ICSI has made a significant format enhancement in our scientific documents. All scientific documents (excluding Order Sets) now have “interactive” capability that allows a user to click on various links in the document and easily navigate from one area to another. For example, you can click on an algorithm box (those denoted with an “A” and those that refer to other algorithm boxes) and link directly to supporting annotation.

A tip for quickly going back and forth within the document:
Go to View, Toolbars, More Tools, Page Navigation, Previous View.
This should give you a back arrow tool that will allow you to go back and forth between views easily.

Note: The interactive links within ICSI PDF guidelines may not work on some mobile devices. However, the GoodReader App (and possibly some other "reader" applications) will allow anyone to open ICSI interactive PDF Guidelines on their mobile device and utilize most of the interactive capabilities.

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:

1. Improve the evaluation and reevaluation of patients 18 years and older with acute and subacute low back pain diagnosis.
   
2. Reduce or eliminate imaging for non-specific low back pain diagnosis in patients 18 years and older in the absence of "red flag" indicators.
   
3. Delay imaging in patients with radicular pattern pain until after six weeks to allow for resolution that usually occurs within this period.
   
4. 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.
   
5. Cautious and responsible use of opioids in the presence of acute or subacute low back pain.
   
6. Increase the utilization of validated pain and function scales to help differentiate treatment approaches in order to improve the patient’s ability to function.
   
7. 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 for diagnosis of non-specific low back pain in patients 18 years and older.
  
• First-line treatment should emphasize patient education and a core treatment plan, that includes encouraging activity, use of heat, no imaging, cautious and responsible 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.
  
• Use opioids cautiously and responsibly in the presence of acute or subacute low back pain.