New Nice Guidelines For Early Management Of Non-specific Low Back Pain
Non-specific low back pan which persists for some time is a common presentation for various health care practitioners to deal with, representing a major reason for absence from work due to sickness. Research has moved ahead quickly over the last decade, making a scientific view of assessment and treatment recommendations possible which could lead to predictable benefits for patients with persistent low back pain. The National Institute for Clinical Excellence (NICE) has just released a new set of guidelines in May 2009.
To conclude that the diagnosis is non-specific low back pain many conditions have to be excluded. These include infections, cancers, broken bones and arthritic diseases such as ankylosing spondylitis, and diagnosis should be reviewed periodically, with appropriate requesting of investigations, if there is any suspicion of a particular diagnosis. Cauda equina syndrome and sciatica (radicular leg pain) are neurological compression syndromes and should be urgently referred for consultation with a spinal surgical specialist.
Clinicians and researchers have classified low back pain into three categories, acute back pain, sub-acute back pain and chronic back pain. If the back pain has lasted for less than six weeks it is said to be acute, if it lasts from six to twelve weeks it is sub-acute and if it continues after the twelve week point it is said to be chronic. This system of back pain classification is only partly useful as its rigid boundaries often do not correspond to the persistence and variability of back pain as people typically experience it.
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 and disability but this is not much improved by three months.
The cost to society of back pain problems is high but modern figures are not available, with the UK market having a large expenditure on private therapists as well as NHS costs, including private physiotherapists, acupuncturists, chiropractors and osteopaths. When someone develops an exacerbation of their back pain or a new episode it is crucial to exclude non-mechanical causes. Older people are more susceptible to malignancies as is anyone with a history of cancer types with are known to spread to bone. A compromised immune system should raise the suspicion that infection is a possibility. Osteoporotic fractures are more common in those on oral steroids and in older people.
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 and loss of work. Distress, disability and pain are the important factors which must be addressed to improve the outcome, as high levels of pain, high disability and psychological distress are predictive of a poorer outcome. A very large number of treatments exist and 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:
External physical interventions such as transcutaneous electrical nerve stimulation (TENS), laser, ultrasound, interferential, spinal traction and lumbar supports.
Exercises which cover individual programmes to group based exercise classes, both on land and in water.
Land or water based exercise programmes, again either individually or as part of an exercise group.
Manual therapies such as manipulative techniques, mobilisation and 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 Physiotherapists, physiotherapy, Physiotherapists in Windsor, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
Click the XML Icon Above to Receive Health & Fitness Articles Via RSS!
