Royal College of General Practitioners Report: On Management of Acute Low Back Pain:
The report on "Clinical Guidelines for the Management of Acute Low Back Pain" was published by the Royal College of General Practitioners in 1996.
The report on "Clinical Guidelines for the Management of Acute Low Back Pain" was published by the Royal College of General Practitioners in 1996.
It was designed to help doctors and other health professionals with the multi-disciplinary approach to the initial assessment, triage, and evidence-based management of acute low back pain (LBP).
Medical assessment (diagnostic triage) should occur to exclude treatable causes (sciatica, red flags such as carcinoma, HIV, spinal abscess, spinal cord compression). X-rays are not routinely indicated for simple back pain. Biopsychosocial assessment should occur early.
Pain killers (relievers, analgesics) should be prescribed regularly and not "as required" to be more effective. Start with paracetamol, adding in anti-inflammatory drugs (ibuprofen, diclofenac), and weak opioids (codeine) as necessary. Consider a short course of a muscle relaxant (diazepam max. 7 days).
Avoid strong opioids if possible (morphine max. 7 days).
Bed rest is not a treatment for simple low back pain. Bed rest may need to be taken early on in the episode, but this should not be considered a treatment. Bed rest for longer than 3 days has been shown to be harmful by delaying the speed of recovery.
Bed rest is not a treatment for simple low back pain. Bed rest may need to be taken early on in the episode, but this should not be considered a treatment. Bed rest for longer than 3 days has been shown to be harmful by delaying the speed of recovery.
Stay as active as possible and continue with normal daily activities. Gently increase activity levels after an acute episode of back pain over a period of days to weeks. If you are in work, then either stay at work or return to work as soon as possible.
Prolonged periods off work will reduce your overall chance of working again (e.g. only 2% of people can return to work after 1 year off sick).
Spinal manipulation treatment within the first 6 weeks has been shown to be beneficial for pain relief and rehabilitation in those where the back pain does not resolve spontaneously.
Active rehabilitation (exercise programme OR physical re-conditioning) should be started at 6 weeks if there has not been return to work or resumption of normal activities.
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