RSSUK Guidelines for Treating Lower Back Pain
The UK’s National Institute for Clinical Excellence in May released guidelines for treating lower back pain.
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 much as possible. The next one is pain medication – first acetaminophen (unfortunately this has also been proven to increase the risk of cardiovascular events). 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):
Medical/Surgical treatments
SSRIs for pain management
Facet injections
Radiofrequency facet joint denervation
IDET (Intradiscal Electrothermal Annuloplasty)
PIRFT (Percutaneous Intradiscal Radiofrequency Thermocoagulation)
Diagnostic tests:
Plain film x-ray under any circumstances
MRI to be offered only to rule out red flags or for surgical referral.
People always call our office and ask if they should see their doctor first before consulting me. Unfortunately it is very likely that your health care provider will ignore these and all other guidelines and do what they have always done, even if the scientific evidence indicate it is not effective.
