By using the summary by Koes et al. (2010), the following summary can be made regarding LBP treatment.
- Education: Reassurance, information, advice, normal resumption of activities and daily life, return to work, set realistic expectations and expectations that LBP may reoccur. In patients with acute or subacute LBP, intensive patient education seems to be effective. For patients with chronic LBP, the effectiveness of individual education is still unclear.
Medication: In order; paracetamol, NSAIDS, weak oral opioids, muscle relaxants, anti-depressants if depression is detected. Muscle relaxants have shown to be effective in the management of non-specific low back pain, but the adverse effects require that they be used with caution (van Tulder et al. 2003).
Exercises: Exercises are not indicated in acute LBP, possibly light walking and keeping as active as possible. Individual specific exercises in chronic LBP, including strengthening, extension, flexion. Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain (Hayden et al. 2005). Generally speaking, exercise programs should focus on facilitating weight loss, trunk strengthening (obliques and extensors) and the stretching of musculotendinous structures (Patel et Ogle 2000).
Manipulations: They are mostly used for acute LBP, may be used in chronic LBP if helpful, but for short periods of time. High-quality evidence suggests that there is no clinically relevant difference between spinal manipulations and other interventions for reducing pain and improving function in patients with chronic low-back pain (Rubinstein et al. 2011). Currently, there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.
Bedrest: Bedrest is generally not advised, if absolutely necessary (patient cannot resume another position), less than 48 hrs.
Referral to specialist: In cases of suspected Red flags (cauda equina, radicular syndromes, cognitive behavioural problems) refer your patient to a specialist.