Recent low back pain guidelines offer similar advice

Recent clinical practice guidelines offer similar recommendations for assessing and managing low back pain, and clinicians can improve patient care by adopting these recommendations, according to a review published in the June issue of The Spine Journal, reported HealthDay News.

Simon Dagenais, PhD, of Palladian Health in West Seneca, N.Y., and colleagues reviewed 10 clinical practice guidelines. All covered both assessment and management of low back pain, were written in English, and summarized evidence since 2000.

The researchers found that the guidelines had high overall methodological quality as defined by Appraisal of Guidelines Research and Evaluation (AGREE) scores. For the assessment of low back pain, guidelines put an emphasis on ruling out serious spinal pathology, specific causes, and neurologic involvement. They also recommended identifying risk factors for chronicity, and assessing the severity of symptoms and functional limitations. For managing acute low back pain, recommendations included patient education, and short-term acetaminophen, nonsteroidal anti-inflammatory drugs, or spinal manipulation; for chronic pain, back exercises, behavioral therapy, and short-term opioids were mentioned. Management of cases with neurologic involvement included consideration of magnetic resonance imaging or computed tomography imaging to identify candidates for epidural steroid injections or decompression surgery, if needed.

“Adopting these recommendations should provide satisfactory care for the vast majority of patients with low back pain within primary settings and may decrease the number of patients who unnecessarily seek advanced diagnostic testing or interventions in secondary [settings] when not warranted,” the authors said.

The authors disclosed financial relationships with Palladian Health.