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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