Low Back Pain, Adult (Guideline) [ICSI-NQMC-AHRQ]

Low Back Pain, Adult (Guideline)

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http://www.icsi.org/guidelines_and_more/gl_os_prot/musculo-skeletal/low_back_pain/low_back_pain__adult_5.html

Scope and Target Population:
Adult patients age 18 and over in primary care who have symptoms of low back pain or sciatica. The focus is on acute and chronic management, including indications for medical, non-surgical or surgical referral. For workers' compensation patients, check with state guidelines where the patient resides and where the injury took place: http://www.workerscompensation.com/workers_comp_by_state.php.

Clinical Highlights and Recommendations:

Back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags" (Cauda Equina syndrome or other conditions) and psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.

Reduce unnecessary imaging unless “red flag” indicators exist.

A conservative approach should be first-line treatment. Emphasize patient education and conservative home self-care, which includes limited bed rest, early ambulation, postural advice, resumption of light-duty activities, use of ice and heat, anti-inflammatory and analgesic over-the-counter medications, and early return to work or activities.

Patients with acute low back pain should be advised to stay active and continue ordinary daily activity within the limits permitted by the pain. For chronic back pain, there is evidence that exercise therapy is effective.

Consult or refer to surgical spine specialist (neurosurgeon, orthopedic surgeon, or other) or non-surgical spine specialist (physical therapist, chiropractic provider, osteopathic or allopathic physician, or other) if conservative treatment fails.
Priority Aims

Improve the assessment and reassessment of adult patients with low back pain.

Reduce unnecessary imaging with adult patients with low back pain in the absence of “red flag” indicators or progressive symptoms.

Increase the use of recommended conservative approach as first-line treatment, such as activity, self-care and analgesics for adult patients with low back pain.