Pt 2 - Evidence based management

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Created by
Hiri P

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Cards (23)

  • Guideline Development Group:
    • Multidisciplinary
    • 14 Healthcare professionals representing MDT (topic area specialists and generalists)
    • 2 patient/carer representatives
    • Methodologists from the NCGC technical team
  • Guideline Development Process:
    • Identify/ refine subject and scope
    • Convene and manage a GDG
    • Source and assess the evidence
    • Translate evidence into recommendations
    • External Review / Consultation
  • Guideline hierarchy of use of treatment:
    • Offer
    • Consider
    • Do not routinely use
    • Do not use
    • No recommendation
  • So what do we know?
    • Diagnosis is difficult in most cases - we try to build a plausible model through assessment
    • The prognosis is usually pretty good and patients with acute back pain should be reassured
    • Some treatments help a bit
    • THERE IS NOT A CURE
    • Living well with back pain is a reasonable goal of intervention
  • What might best management of Acute LBP look like?
    1. Skilled and careful assessment- rule out red flags/ specific spinal pathology Stratify
    2. Educate - Explain the lack of obvious serious tissue damage, emphasise the good prognosis
    3. Educate - Encourage activity, discourage bed rest, decriminalise movement
    4. Educate - Discuss possible barriers to return to normality - yellow flags, type of work
    5. Manage pain - Analgesia? ?other modalities All only for transient pain relief
    6. Move - Exercises? Specific or general? Provocative or pain free?
  • What might best management of Acute LBP look like - AVOID:
    • Focus on structural explanations or models of spinal damage that lack validity
    • There may be an anatomical driver but you sure as shizzle can’t tell what it is.
  • Management of chronic LBP:
    • Address barriers to recovery - CBT model
    • Graded exposure to exercise/ movement
    • Set goals – what does the patient want?
    • Exercise should probably be general & functional not specific
    • Pacing: discourage boom-bust activity
    • Multidisciplinary pain clinics
    • Know your limits: chronic pain is a frustrating syndrome – there are no clear answers