Scope and Target Population:Adult patients age 18 and over in primary care who have symptoms of low back pain or radiculopathy. The focus is on the acute (pain for up to 7 weeks) and subacute (pain for between 7 and 12 weeks) phases of low back pain. It includes the ongoing management, including indications for spine specialist referral within the first 12 weeks of onset.
Aims:- Improve the evaluation and reevaluation of patients 18 years and older with acute and subacute low back pain diagnosis.
- Reduce or eliminate imaging for non-specific low back pain diagnosis in patients 18 years and older in the absence of "red flag" indicators.
- Delay imaging in patients with radicular pattern pain until after six weeks to allow for resolution that usually occurs within this period.
- Increase the use of a core treatment plan as first-line treatment. This includes activity, heat, education, exercise and analgesics for patients 18 years and older with low back pain diagnosis.
- Limit the use of opioids to the appropriate management of acute or subacute low back pain.
- Increase the utilization of validated pain and function scales to help differentiate treatment approaches in order to improve the patients ability to function.
- Increase the use of collaborative decision-making to allow patients to make more informed decisions about their care. Focus on shared decisions related to imaging, interventions and surgery for radicular pain diagnosis.
Clinical Highlights:
- Low back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags," psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment.
- Reduce or eliminate imaging unless "red flag" indicators exist.
- A conservative approach should be first-line treatment. Emphasize patient education and a core treatment plan, that includes encouraging activity, use of heat, no imaging, rare use of opioids, anti-inflammatory and analgesic over-the-counter medications and return to work assessment.
- Patients with acute or subacute low back pain should be advised to stay active and continue ordinary daily activity as tolerated.
» Provide Feedback on this Item
Updated: 1/30/2012
