Management of acute simple low back pain of more than 6 weeks duration

If acute simple low back pain is not responding to treatment then reapply diagnostic triage.

Consider investigations e.g. ESR, calcium, alkaline phosphatase. In general, xrays are not very useful for screening.

NICE suggest that:

• X-ray of the lumbar spine is not indicated for the management of non-specific low back pain
• an MRI scan for non-specific low back pain is only indicated within the context of a referral for an opinion on spinal fusion
  • MRI (magnetic resonance imaging) is indicated when a diagnosis of spinal malignancy, infection, fracture, cauda equina syndrome or ankylosing spondylitis or another inflammatory disorder is suspected
    

If screening and diagnostic triage confirms simple mechanical back pain then possible therapeutic options include:

• physical activity and exercise
• manual therapy
• acupuncture

These management options are detailed in the linked item.

If patient with simple mechanical back pain has not returned to work after 3 months then consider referral to secondary care e.g. rheumatology, orthopaedics, pain management.

Reference:

• 1. ARC - Reports on Rheumatic Diseases 1999;17:1-4.
• 2. Drug and Therapeutics Bulletin 1998; 36 (12): 93-4.
• 3. NICE (May 2009).Low back pain - Early management of persistent non-specific low back pain