LBP clinical practice guidelines Flashcards
describe the guidelines for patients in the low risk category
-are very likely to improve
-aim to support and enable self management
-one off consultation with clinician
-assessment to include medical issues but also patient worries, concerns and social impact
-brief physical assessment as appropriate
what is considered low risk for LBP?
-low risk of chronicity
-advice, reassurance and medication
what is considered medium risk for LBP
-physical obstacles to recovery
-face to face conservative treatment
how would we treat low risk patients?
-medication review and advice
-address specific patient issues from the assessment
-seek to encourage activity and self management
-avoid unhelpful labels and medicalisation
-provide both oral and written information
what is considered high risk LBP?
psychological obstacles to recovery
-enhanced package of care - complex
what are the guidelines for medium risk LBP
-main aims are to restore function incl work, minimise disability even if pain is unchanged and to support appropriate self management
-similiar to low risk, elicit concerns and adequate physical exam
-tailored treatment according to the physical findings
-specific exercises or manual therapy could be used
-some patients will need onward referral to specialist services
how can a physio deliver the high risk package for LBP
-the physios delivering these packages have additional training to provide them with professional psychosocial support
-6 physio appointments over 3 months using a combined physical and cognitive behavioural approach
-specific focus on cognitive, emotional and behavioural responses to pain and their impact on function
what medication is recommended for LBP?
-NSAIDS
-weak opioids
NOT PARACETAMOL
What’s the first recommendation from the American college of physicians for acute or subacute LBP?
-given that most patients with acute or subacute LBP, pain improves over time regardless of Rx
-clinicans + patients should select non Pharma treatment with superficial heat, massage, acupuncture,
-if Pharma treatment is desired, clinicians and patients should select NSAIDS or skeletal muscle relaxants
what’s the 2nd rec from the ACOF for chronic LBP
-for patients with CLBP, clinicians ad patients should initially select non pharma rx
-exercise
-MDT rehab
-acupunture
-mindfulness based stress reduction
-tai chi
-motor control exercise
-electromyography biofeedback
according to the lancet back pain series, what are the 1st and second line options for rx for acute LBP?
-advice to remain active- 1st
-education-1st
-massage + spinal manipulation - 2nd line
-acupuncture - 2nd line
what are the 1st and 2nd line treatments for chronic LBP according to the lancet back pain series?
-advice to remain active + education =1st line
-exercise therapy + 1st line
-CBT- 1st line
-spinal manipulation, massage, acupuncture yoga etc = 2nd line treatment
what are the pharmacological recommendations for acute and chronic LBP
acute
-NSAIDS- 2nd line
chronic
-NSAIDS
-selective norepinephrine reuptake inhibitors
what should be included for education for LBP?
-diagnostic triage category
-natural history of disorder + recurrence risk
-relieving activities - first aid actions and exercises, posture
-address modifiable factors
-pain neuroscience education eg if nociplastic pain - maladaptive beliefs
what does WHO not recommend for non surgical management of chronic LBP?
-traction
-ultrasound
-TENS
-lumbar braces or belts
-some medicines eg antidepressants, opiods, skeletal muscle relaxants etc
