- Low back pain (LBP) is defined as pain and/or discomfort below the costal margin and above the inferior gluteal folds, with or without leg pain
- Non-specific LBP is defined as tension, soreness and/or stiffness in the lower back that is not - attributed to a known specific pathology
In clinical practice, there are no sharp distinctions between acute, subacute and persistent LBP; however, for research purposes the following definitions have been described:
- acute – pain present for less than 6 weeks (although some guidelines define this as pain present for less than 4 weeks, and others as less than 3 months)
- persistent non–specific pain present for more than 6 weeks (although some guidelines define this as being more than 12 weeks)
- sub-acute – has been used to describe pain that is of intermediate duration (typically 6-12 weeks), although many guidelines and literature sources do not refer to subacute chronicity (pain related disability) at all. The American Guidelines use the starting point for sub-acute pain as 4 weeks.
- chronic - defined as constant or intermittent pain (in same pain site) for 6 months or longer (in the older adult, this is reduced to 3 months)
|Guidelines: see key below|
|Self Care||Stay active and continue normal daily activities including work||a||a||a||a||a|
|Back Book / handouts||a||a||a||a||a|
|Application of superficial heat||a||x||x||x|
|Stand alone formal educational programmes||x|
|Assessment and diagnosis||Focused history and diagnostic triage||a||a||a||a|
|Risk Factors for chronicity (Flags)||a||a||a||a||a|
|Routine radiographic imaging is not recommended (used for structural deformities)||a||a||a||a||a|
|Routine MRI / CT is not recommended (used in patients with severe or progressive neurological deficits/suspected serious conditions)||a||a||a||a||Only for an opinion on spinal fusion|
|Strong opioids (used judiciously/short term use)||a||a||x||a|
|Back school (short term)||x||x||x||a||a|
|Short wave diathermy||?||?||x|
|Supervised educational programmes||a|
|Facet nerve blocks||x||x||x|
|Sacroliliac injections of steroids||x||x||x|
|Injections of sclerosants / Prolotherapy||x||x|
|Trigger point injections||x||x||x|
|RF facet denervation||x||x||x|
|Intradiscal radio frequency||x||x|
|Spinal cord stimulation||x||x||x|
|Fusion surgery||Ref spinal surgeon||After 2 years and after evidence based treatment exhausted||After a year and after evidence based treatment exhausted||a|
|Artifical disc replacement||?|
A = American Low back pain (2007): Acute: less than 4 weeks
B = American Low back pain (2007): Sub acute - chronic: greater than 4 weeks
C = European Acute Back Pain Guidelines (2006): Acute: less than 6 weeks
D = European Chronic Non Specific Low Back Pain (2004): Chronic: 12 weeks or more
E = NICE Low Back Pain Guidelines: Sub-acute to chronic (2008): greater than 6 weeks and up to a year
F = American Pain Society Guidelines Interventional therapies (2009)
- Airaksinen O, Brox JI, Cedraschi C. European guidelines for the management of chronic non-specific low back pain. Brussels: European Commission Research Directorate General;2005.
- Chou R, Qaseem A, Snow V et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. AnnInternMed2007;147:478-91.
- Clinical Knowledge Summaries (CKS). Back pain low (without radiculopathy). Newcastle upon Tyne:CKS;2009.
- McIntosh G,Hall H. Lowbackpain(acute).ClinEvid2008;10:1102-32.
- McIntosh G, Hall H. Lowbackpain(chronic).ClinEvid2008;10:1116-44.
National Health and Medical Research Council (NHMRC). Evidence based management of acute musculoskeletal pain. Canberra:NHMRC;2003.
- National Institute of Health and Clinical Excellence (NICE). Low back pain. Clinical guideline 88. London: NICE; 2009.
- Shiri R, Karppinen J, Leino-Arjas P et al. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol 2010;171:135-54.
- Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. COST Action B13.Brussels:European Commission Research Directorate General;2004.