LowBackPainIxMx in afya

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2009 NICE low back pain guidelines. 
apply to non-specific lower back pain (i.e. not due to malignancy, infection, trauma etc) that has lasted for more than 6 weeks and less than 12 months.

''Investigation''
    lumbar spine x-ray should //not// be offered
    MRI should only be offered to patients with non-specific back pain where spinal fusion is being considered and to patients where malignancy, infection, fracture, cauda equina or ankylosing spondylitis is suspected

''Advice''
    try to encourage self-management
    stay physically active and exercise

''Analgesia''
    paracetamol is first-line
    proton pump inhibitors should be co-prescribed for patients over the age of 45 years who are given NSAIDs
    tricyclic antidepressants should be considered if other medications are insufficient
    strong opioids should be considered for short-term use

''NICE - Rx to offer''
    exercise programme
    manual therapy
    acupuncture
Try one and if still high disability and/or psychological distress consider combined physical and psychological treatment programme, (100 hours over a maximum of 8 weeks).

''Exercise programme''
    up to 8 sessions over up to 12 weeks
    supervised group exercise

''Manual therapy''
    up to 9 sessions over up to 12 weeks
    includes spinal manipulation, spinal mobilisation and massage
    spinal manipulation can be performed by chiropractors and osteopaths, and doctors/physiotherapists who have undergone specialist training

''Acupuncture''
    up to 10 sessions over up to 12 weeks

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