Back Pain: Introduction FeedbackA general introduction to Back Pain.Source: Clinical Knowledge Summaries, 05 Jun 2014
Low back pain is pain in the lumbosacral area of the back, between the bottom of the ribs and the top of the legs.
It affects around one third of the UK adult population each year.
In most people, low back pain is non-specific and serious specific causes are rare.
Development of chronicity and depression.
Disability and loss of employment.
Inappropriate use of strong opioids.
Non-specific low back pain is often a chronic problem in which periods of little pain or disability are interrupted by acute episodes of severe pain.
To diagnose non-specific low back pain:
Serious spinal pathology, inflammatory features, and sciatica should be excluded.
Non-specific low back pain should be diagnosed in all other people with low back pain that varies with posture and is exacerbated by movement.
An X-ray of the back should not be taken to diagnose non-specific low back pain, as it will not inform management.
To manage low back pain:
Red flags indicating serious conditions should be checked for; if present, the person should be admitted or referred with appropriate urgency.
An assessment should be carried out including enquiring about psychosocial risk factors for long-term pain and disability.
Information and self-care advice should be provided.
Paracetamol (preferred), ibuprofen, or a coxib should be used to manage the pain and to help the person keep active. For additional analgesia, paracetamol combined with an NSAID, or adding a weak opioid such as codeine or dihydrocodeine should be considered.
For acute back pain (up to 6 weeks duration):
Strong opioids are rarely necessary. If indicated, they should be prescribed for a short period, and stepped down to a weak opioid when appropriate.
If the paraspinal muscles are in spasm, a short course of a benzodiazepine such as diazepam can be considered.
If pain or disability remains problematic for more than two or three weeks, early referral for physiotherapy can be considered, particularly if the person is thought to be at higher risk of poor prognosis.
If symptoms continue for more than 6 weeks, the person should be managed as for chronic low back pain.
For chronic back pain (more than 6 weeks duration):
If additional analgesics are ineffective, a trial of a tricyclic antidepressant such as amitriptyline should be considered.
Rarely, a strong opioid such as morphine is required. If the use of a strong opioid becomes chronic, or the required dose is escalating, referral to, or advice from, a pain specialist is necessary.
Physical treatments should be offered, taking individual preference and availability into account. Examples include a structured exercise programme, a course of manual therapy that includes spinal manipulation, or a course of acupuncture.
If there is a poor response to treatment, referral should be considered. Depending on local availability, options include another type of physical treatment, or a combined physical and psychological pain management programme if the person has high disability and/or significant psychological distress.
If severe pain persists, referral to a specialist spinal surgical service should be considered.
Back Pain: Guidance FeedbackThe most relevant search results for Back Pain from producers of guidance information.
- National Institute for Health and Care Excellence, 01 May 2009
- National Institute for Health and Care Excellence, 01 March 2009
- Department of Health Western Australia - Diagnostic Imaging Pathways, 03 June 2014
- Clinical Knowledge Summaries, 05 June 2014
- Low back pain (early management) - NICE Pathways
- Department of Health Western Australia - Diagnostic Imaging Pathways, 11 June 2014
Back Pain: Commissioning FeedbackThe most relevant search results for Back Pain from producers of commissioning advice.
Information for the public
Back Pain: Information for the public FeedbackThe most relevant search results for Back Pain, from Department of Health accredited producers of patient information.
- Bupa , 09 July 2014
- Bupa , 06 August 2014
- NHS Choices, 21 February 2013
- Bupa , 10 February 2014
- Bupa , 16 April 2013
- Bupa , 16 April 2013
- Patient UK
- Patient UK
- Patient UK
- NHS Choices, 01 August 2014
Back Pain: Medicines FeedbackAppropriate medicines information for Back Pain supplied by Datapharm, a leading source of trusted, credible information about medicines.
Back pain - Medicines Information
- Anadin Ibuprofen (a brand of Ibuprofen)
- Anadin Original (a brand of Aspirin)
- Anadin Paracetamol (a brand of Paracetamol)
- Brufen (a brand of Ibuprofen)
- Calprofen (a brand of Ibuprofen)
- Cuprofen (a brand of Ibuprofen)
- Cuprofen Plus
- DHC Continus (a brand of Dihydrocodeine Tartrate)
- Diclofenac potassium
- Diclofenac sodium
- Dicloflex (a brand of Diclofenac Sodium)
- Diclomax (a brand of Diclofenac Sodium)
- Dihydrocodeine Tartrate
- Dromadol (a brand of Tramadol Hydrochloride)
- Econac (a brand of Diclofenac Sodium)
- Emflex (a brand of Acemetacin)
- Eucalyptus/Terpineol/Methyl salicylate/Menthol/Camphor
- Froben (a brand of Flurbiprofen)
- Generic Sciargo tablets
- Hedex Ibuprofen (a brand of Ibuprofen)
- Hydroxyethyl salicylate/Methyl nicotinate (a generic version of Ralgex Heat Spray)
- Hydroxyethyl salicylate/Methyl nicotinate/Capsicum oleoresin (a generic version of Ralgex Cream)
- Ibuprofen/Codeine phosphate (a generic version of Cuprofen Plus)
- Indolar (a brand of Indometacin)
- Ketocid (a brand of Ketoprofen)
- Ketovail (a brand of Ketoprofen)
- Larapam (a brand of Tramadol Hydrochloride)
- Motifene (a brand of Diclofenac Sodium)
- Nurofen (a brand of Ibuprofen)
- Nurofen Plus
- Orudis (a brand of Ketoprofen)
- Oruvail (a brand of Ketoprofen)
- Pain Relief balm
- Panadol (a brand of Paracetamol)
- Panadol Night
- Paracetamol/Codeine/Doxylamine/Caffeine (a generic version of Propain Plus)
- Paracetamol/Dihydrocodeine (a generic version of Paramol Soluble Tablets)
- Paracetamol/Diphenhydramine tablets
- Paracetamol/Sodium salicylate
- Paracetamol/Tramadol hydrochloride
- Paramol Soluble tablets
- Paramol tablets
- Pardelprin (a brand of Indometacin)
- Propain Plus
- Ralgex cream
- Ralgex Heat spray
- Remedeine (a brand of Dihydrocodeine Tartrate , a brand of Paracetamol)
- Salicylic acid/Mucopolysaccharide polysulphate (a generic version of Movelat)
- Solpadeine Migraine ibuprofen and codeine tablets
- Surgam (a brand of Tiaprofenic Acid)
- Tiaprofenic Acid
- Tramacet (a brand of Paracetamol , a brand of Tramadol Hydrochloride)
- Tramadol hydrochloride
- Tylex (a brand of Codeine , a brand of Paracetamol)
- Voltarol Rapid (a brand of Diclofenac Potassium)
- Zamadol (a brand of Tramadol Hydrochloride)
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...connective tissue disorders Very rare Back pain, arthralgia, myalgia Renal and...connective tissue disorders Very rare Back pain, arthralgia, myalgia PAR Candesartan...connective tissue disorders Very rare Back pain, arthralgia, myalgia Renal and...
Medicines and Healthcare products Regulatory Agency, 12 December 2011
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Cancer Research UK, 17 March 2014
Cabazitaxel for hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing regimen - guidance (TA255)
...vomiting, constipation, asthenia, haematuria, back pain, anorexia, pyrexia, dyspnoea, abdominal pain, dysgeusia, cough, arthralgia, and alopecia...weight, peripheral neuropathy, dizziness, pain in extremities, and febrile neutropenia...
National Institute for Health and Care Excellence, 01 May 2012
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Cancer Research UK, 30 June 2014
...diarrhoea, increased alanine transaminase (ALT), back pain. Common (≥1/100 to <1/10); herpes viral infections...dizziness, parasthesia, migraine, blurred vision, eye pain, bradycardia, atrioventricular block, hypertension, dyspnoea...
Medicines and Healthcare products Regulatory Agency, 02 December 2013
...including diarrhoea, and stomach pain) (figures not reported...as disturbed sleep, chronic pain or poor nutrition; and the...diarrhoea, nausea and stomach pains. In the trial by Stankoff...nausea, anxiety/nervousness, back pain, headache, dizziness and insomnia...
National Institute for Health and Care Excellence, 02 April 2013
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