TABLE 1.

Summary of diagnostic and treatment recommendations for low back pain from 11 international guidelines

Diagnosis

Diagnostic triage to classify patients as having nonspecific low back pain, specific low back pain or sciatica/radicular syndrome

History taking and physical examination to exclude red flags (findings that suggest a serious pathology such as cancer)

Neurological screening

Radiography is not useful and should be restricted to patients with red flag indications

Psychosocial factors should be considered if there is no improvement

Treatment

Acute or subacute pain

Provide information and reassurance to the patient

Advise to stay active and progressively increase activity level

Prescribe medication if necessary (time contingent): First choice acetaminophen, second choice nonsteroidal anti-inflammatory drugs; consider muscle relaxants or opioids

Discourage bed rest; if needed for pain severity, then restrict to no more than a few days

Consider spinal manipulation for pain relief

Do not advise back-specific exercises

Only refer to a specialist if a red flag, sciatica/radicular syndrome or a neurological problem is present

Chronic pain

Refer for exercise therapy

Data from reference 16