The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page




 


Figure 5

Primary Care Management of Simple Backache

 
Is the patient acutely distressed?
PRIMARY CARE
MANAGEMENT
OF SIMPLE BACKACHE 		PRIMARY CARE
MANAGEMENT
OF SIMPLE BACKACHE
& ACUTE DISTRESS
Provide reassurance: "nothing dangerous" "expect recovery" Symptomatic measures: local ice or heat analgesics, NSAIDs avoid bed rest stay active
Provide reassurance: "nothing dangerous" "expect recovery" X-ray & specialist not required Symptomatic measures: local ice or heat analgesics, NSAIDs muscle relaxants <2 / 52 avoid narcotics if pos <2 / 52 Modified acitivities

Is acute distress settling?

Is the pain settling, even if still present? 		PHYSICAL THERAPY OR
ACUTE PAIN SERVICE
Adjust analgesics Consider manipulation Progressively increase activity
Adjust analgesics
Progressively increase activities
Is function improving, even if still with some pain?

RETURN TO
WORK OR
NORMAL
ACTIVITY

Consider physical therapy

Is function improving, even if still with some pain?

RETURN TO
WORK OR
NORMAL
ACTIVITY

REASSESS Review diagnostic triage Consider X-ray & ESR Psychosocial & vocational

REFER OR
MANAGE
APPROPRIATELY

CONTINUED PRIMARY CARE MANAGEMENT
Patient information & advice
Alternative symptomatic measures
Active rehabilitation
Is function improving, even if still with some pain?

RETURN TO
WORK OR
NORMAL
ACTIVITY
CONSIDER SECOND OPINION
SPECIALIST PHYSICAL THERAPIST
GP WITH SPECIAL INTEREST
Is function still improving, even with some pain?

RETURN TO WORK OR
NORMAL ACTIVITY

FAILED PRIMARY
CARE MANAGEMENT

 

SECONDARY CARE REFERRAL TO
BACK PAIN REHABILITATION SERVICE

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