Non Specific Low Back Pain " New NICE Guidelines for Early Management by Jonathan Blood Smyth
Persistent low back pain of non specific origin is commonly assessed managed by healthcare practitioners making up a major proportion of all those people off work due to sickness absence. During the last ten years there have been significant increases in valid research work on this subject allowing for the first time an evidence based set of recommendations for the assessment management of longer term back pain. In May 2009 the National Institute for Clinical Excellence NICE has published updated guidelines.
The first requirement in the assessment of back pain is to establish a diagnosis. By definition the source is not clear in non specific low back pain but many potential diagnoses have been ruled out such as ankylosing spondylitis arthritic diseases fractures infections or tumours. Diagnosis is not a one time thing with periodic reassessment important if things change investigations should be requested if a specific diagnosis is suspected. Radicular symptoms in the leg typically called sciatica cauda equina syndrome are neurological syndromes which cause severe very specific symptoms need consultation with a spinal surgeon.
The classification of low back pain has been traditionally divided into chronic back pain sub acute back pain acute back pain. Chronic back pain refers to pain persisting longer than 12 weeks with sub acute back pain lasting between 6 12 weeks. Under six weeks duration is referred to as acute low back pain. However due to the variability of symptoms the long term nature of many back pain syndromes this classification system is too rigid to be useful in the assessment management of back pain.
Low back pain is estimated to affect around 30 percent of the population of the UK every year with about a fifth of this number consulting their general practitioner about their back pain. In the past most back pain was thought to settle by six weeks but more recent research has shown that a year after their back pain episode sixty two percent of sufferers still have pain. In those who are off work with their back pain sixteen percent are still off work at a year. The first month shows a rapid improvement in pain disability but this is not much improved by three months.
Contemporary figures for the costs of back pain to society are not available but are known to be very high. Patients spend a lot of money on private therapists in the UK patronising private physiotherapists acupuncturists osteopaths chiropractors. A new episode or a worsening of low back pain makes the exclusion of non mechanical causes for the back pain vital. Infection is more common in people with immune system problems such as HIV. The incidence of the types of cancers which spread to bone is higher in older age groups. Fractures due to osteoporosis have a higher incidence in older people anyone on steroids.
The early management of non specific low back pain which persists for any time from six weeks to a year is to ensure the episode does not turn into long term disability loss of normal activities loss of work. Distress disability pain are the important factors which must be addressed to improve the outcome as high levels of pain high disability psychological distress are predictive of a poorer outcome. A very large number of treatments exist are claimed to be helpful but the scientific basis for most treatments is not good. The NICE group decided to look at an overall package of care potentially deliverable by many professional groups rather than individual therapies.
The large number of potential interventions for low back pain includes:
Patient education which covers advice explanations from professionals written material education sessions.
Non invasive physical therapies such as transcutaneous electrical nerve stimulation traction spinal corsets interferential laser ultrasound.
Education for patients such as group sessions written explanatory material individual instruction from therapists.
Manual therapies such as manipulative techniques mobilisation massage.
Psychological interventions to improve self management either mindfulness or a form of cognitive behavioural therapy.
Jonathan Blood Smyth editor of the Physiotherapy Site writes articles about Physiotherapy thephysiotherapysite. co. uk back pain orthopaedic conditions neck pain injury management physiotherapists in Hartlepool thephysiotherapysite. co. uk physiotherapy physiotherapists uk cleveland hartlepool. Jonathan is superintendant physiotherapist at an NHS hospital in the South West of the UK. Non Specific Low Back Pain " New NICE Guidelines for Early Management
