Primary care management of non-specific low back pain: key messages from recent clinical guidelines
Introduction: 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 1e2 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