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LOW BACK PAIN
Treatment Guideline Chart
It is pain, stiffness, or discomfort in the lower back area below the costal margin and above the gluteal creases.
Low back pain is also called spinal pain or lumbago.
Nonspecific low back pain is without identifiable specific causes and makes up 90-95% of all low back pain cases.  It also includes pain felt in the proximal lower extremities.
Patients with low back pain may have mobility deficits caused by severe or progressive neurologic disorders or comorbidities.
Specific spinal pathology includes cauda equina syndrome, tumor, infection, ankylosing spondylitis, or inflammatory disorders.
Low back pain associated with radiculopathy or spinal stenosis is dermatomal pain with or without neurologic deficits that is most often caused by nerve root compression.

Low Back Pain References

  1. Airaksinen O, Hildebrandt J, Mannion AF, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006 Mar(15)(Suppl 2):S192-S300. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454542/pdf/586_2006_Article_1072.pdf. PMID: 16550448
  2. Chou R, Huffman LH. Evaluation and management of low back pain: evidence review. American Pain Society website. http://americanpainsociety.org/uploads/education/guidelines/evaluation-management-lowback-pain.pdf. 2007.
  3. Chou R, Huffman LH; American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct;147(7):505-514. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00008.pdf. PMID: 17909211
  4. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct;147(7):492-504. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00007.pdf. PMID: 17909210
  5. Chou R, Qaseem A, Snow V, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct;147(7):478-491. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00006.pdf. PMID: 17909209
  6. Delitto A, George SZ, Van Dillen LR, et al; Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-A57. doi: 10.2519/jospt.2012.0301. PMID: 22466247
  7. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov;25(22):2940-2952; discussion 2952. http://www.womenshealthapta.org/wp-content/uploads/2013/12/Oswestry-Fairbanks.pdf. PMID: 11074683
  8. Goertz M, Thorson D, Bonsell J, et al. Adult acute and subacute low back pain. Institute for Clinical Systems Improvement (ICSI). https://www.icsi.org/. Nov 2012. Accessed 18 Apr 2015.
  9. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement (ICSI) website. https://www.icsi.org/_asset/bw798b/ChronicPain.pdf. Nov 2013.
  10. Kuijer PP, Verbeek JH, Visser B, et al. An evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain. Ann Occup Environ Med. 2014 Jun;26:16. doi: 10.1186/2052-4374-26-16. Accessed 18 Apr 2015. PMID: 24999432
  11. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013 Apr;16(Suppl 2):S49-S83. http://www.painphysicianjournal.com/2013/april/2013;16;S49-S283-final.pdf. PMID: 23615883
  12. National Institute for Health and Care Excellence (NICE). Low back pain: early management of persistent non-specific low back pain. NICE clinical guideline 88. National Institute for Health and Care Excellence (NICE). http://www.nice.org.uk/guidance/cg88/resources/guidance-low-back-pain-pdf. May 2009.
  13. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine. 2012 Mar;79(2):176-185. doi: 10.1016/j.jbspin.2011.03.019. PMID: 21565540
  14. Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Scottish Intercollegiate Guidelines Network (SIGN). http://www.sign.ac.uk/. Dec 2013. Accessed 18 Apr 2015.
  15. Singh D, Mansor M, Vijayan R, et al. The Malaysian low back pain management guidelines. 1st ed. Malaysian Association of the Study of Pain. http://www.masp.org.my/. 2009. Accessed 18 Apr 2015.
  16. Talmage JB, Belcourt R, Galper J, et al. Low back disorders. In: Hegmann KT. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2011. http://www.guideline.gov/content.aspx?id=38438. Accessed 18 Apr 2015:333-796.
  17. Chou R. Subacute and chronic low back pain: nonpharmacologic and pharmacologic treatment. UpToDate. https://www.uptodate.com. Jul 2020. Accessed 09 Jan 2020.
  18. Chou R, Deyo R, Friedly J, et al. Noninvasive treatments for low back pain. Comparative effectiveness review no. 169. Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov. Feb 2016.
  19. Institute for Clinical Systems Improvement (ICSI). Health care guideline: adult acute and subacute low back pain. ICSI. http://www.icsi.org. Mar 2018.
  20. Institute of Health Economics Alberta Canada. Evidenced-informed primary care management of low back pain. Clinical practice guideline. Toward Optimized Practice . http://www.topalbertadoctors.org. Dec 2015. Accessed 24 Sep 2018.
  21. Knight CL, Deyo RA, Staiger TO, et al. Treatment of acute low back pain. UpToDate. https://www.uptodate.com. 19 Mar 2020. Accessed 09 Jan 2020.
  22. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an update overview. Jul 03, 2018. Eur Spine J. doi: 10.1007/s00586-018-5673-2. PMID: 29971708
  23. Philippine Academy of Rehabilitation Medicine (PARM). Clinical practice guideline on the diagnosis and management of low back pain. PARM. http://www.parm.com.ph. 2011. Accessed 24 Sep 2018.
  24. Wheeler SG, Wipf JE, Staiger TO, et al. Evaluation of low back pain in adults. UpToDate. http://www.uptodate.com. 25 Jun 2019. Accessed 24 Sep 2018.
  25. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE. https://www.nice.org.uk. Nov 2016.
  26. Qaseem A, Wilt TJ, McLean RM, et al; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr;166(7 ):514-530. doi: 10.7326/M16-2367. Accessed 20 Jul 2017. PMID: 28192789
  27. Levin K, Hsu PS, Armon C. Acute lumbosacral radiculopathy: treatment and prognosis. UpToDate. https://www.uptodate.com. 03 Jun 2019.
  28. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012 Feb 15;85(4):343-350. PMID: 22335313
  29. Verhagen AP, Downie A, Popal N, et al. Red flags presented in current low back pain guidelines: a review. Eur Spine J. 2016;25:2788–2802. doi: 10.1007/s00586-016-4684-0.
  30. North American Spine Society (NASS). Evidence-based clinical guidelines for multidisciplinary spine care: diagnosis and treatment of low back pain. NASS. http://www.spine.org/. 2020.
  31. Hegmann KT, Travis R, Andersson GBJ, et al.. Non-invasive and minimally invasive management of low back disorders. J Occup Environ Med. 2020 Mar;62(3):e111-e138. doi: 10.1097/JOM.0000000000001812. Accessed 11 Dec 2020.. PMID: 31977923
  32. Chou R. Subacute and chronic low back pain: Nonsurgical interventional treatment. UpToDate. https://www.uptodate.com/. 02 Jan 2020. Accessed 09 Dec 2020.
  33. Erdil M. Occupational low back pain: Evaluation and management. UpToDate. https://www.uptodate.com/. 03 Nov 2018.
  34. Chou R. Subacute & chronic low back pain: surgical treatment. UpToDate. http://www.uptodate.com/. Apr 2020.
  35. ClinicalKey. Chronic low back pain in adults. ClinicalKey. https://www.clinicalkey.com/. Mar 2021. Accessed 16 Mar 2021.
  36. ClinicalKey. Clinical overview: acute low back pain. ClinicalKey. https://www.clinicalkey.com/. Apr 2019.
  37. Hartigan C, Bernard KK. Exercise-based therapy for low back pain. UpToDate. http://www.uptodate.com/. Aug 2019.
  38. Hegmann KT, Travis R, Belcourt RM, et al. Diagnostic tests for low back disorders. J Occup Environ Med. 2019 Apr;61(4):e155-e168. doi: 10.1097/JOM.0000000000001551. PMID: 30694882
  39. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain w/ emphasis on imaging. Ann Intern Med. 2002 Oct;137(7):586-597. doi: 10.7326/0003-4819-137-7-200210010-00010. PMID: 12353946
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