Back pain choices

Back Pain Choices

Clinical assesment

Answer the following questions and a suggested diagnosis will show.
You can see alternative diagnoses by changing the clinical variables at any time.

Acute non-specific low back pain — first visit

Key considerations

  • Imaging not required.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • Regular paracetamol for pain control.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Acute non-specific low back pain — repeat visit

Key considerations

  • Imaging not required (unless serious pathology is now suspected).
  • Check compliance with management.
  • Review patient's progress (pain, activity levels).
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • If regular paracetamol and local heat are not controlling pain consider a stronger pain medicine or referral for manual therapy.
  • Review as required.
Treatment considerations

Persistent non-specific low back pain — first visit

Key considerations

  • Imaging not required.
  • Reassure the patient: recovery likely with treatment, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider simple physical therapies such as manual therapy or exercise before more intensive treatment options.
  • Review in 2–4 weeks
Treatment considerations

Persistent non-specific low back pain — repeat visit

Key considerations

  • Imaging not required (unless serious pathology is now suspected).
  • Check compliance with management.
  • Review patient's progress (pain, activity levels).
  • Reassure the patient: recovery likely with treatment, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider simple physical therapies such as manual therapy or exercise before more intensive treatment options.
  • Review as required.
Treatment considerations

Acute back pain with Sciatica/Radiculopathy — first visit

Key considerations

  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Acute back pain with Sciatica/Radiculopathy — repeat visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks.
Treatment considerations

Persistent back pain with Sciatica/Radiculopathy — first visit

Key considerations

  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations

Persistent back pain with Sciatica/Radiculopathy — repeat visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations

Acute back pain with Spinal Stenosis — first visit

You have selected indications that suggest both sciatica/ radiculopathy and spinal stenosis.
Guidelines recommend treat as per spinal stenosis.

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Acute back pain with Spinal Stenosis — repeat visit

You have selected indications that suggest both sciatica/ radiculopathy and spinal stenosis.
Guidelines recommend treat as per spinal stenosis.

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Persistent back pain with Spinal Stenosis — first visit

You have selected indications that suggest both sciatica/ radiculopathy and spinal stenosis.
Guidelines recommend treat as per spinal stenosis.

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations

Persistent back pain with Spinal Stenosis — repeat visit

You have selected indications that suggest both sciatica/ radiculopathy and spinal stenosis.
Guidelines recommend treat as per spinal stenosis.

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations

Acute back pain with Spinal Stenosis — first visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Acute back pain with Spinal Stenosis — repeat visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Reassure the patient: recovery likely, simple treatments work well, serious disease rare.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review in 1–2 weeks
Treatment considerations

Persistent back pain with Spinal Stenosis — first visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations

Persistent back pain with Spinal Stenosis — repeat visit

Key considerations

  • Check compliance with management.
  • Conservative management is recommended in the first instance.
  • If no improvement by 4 weeks or neurological deficits progress, further investigation or specialist referral may be appropriate.
  • Encourage graded resumption of normal activity.
  • First choice for pain control is regular paracetamol; if insufficient consider a stronger pain medicine.
  • Consider locally applied heat.
  • Review as required.
Treatment considerations
  1. Duration of symptoms
    Are any features suggesting sciatica / radiculopathy present?
    • Back pain with multiple leg symptoms in a nerve root distribution
    • Paraesthesia and motor loss or diminished reflex
    Are any features suggesting spinal stenosis present?
    • Radiating leg pain
    • Older age
    • Pseudoclaudication
    This is