Chapter 3 - European guidelines for the management of acute nonspecific low back pain in primary care

Summary of recommendations for diagnosis of acute nonspecific 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 nonspecific 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 nonspecific 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 subacute low back pain and sick leave for more than 4-8 weeks.