Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

Abstract

Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged. Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1-2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP. Changes in management as a result of the guidelines: The major changes include: emphasising simple first line care with early follow-up; encouraging non-pharmacological treatments over pharmacological treatments; and recommending against the use of surgery, injections and denervation procedures.

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

“…We thank Lin and colleagues for their interest in our recent article 1 and appreciate the opportunity to reply. We agree with the important points they raise regarding Aboriginal people with musculoskeletal pain conditions.…”

The value of the rehabilitation treatment in the non-specific low back pain

“…Causes of LBP can be divided into two main groups: overloading and extension of ligaments or overloading of muscle groups [6]. These factors lead to anatomical and neurophysiological changes in this segment of the spine [7].…”

“…Depending on the duration of non-specific back pain, the following periods can be distinguished: -acute period -usually lasts up to six weeks (red flags), -subacute period -up to three months, -chronic period -over three months [6]. Establishing a diagnosis of non-specific low back pain poses no major problems.…”

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

“…The recent guideline review by Almeida and colleagues 1 coincides with an international call for action to address the burden of low back pain 2 . Low back pain is a major societal problem and the number one cause of disability internationally.…”

“…The implementation of effective, high value, first line care described by Almeida and colleagues 1 is critical for Aboriginal people with low back pain; however, it needs to be adapted so that it is acceptable, accessible and appropriate. For example, advice and education to reassure patients and encourage self‐management may need to be supported by culturally appropriate low back pain information.…”