumbar surgery syndrome, lumbar central stenosis and recalcitrant lumbar disc herniation [54][55][56][57][58]. Furthermore, British Pain Society guidelines also have endorsed epidural steroid injections [59].…”

Nonspecific low back pain: Causes, clinical picture, diagnosis, and treatment

“…Тактика дифференцированного подхода к лечению показала его высокую медицинскую и экономическую эффективность. Опросник STarT Back tool все шире внедряется в клиническую и научно-исследова-тельскую практику других стран [63,64].…”