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National Collaborating Centre for Primary Care (UK). Low Back Pain: Early Management of Persistent Non-specific Low Back Pain [Internet]. London: Royal College of General Practitioners (UK); 2009 May. (NICE Clinical Guidelines, No. 88.)
A number of key priority recommendations have been identified for implementation listed below. These recommendations are considered by the GDG to have the most significant impact on patients’ care and patients’ outcomes.
The criteria the GDG used to select these key priorities for implementation included whether a recommendation is likely to:
Have a high impact on patients’ outcomes in particular pain, disability or psychological distress.
Have a high impact on reducing variation in the treatment offered to patients.
Lead to a more efficient use of NHS resources.
Enable patients to reach important points in the care pathway more rapidly
Promote patient choice.
Provide people with advice and information to promote self-management of their low back pain.
Offer one of the following treatment options, taking into account patient preference: an exercise programme, a course of manual therapy or a course of acupuncture. Consider offering another of these options if the chosen treatment does not result in satisfactory improvement.
Consider offering a structured exercise programme tailored to the person:
This should comprise of up to a maximum of 8 sessions over a period of up to 12 weeks.
Offer a group supervised exercise programme, in a group of up to 10 people.
A one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.
Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks
Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.
Do not offer injections of therapeutic substances into the back for non-specific low back pain.
Consider referral for a combined physical and psychological treatment programme, comprising around 100 hours over a maximum of 8 weeks for patients who:
have received at least one less intensive treatment and.
have high disability and/or significant psychological distress.
Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.
Only offer an MRI scan for non-specific low back pain within the context of a referral for an opinion on spinal fusion.
Consider referral for an opinion on spinal fusion for people who:
have completed an optimal package of care, including a combined physical and psychological treatment programme and
still have severe non-specific low back pain for which they would consider surgery.
Copyright © 2009, Royal College of General Practitioners.
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