Physio Penrith Acute Low  Back Pain Treatment

TREATMENT OF ACUTE LOW BACK PAIN AT SYDNEY MUSCLE & JOINT PHYSIO PENRITH

Acute low back pain treatment guidelines

Low back pain is a common condition and it is one of the leading causes of disability internationally. It is known to prevent many Australians from continuing a productive and happy life. Acute low back pain is defined as low back pain with duration of less than three months, whereas chronic low back pain is greater than 3 months.

Typically, acute low back pain is non-specific in nature and this means that the pain occurring primarily in the back is without signs of a serious underlying condition such as spinal stenosis or radiculopathy, or other specific spinal causes such as spondylolysis, spondylolisthesis or vertebral compression fracture.

Studies have shown that about 40% of those reporting an episode of acute low back pain recover within six weeks. However, 48% still have pain and disability after three months and of these almost 30% do not recover by 12 months. A key problem in the management of acute low back pain is the number of people who develop chronic low back pain following an acute low back pain episode. Expectations are that early appropriate care may reduce such a transition.

 

There is much evidence that supports a conservative care approach for most episodes of acute low back pain and many guidelines to support these approaches. As evidence based physiotherapists, exercise physiologists and chiropractors, Sydney Muscle & Joint Clinic Penrith utilises the following model of care in the treatment of acute low back pain.

ACI Musculoskeletal Network – Management of people with acute low back pain – Model of care

A model of care has been developed through the ACI Musculoskeletal Network in consultation with the ACI Pain Management Network. This collaboration ensures consistent interventions and messaging across acute and chronic pain management. The model of care consists of 10 key principles:

1. Assessment – history and examination

A systematic and formal history and examination including the consideration of red flags is required at the outset to determine the pathway of care for each individual patient.

2. Risk stratification

Prognostic risk stratification tools, such as the STarT Back and Örebro questionnaires, stratify patients into low, medium or high risk groups, determining the amount and type of treatment that they require.

3. Patient education

From the first assessment, each person will receive one-on-one discussion and support of self-management, along with electronic and paper-based education packs that detail the best practice management.

4. Active physical therapy encouraged

Physical therapies will primarily be a ‘hands off’ approach. The emphasis is on self-management assisting the patient to understand their condition and a staged resumption of normal activities. Consultation with team members may include a physiotherapist or practice nurse.

5. Begin with simple analgesic medicines

Where pain medicines are required it is best to begin with simple analgesics using time-contingent dosing. Non-steroidal anti-inflammatory medications can be used for short time-frames after consideration of possible adverse reactions. Opiates should be avoided.

6. Judicious use of complex medicines

In the presence of persisting severe leg pain, some complex medication regimens may support pain control. These include tricyclic anti-depressants, anticonvulsant agents and serotonin noradrenaline re-uptake inhibitors. However, caution is required considering the impact of potential mood changes and somnolence. Opiates are less effective in this patient group, and corticosteroid spinal injections offer only short-term pain relief and should not be initiated in the primary care setting.

7. Cognitive behavioural approach

The principles of cognitive behavioural therapy are used to ensure the patient is supported to understand the relationship between beliefs and behaviours, and to develop a goal-orientated plan of care.

8. Only image those with suspected serious pathology

Imaging is only indicated when a thorough patient history and physical examination indicates that there may be a medically serious cause for the lower back pain.

9. Pre-determined times for review

Review each individual’s progress at two, six and twelve weeks. If there has been insufficient progress then change the treatment plan as outlined in the model of care.

10. Timely referral and access to specialist services

If the patient has not recovered by twelve weeks arrange for review by a musculoskeletal specialist as outlined in the model of care.

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