How to Treat: Acute low back pain

+How to treat

How to Treat: Acute low back pain

by Cathy Chapple and Julia Hill
Acute low back pain

The International Association for the Study of Pain has designated 2021 as the Global Year About Back Pain, so it is timely to consider how to treat patients with acute low back pain in New Zealand. This article, by Cathy Chapple and Julia Hill, describes the STarT Back screening tool and matched care approach, which is based on identification of psychosocial factors that increase the risk of developing chronic low back pain.

This continuing medical education activity has been endorsed by the RNZCGP and has been approved for up to 1 CME credit for the General Practice Educa
References
  1. Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 2009;147(1–3):17–19.
  2. Vos T, Allen C, Arora M, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1545–602.
  3. Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med 2020;8(6):299.
  4. National Health Committee. Low Back Pain (LBP) Tier 2 Assessment. November 2015. health.govt.nz
  5. da C Menezes Costa L, Maher CG, Hancock MJ, et al. The prognosis of acute and persistent low-back pain: a meta-analysis. CMAJ 2012;184(11):E613–24.
  6. da Silva T, Mills K, Brown BT, et al. Risk of recurrence of low back pain: A systematic review. J Orthop Sports Phys Ther 2017;47(5):305–13.
  7. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791–803.
  8. Verhagen AP, Downie A, Popal N, et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J 2016;25(9):2788–802.
  9. Hall AM, Aubrey-Bassler K, Thorne B, et al. Do not routinely offer imaging for uncomplicated low back pain. BMJ 2021;372:n291.
  10. Foster NE, Hill JC, O'Sullivan P, et al. Stratified models of care. Best Pract Res Clin Rheumatol 2013;27(5):649–61.
  11. Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011;378(9802):1560–71.
  12. Whitehurst DG, Bryan S, Lewis M, et al. Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. Ann Rheum Dis 2012;71(11):1796–802.
  13. Foster NE, Mullis R, Hill JC, et al. Effect of stratified care for low back pain in family practice (IMPaCT Back): a prospective population-based sequential comparison. Ann Fam Med 2014;12(2):102–11.
  14. Sowden G, Hill JC, Konstantinou K, et al. Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281). Fam Pract 2012;29(1):50–62.
  15. ACC. New Zealand Acute Low Back Pain Guide. Wellington, NZ: ACC; 2004. healthnavigator.org.nz
  16. O'Sullivan K, O'Keeffe M, O'Sullivan P. NICE low back pain guidelines: opportunities and obstacles to change practice. Br J Sports Med 2017;51(22):1632–33.

Further reading

STarT Back references:

Hill JC, Whitehurst DG, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011;378(9802):1560–71.

Sowden G, Hill JC, Konstantinou K, et al. Targeted treatment in primary care for low back pain: the treatment system and clinical training programmes used in the IMPaCT Back study (ISRCTN 55174281). Fam Pract 2012;29(1):50–62.

The Lancet series on LBP:

Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391(10137):2356–67.

Foster NE, Anema JR, Cherkin D, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018;391(10137):2368–83.

Buchbinder R, van Tulder M, Öberg B, et al. Low back pain: a call for action. Lancet 2018;391(10137):2384–88.

International guidelines:

Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791–803.

Verhagen AP, Downie A, Popal N, et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J 2016;25(9):2788–802.