Chronic LBP (pain >3 mths)

Question 1

Investigations

Answer 1

plain X-ray
ESR
urine analysis
PSA (♂ >50 yrs)

Question 2

Management

Answer 2

• Back education program and ongoing support
• Normal activities
• Analgesics, e.g. paracetamol 665 mg (o) 8 hrly
• NSAIDs: 14 d (if inflammation)
• Exercise program
• Trial of mobilisation/manipulation (if untried) × 3, if no contraindications
• Referral for physiotherapy
• Consider duloxetine or amitriptyline (second-line therapy)