GUIDELINES FOR ACUTE NONSPECIFIC LOW BACK PAIN
Based on systematic reviews and existing clinical guidelines
Summary of recommendations for diagnosis of acute non-specific low back
pain:
• Case history and brief examination should be carried out
• If history taking indicates possible serious spinal pathology or nerve root
syndrome, carry out more extensive physical examination including neurological
screening when appropriate
• Undertake diagnostic triage at the first assessment as basis for management
decisions
• Be aware of psychosocial factors, and review them in detail if there is no
improvement
• Diagnostic imaging tests (including X-rays, CT and MRI) are not routinely
indicated for non-specific low back pain
• Reassess those patients who are not resolving within a few weeks after the first
visit, or those who are following a worsening course
Summary of recommendations for treatment of acute non-specific low back
pain:
• Give adequate information and reassure the patient
• Do not prescribe bed rest as a treatment
• Advise patients to stay active and continue normal daily activities including work if
possible
• Prescribe medication, if necessary for pain relief; preferably to be taken at regular
intervals; first choice paracetamol, second choice NSAIDs
• Consider adding a short course of muscle relaxants on its own or added to
NSAIDs, if paracetamol or NSAIDs have failed to reduce pain
• Consider (referral for) spinal manipulation for patients who are failing to return to
normal activities
• Multidisciplinary treatment programmes in occupational settings may be an option
for workers with sub-acute low back pain and sick leave for more than 4 – 8 weeks
Guideline PDF: http://www.backpaineurope.org/web/files/WG1_Guidelines.pdf