Diagnosis and management of low-back pain in primary care Free PMC article

KEY POINTS

• Most low-back pain with or without radicular pain or neurogenic claudication does not require immediate diagnostic imaging and can be managed in primary care.

• All patients with nonspecific low-back pain should be offered information on the nature of low-back pain, reassurance about the likely low risk of serious underlying disease and advice on evidence-based self-management.

• Patients with acute low-back pain who do not respond to initial management, or who are screened as being at high risk of a poor outcome with a validated prognostic screening tool, may benefit from nonpharmacologic treatments for pain relief, such as heat, massage or spinal manipulation.

• For patients with persistent low-back pain with no obvious pathology, nonpharmacologic treatments for pain relief, such as exercise programs, cognitive behavioural therapy, mindfulnessbased stress reduction, operant therapy, massage, spinal manipulation, acupuncture or multidisciplinary rehabilitation programs, may be of benefit.

• For patients with persistent low-back pain, there is limited evidence for the effectiveness of pharmacologic treatment and For patients with persistent low-back pain, there is limited evidence for the effectiveness of pharmacologic treatment and mixed recommendations from guidelines.

Canadian Medical Association Journal 2017 Nov 13;189(45):E1386-E1395.