Table VII. —Recommendations on advice and (pain) education.

Give patients with LBP in treatment profiles 1, 2 and 3 information and advice
Type of information and advice	• Integrate information and advice as a part of the therapy for all patients with LBP. The information and advice takes place during the preliminary stage, treatment and follow-up care • Provide the patient with clear, consistent and personalized information and communicate with empathy in clear, comprehensible language • Avoid language that encourages fear of pain and catastrophic thinking (e.g. terms like: injury, degeneration or wear and tear) • Use the term ‘LBP’ and avoid the term ‘non-specific’ • Consider employing (pain) education in addition to information and advice for patients with profile 3, e.g. if there is unrealistic pain-related fear of movement and/or catastrophizing
Information and advice for patients with LBP
The nature of LBP	• Explain that it is often unclear how LBP exactly arises and that there is often a combination of factors present
The course and prognosis	• Explain that LBP occurs often and frequently returns, and that the severity and duration of the LBP can differ each time • Explain that after three months about half of the patients are pain-free and physical functioning has been recovered
Inhibiting and facilitating factors (if applicable)	• Explain that recovery can be expedited by remaining active and limiting bed rest, self-management for recovery, active coping strategies, positive emotions and a healthy lifestyle • Explain that the presence of negative prognostic factors can cause the recovery to progress less rapidly
Diagnosis	• Explain that the vast majority of people with LBP have no indications for an underlying rare condition • Explain that diagnosis of LBP typically takes place in the primary care setting, by the general practitioner and/or by the physical therapist* • Explain to patients who need information about imaging diagnostics (X-ray or Magnetic Resonance Imaging [MRI]) that this type of diagnostics is not recommended for patients with LBP without warning signs
The treatment options	• Explain that treatment of LBP typically takes place in the primary care setting, by the general practitioner and/or by the physical therapist • Explain that the treatment focuses on an active approach. Inform the patient about how to adequately deal with the pain and the consequences of pain
Information and advice for patients with LRS
The nature and diagnosis	• Explain that LRS is characterized by the stimulation of a nerve root in the back, usually due to a herniated intervertebral disc, and that this results in sciatica and sometimes also in sensory disorders and loss of strength in the area innervated by this nerve. Also explain that the herniated intervertebral disc retracts on its own in most cases
The course and prognosis	• Explain that LRS significantly recovers in most patients in the first three months, without requiring surgical intervention
Diagnosis	• Explain to patients who need information about imaging diagnostics (X-ray or MRI) that the medical specialist will decide whether or not the patient is eligible for this • Explain that a MRI is indicated if there are signs of a rare cause of the back complaints, or if the symptoms of LRS are so debilitating and/or long-lasting that surgery or another specialized therapy is considered • Explain that proving a hernia nuclei pulposi (HNP) by means of a MRI has no added value in conservative treatment
The treatment options	• Explain that, in case of a LRS, the treatment is generally conservative during the first three months • Advise the patient to continue moving and engaging in daily activities (including work) if complaints permit • Explain that several days of bed rest is an option if moving causes a major exacerbation of the complaints, but that bed rest does not contribute to faster recovery • Advise the patient to move guided by the pain and to gradually increase physical activity. Keep in mind that increased pain should be prevented in the presence of high irritability. High irritability is defined as: a lumbar flexion range of motion (ROM) of 0 to 30 degrees, constant pain in the leg, night-time pain, morning pain or stiffness lasting longer than 60 minutes and when walking a short distance does not lead to pain alleviation. Moderate irritability is defined as intermittent moderate pain, with short-term increased pain (during a part of a day) being deemed acceptable • Explain that if the complaints have not sufficiently improved after six to eight weeks, a referral to the physician / general practitioner will be provided so that the treatment options can be discussed: continued conservative treatment or a secondary care referral to carry out further examination
Advise the patient with LRS to immediately contact the general practitioner in the event of: • saddle numbness • unintentional loss of urine or bowel movement or inability to urinate • increasing loss of muscle strength in the legs

*Do not explain diagnosis of LBP if you are not competent and authorized to do this or you have insufficient knowledge to determine diagnosis.