NICE which is the UK's National Institute for Clinical Excellence has just released guidelines for treating low back pain (LBP).
The first recommendation is to promote self-management. This means to suggest to patients with LBP to exercise and try to continuing doing ones normal activity, as possible. The next one is pain medication - first acetaminophen. The final recommendation is exercise or manual therapy (i.e. spinal manipulation) or acupuncture.
Another interesting feature is what the guidelines proscribe. All of the following are treatments/diagnostic tests that are NOT allowed (because they either don't work or aren't needed):
- SSRIs for pain management
- Facet injections
- Radiofrequency facet joint denervation
- IDET (Intradiscal Electrothermal Annuloplasty)
- PIRFT (Percutaneous Intradiscal Radiofrequency Thermocoagulation)
- Laser therapy (AKA Cold Laser)
- Interferential electrical stimulation
- Therapeutic ultrasound
- TENS (another kind of electical stimulation)
- Lumbar supports or belts - back braces
- Plain film x-ray under any circumstances
- MRI to be offered only to rule out red flags or for surgical referral
- I think of an MRI for a a back pain patient, a road map for a surgeon. Keep that in mind if you are pushing your doctor to get one.
- Red Flags are signs of:
- Spinal cancer
- Cauda equina syndrome
- Ankylosing spondylitis or another inflammatory disorder
- Treatments that don't work
- Resistance to using the best treatement
- Ultracrepidarian Doctors and Back Pain