Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Abstract

We identified 15 clinical practice guidelines for the management of low back pain in primary care. For diagnosis of patients with non-specific low back pain, the clinical practice guidelines recommend history taking and physical examination to identify red flags, neurological testing to identify radicular syndrome, use of imaging if serious pathology is suspected (but discourage routine use), and assessment of psychosocial factors. For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods. For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. In addition, referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 weeks. While there were a few discrepancies across the current clinical practice guidelines, a substantial proportion of recommendations was consistently endorsed. In the current review, we identified some differences compared to the previous overview regarding the recommendations for assessment of psychosocial factors, the use of some medications (e.g., paracetamol) as well as an increasing amount of information regarding the types of exercise, mode of delivery, acupuncture, herbal medicines, and invasive treatments. These slides can be retrieved under Electronic Supplementary Material.

Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration

“…Although recent national guidelines came to divergent recommendations on the importance of opioids in the management of chronic low back pain (CLBP) (Oliveira et al, 2018), opioid analgesics are commonly used for CLBP in Europe and North America (Shaheed, Maher, Williams, Day, & McLachlan, 2016). The long-term use of opioids for chronic non-cancer pain contributed to the opioid crisis in North America with a parallel increase in prescriptions of opioids, their non-medical use and associated increased mortality (Ranapurwala, Naumann, Austin, Dasgupta, & Marshall, 2019).…”

Changes in the macroscopic morphology of hip muscles in low back pain

“…; Oliveira et al. ), with 84% of people in all age groups expected to experience LBP during their lifetime (Balagué et al. ; Ostelo, ).…”

“…Low back pain (LBP) is the main musculoskeletal disorder responsible for disability worldwide (Hoy et al 2014;Maher et al 2017;Hartvigsen et al 2018;Oliveira et al 2018), with 84% of people in all age groups expected to experience LBP during their lifetime (Balagu e et al 2012;Ostelo, 2018). A systematic review showed that approximately 12% of the general population are affected by LBP (Hoy et al 2012).…”

Sacroiliac Joint Hypermobility Biomechanics and What it Means for Health Care Providers and Patients

“…The clinical presentation of the hypermobile joint is multifactorial and requires a detailed assessment to guide clinical decision‐making . A comprehensive evaluation should assess for factors contributing to hypermobility related to a systemic disorder or several conditions with overlapping symptoms .…”

“…Treatment goals for the hypermobile sacroiliac joint should address strength, flexibility, stabilization, restoration of normal neuromuscular lumbopelvic control, and correction of functional adaptive changes as well as pain reduction. These goals are best accomplished with multiple and integrative therapies …”