Symptomatic management for acute low back pain

This resource is designed to help health professionals provide advice to their patients on the symptomatic management of acute low back pain.

You can download and print the handout for your patient with the link to the right.

You can also order printed pads from our orders section.

Background information for health professionals is provided below.

Imaging tests are not always necessary

Imaging tests (X-rays, CT scans and MRIs) are not necessary in the majority of cases of acute low back pain. They are often unhelpful in identifying the cause of pain and do not lead to a greater improvement in the patient’s pain or physical function. Symptoms, pathology and radiological features are often poorly correlated, and there is a high prevalence of anatomical abnormalities in asymptomatic people.

Most cases (about 85%) of acute low back pain are non-specific, with no identifiable cause. Serious pathologies are rare. Use a history and physical examination to assess for signs and symptoms of any serious underlying condition that may require further investigation.

Reassure patients that low back pain is rarely serious, most pain settles quickly and imaging does not often explain the reason for pain.

Use a ‘step up approach’ to provide adequate analgesia

Before recommending pain relief, check the patients other medications for possible drug interactions.

Regular paracetamol is the preferred choice of analgesic as it is generally better tolerated than other pharmacological options, especially when used in the longer term. An oral NSAID (e.g. ibuprofen or diclofenac) may be used instead of, or as well as, paracetamol, in the short term. A topical NSAID can also be considered as an alternative to an oral NSAID.

If insufficient pain relief is achieved and pain is interfering with the patient’s ability to function and/or daily activities, consider the addition of a short term opioid, for example: codeine, tramadol or oxycodone.

Opioids can have serious adverse effects. They should be taken only as directed and
only for the length of time recommended.

Advise patients to stay active

Prolonged bed rest is not recommended for acute low back pain. Advise patients to stay active, even if moving about is painful. It is important to resume normal activities as soon as possible as this increases the rate of recovery, reduces time spent off work and is not associated with recurrent pain.
Encourage regular stretching and moving and avoiding long periods in one position.

Other non-medicine treatments

There are many non-medicine treatments for acute low back pain (e.g. heat and cold, and manual therapies like massage, spinal mobilisation or spinal manipulation) but not all have been studied in detail. However, this does not mean that they will not help your patient. Written information can help reinforce verbal advice. Use this pad to provide personalised information to your patient.

Transient application of heat or cold (for example, a warm blanket, wheat bag, hot water bottle, warm bath or shower, frozen peas or a cold pack) may be helpful in the short term.

Exercise interventions may be useful for preventing recurrence of low back pain. Some examples of suitable low back exercises are available in Therapeutic Guidelines: Topics in rheumatology version 2 (November 2010).

Advise your patient to contact their doctor if their pain does not improve, they are concerned or they develop any unusual symptoms.

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