Cited by 174Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

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Primary care management of non-specific low back pain: key messages from recent clinical guidelines

Almeida, Matheus, Saragiotto, Bruno, Richards, Bethan, Maher, Chris G·2018·Medical Journal of Australia

DOI 10.5694/mja17.01152

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Abstract

Introduction: Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged. Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1–2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP. Changes in management as a result of the guidelines: The major changes include: emphasising simple first line care with early follow-up; encouraging non-pharmacological treatments over pharmacological treatments; and recommending against the use of surgery, injections and denervation procedures.

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Authors: Almeida, M., Saragiotto, B., Richards, B., & Maher, C. G.
Affiliations: Universidade de São Paulo (BR)
The University of Sydney (AU)
Royal Prince Alfred Hospital (AU)
University of Sydney, Sydney, NSW
ORCID: Almeida, Matheus
Saragiotto, Bruno
Richards, Bethan
Venue: Medical Journal of Australia
Publisher: AMPCo
Published: 2018-04
Volume: 208
Issue: 6
Pages: 272-275
ISSN: 0025-729X (ISSN-L)
1326-5377
DOI: 10.5694/mja17.01152
OpenAlex: W2794567591
Cited by: 174
References: 28
Citations by year: 2026: 9 · 2025: 25 · 2024: 15 · 2023: 25 · 2022: 33 · 2021: 26 · 2020: 16 · 2019: 18 · 2018: 7
FWCI: 10.81
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1 d)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: The Medical Journal of Australia (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Keywords: non-specific low back pain, primary care management, triage, self-management, non-pharmacological treatment, exercise therapy, cognitive behavioral therapy, multidisciplinary treatment, chronic low back pain, pharmacotherapy, electrotherapy, traction, orthoses, bed rest, spinal injections, denervation
MeSH terms: Algorithms, Humans, Primary Health Care, Triage, Low Back Pain, Practice Guidelines as Topic, Risk Assessment

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Primary care management of non-specific low back pain: key messages from recent clinical guidelines

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