8/12/2019 321 Lbp Clinical Pathway

1/1

Please refer using the Low Back Pain standard referral available from the SAFKI Medicare Local website www.safkiml.com.au

Patient presents to GP or otherprovider with

Low Back Pain (LBP)

Imminent life or majorhealth threatening

condition? 1

Immediate telephonereferral to Spinal

Consultant 8204 5511

Yes

Presence ofred flags? 2

Investigationspositive?

Specialistreferral

Yes

No

Presence ofradicular

symptoms? 3

Yes No No

Advice/Education.Keep active

Simple analgesicsReview 1-2 weeks

Avoid opioids

Advice/EducationKeep active

Simple analgesicsReview 2 weeks Avoid opioids

NoYes

Improving? Improving?

Analgesic review 4Consider low dose TCA's

Consider Allied Health referralContinue 1-2 weekly review

Analgesic review 4Screen for Yellow Flags 5

Consider Allied Health referral 6Continue 1-2 weekly review

NoNo

Yes Yes

Improving at

4-8 weeks?

Improving at

8-12 weeks?

OngoingGP

Management 8+

consideration of All ied HealthIntervention as

requiredor as available

No No

Yes Yes

Consider CT/MRI 7if indicated

Refer to public NeurosurgeryFax No: 8204 5116

(MRI will be fast tracked whereclinical information indicates valid

clinical need),or private specialist if eligible

1. Emergency PresentationsCauda Equina (loss of bladder/bowel control , saddleanasthesia)Rapidly progressing motor neurology/gait disturbances

2. Red FlagsHistory of malignancy

Age>50 at initial onsetNight pain and/or pain worse supineUnexplained weight loss (~5% in 3-6 months)Presentation suggestive of infection (eg fever, systemicallyunwell, IV drug user, immunosupressed, penetrating injury)Significant trauma or minor trauma if >50 years or history ofosteoporosis and/or corticosteroid use.

InvestigationsPlain XRays indicated for any red flagsCRP, WCC indicated if infection or cancer suspectedOther tests indicated according to clinical indication

NB If there exists a strong suspicion of serious pathology despitenegative investigations, full investigation +/- specialist referral isindicated.

3. Radicular Symptom sSymptoms distal to the buttock crease indicate neurologicaltesting required including sensation, reflexes and myotomes +/upper motor testing

4. Analgesic Review (click box to go to link)Refer to National Prescribing Service for recommended staging ofanalgesics.There is no strong evidence to support the use of opioids forchronic LBP, with high associated abherrant medication takingbehaviour (up to 24%)

Any trial of opioids should be carefu lly considered and shouldgenerally only be a short term trial

5. Yello w Flags (Use the 'STarT Tool' to evaluate clickfor online assessment)Certain psycho-social factors ('Yellow Flags') can indicate a poorprognosis for LBP. If present consider referral to physiotherapyfor active management

6. Allied HealthShould focus on strategies to remain active (eg exercise basedtherapy)

Short trial of 'hands on' therapy (eg manipulation) is appropriate

Consider Psychology referral if scores high for Yellow Flags orother psychosocial issues

Monitor progress with Allied Health professional to determineefficacy of intervention.

7. CT/MRIShould only be considered if significant potential for surgery orinjection therapy OR suspicion of serious pathology.

MRI is the modality of choice, however if not feasible, CT canalso be considered.

CT lumbar spine radiation exposure is the equivalent of 500chest Xrays

Low Back Pain - Management Guidelines

8. Consumer advice/informationClick on name to print fact sheets fromNational Prescribing Service or

Disclaimer:This Consensus Based guideline is based on the best available evidence with the expectation that it will be followed by health care provid ers in the SAFKI Medicare Local region.

First developed by gpns September 2011 Reviewed March 2012

National Health and Medical Research Council

Consider referral toPain Management Clinic

Fax No: 8374 1758or other pain management service

Presence ofyellow Flags? 5

No

http://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_reliefhttp://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.keele.ac.uk/sbst/downloadthetool/http://www.nps.org.au/__data/assets/pdf_file/0018/111168/LBP-symtomatic-management-pad.PDFhttp://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94a.pdfhttp://www.nps.org.au/__data/assets/pdf_file/0018/111168/LBP-symtomatic-management-pad.PDFhttp://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94a.pdfhttp://www.keele.ac.uk/sbst/downloadthetool/http://www.nps.org.au/health_professionals/publications/nps_news/current/analgesic_options_for_pain_relief