Clinical Practice Guidelines on Management of LBP

Question 1

list Keele STarT back tool scoring

Answer 1

My back pain has spread down my leg(s) at some time in the last 2 weeks
I have had pain in the shoulder or neck at some time in the last 2 weeks
I have only walked short distances because of my back pain
In the last 2 weeks. I have dressed more slowly than usual because of back pain It’s not really safe for a person with a condition like mine to be physically active
Worrying thoughts have been going through my mind a lot of the time I feel that my back pain is terrible and it’s never going to get any better
In general I have not enjoyed all the things I used to enjoy
3 or less = low risk
4 or more with a sub score of 3 or less between question 5-9 is medium risk
sub score of 4 or more between questions 5-9 = high risk

Question 2

management of low risk patients according to the Keele STarT questionnaire

Answer 2

likely to improve
enable self management -and activity address the patients concerns and provide info
once off consultation with clinician sufficient
assessment include medical issues
brief physical assessment
medication review and advice
provide oral and written info

Question 3

management strategy for medium risk package

Answer 3

builds on low risk package
aim to restore function, minimise disability
tailored treatment according to physical findings
specific physio intervention for clear specific findings e.g. manual therapy, specific exercises
general functional activities no strong relationship between physical findings and back pain complaint

Question 4

management strategies for high risk package

Answer 4

aim to reduce pain, reduce disability and improve physiological function
physio have additional training, mentorship ongoing professional support to enable them to elicit and address more complex issues
6 individual physio appointments over 3 months using physical and CBT

Question 5

what should not be offered in low pack pain or sciatica patients

Answer 5

acupuncture and electrotherapy
traction, orthotics, belts and corset
spinal injections and disc replacement
spinal fusion

Question 6

recommendation in management of acute or sub-acute LBP American College of Physicians CPG

Answer 6

Pain management - superficial heat, massage, acupuncture, spinal manipulation (low quality evidence)

Question 7

recommendation in management of chronic LBP American College of Physicians CPG

Answer 7

exercise,
multidisciplinary rehabilitation,
acupuncture,
mindfulness-based stress reduction (moderate-quality evidence),
tai chi,
yoga,
motor control exercise,
Progressive relaxation,
electromyography biofeedback,
LLT,
operant therapy,
CBT, or
Spinal manipulation (low-quality evidence).

Question 8

pharmacological management of chronic low back pain

Answer 8

first line NSAIDS
second line - Tramadol or Duloxetine
Opioids is only an option in patients who have failed the aforementioned treatment