Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines

Abstract

Given the scale and cost of the low back pain problem, it is imperative that healthcare professionals involved in the care of people with low back pain have access to up-to-date, evidence-based information to assist them in treatment decision-making. Clinical guidelines exist to promote the consistent best practice, to reduce unwarranted variation and to reduce the use of low-value interventions in patient care. Recent decades have witnessed the publication of a number of such guidelines. In this narrative review, we consider three selected international interdisciplinary guidelines for the management of low back pain. Guideline development methods, consistent recommendations and inconsistencies between these guidelines are critically discussed.

Managing non‐serious low back pain in the emergency department: Time for a change?

“…Imaging of patients with non‐serious low back pain is discouraged in all major guidelines, as well as by Emergency Medicine Colleges and in the Choosing Wisely campaigns . For these patients, imaging does not improve clinical outcomes, increases healthcare costs, and might be harmful.…”

Red flag screening for low back pain: nothing to see here, move along: a narrative review

“…The vast majority of current clinical practice guidelines for back pain recommend the use of red flags for determining potential presence of spinal fracture or malignancy 12. Those that then present with these suggested red flags are recommended to undergo more extensive, costly and potentially harmful diagnostic testing.…”

Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders

“…In guidelines from Canada and the UK, the target population is people with LBP with or without sciatica (9)(10)(11), without identification of the causes of pain or anatomical structure involved (12). The US guidelines are similar, but include lumbar spinal stenosis (LSS), in addition to LBP and radicular pain (10).…”

“…Yes, *giggles* both physically and mentally that you feel that you are strengthened by it (exercise), that you don't sink deeper *giggles* because you have pain it, it is hard, sort of, to get yourself out of it maybe…." (12) Experiences of an improved ability to cope with symptoms, greater knowledge about the pain, and the discovery that it is not dangerous to move with some pain. Other examples were: using postural or specific exercises to manage symptoms, being more attentive while performing activities and during periods of intense pain, medication was required, to be able to be more active.…”

“…Exercise plays a major role in the treatment of chronic LBP with or without sciatica according to three large recently updated guidelines (9)(10)(11), of which the UK guidelines give exercise the most central role in non-surgical interventions. All three guidelines also recommend multimodal care that includes self-management and psychological approaches (12). Information to the patient about symptoms and treatments plays a major role and patients should be involved in their care to be able to make informed decisions about their care (9).…”