Non-specific LBP

• Overview:

  • LBP is an extremely common presentation in primary care
  • 90-95% of cases are non-specific: also referred to as mechanical, MSK or simple LBP
  • A specific reason for the pain is not identified but is likely due a minor problem in a muscle, ligament or tendon
• History:

  • Non-specific back pain typically varies with posture and time
  • Exacerbated by movement
  • Ask about back pain red flags
  • Assess impact on daily functioning and psychological wellbeing
• Risk factors for non-specific LBP:

  • Obesity
  • Physical inactivity
  • Occupation - heavy lifting, bending, twisting
  • Stressful life events or depression
• Yellow flags for back pain are risk factors for prolonged or complex recovery, or at risk of developing chronic pain and disability:

  • Pain lasting >12 weeks
  • Anxiety and depression
  • Stressful life events
  • Previous or current substance misuse
  • Perceived risk of persistent pain
  • High baseline pain intensity and disability (severe pain straight after injury)
  • Maladaptive coping strategies and fear avoidance
  • Catastrophise about pain and the future
  • PMH of other chronic pain syndromes
• Should also use a risk stratification screening tool e.g. the Keele STarT Back tool to identify people with risk factors for prolonged or complex recovery to help guide management
• Routine imaging not required for non-specific back pain

  Only investigate if concerned about specific pathologies
• Management - education:

  • Reassure unlikely to be any serious structural cause and most people recover within weeks
  • Encourage patients to keep active and resume normal activities as soon as possible
• Analgesia:

  • Heat packs
  • First line = NSAIDs, ibuprofen and consider PPI
  • Don't use paracetamol alone - ineffective
  • If can't take NSAIDs consider short term codeine with or without paracetamol
• If person at risk of prolonged or complicated recovery offer

  •Group exercise programmes

  •Manual therapy

  •Psychological support- CBT
• •

  If persistent symptoms after 3-4 weeks or worsening symptoms:

  •Reassess to ensure not missed underlying cause

  •Assess treatment adherence

  •Consider group exercise programme, manual therapy and CBT if not already tried

  •If chronic low back pain and non-invasive treatments are ineffective consider referral to specialist back pain service for further assessment and management