Mount Carmel Health Partners Clinical Guidelines Low Back Pain

Acute Low Back Pain Clinical Guideline
Low back pain is the second most common reason for clinical visits in the U.S. Only 15 percent of all low back pain has an anatomical explanation and
84 percent of adults have low back pain at some point; it is usually a benign, self-limiting condition. Ninety percent of these patients resolve within six
weeks regardless of intervention. Acute low back pain last no more than 4 weeks. Subacute low back pain last between 4 to 12 weeks and may
develop into Chronic low back pain which persist for greater than 12 weeks.
Evaluation
Treatment
Patient with Low Back Pain—Initial Evaluation
• Check vital signs
• History:
• Physical exam:
- Previous treatment and outcomes
- Pain scale evaluation
- Medications, coagulopathy
- Function testing (Oswerthy Disability Questionnaire)
- Traumatic injury
- Incisions, skin changes, rash (suggesting herpes zoster)
- Recent post-op patient
- Vascular exam: pulsatile abdominal or inguinal mass
- Osteoporosis
- Focal spinal tenderness
- Drug seeking behavior
- Neurological exam: signs of cord compression, bilateral leg weakness or numbness or signs of cauda
equina syndrome; significant signs of nerve root compression
- Macromastia
Are there red
flag Indicators?
• Cancer (or other serious
disease) present or suspected
• Severe progressive neurologic
deficits
• Infection
• Cauda equina
• Trauma
• Vascular
• Renal colic suspected
Yes
Conservative Treatment Plan
• Provide reassurance
• Education
• Avoid imaging
• Heat or cold
• Encourage activity; exercise with core strengthening,
as tolerated
• Weight loss
• Consider nonsteroidal anti-inflammatory drugs
(NSAIDs)/acetaminophen medications
• Consider muscle relaxants as an short term option
for 1-7 day ( be aware of possible side effects)
• Address psychosocial issues and fears, such as
depression or pain Rx addiction
• Consider chiropractic referral
• Consider acupuncture
• Consider referral for physical therapy
• Avoid narcotics (either as a sole prescription or in
combination)
• Re-evaluate after 1-2 weeks
Red flags are
present.
See red flag
indicator
algorhythm
Care is complete
No
Yes
Are
symptoms improved
(<12 weeks from
onset)?
No
Re-evaluate for Red Flag Indicators
• Provide reassurance
• Evaluate for specific conditions
• Consider MRI or CT myelogram
• Encourage activity; exercise with or without strengthening, as tolerated
• Consider referral to a specialist; provide medical necessity documentation for specialist referral: duration of symptoms , level of pain,
and supporting documents of conservative treatment trials, i.e., pain specialists, physical therapy, acupuncture, and other physicians
February 2018