Lumbar spine
Definition/Description
- Low back pain with or without sciatica
- See separate clinical pathways for cauda equina and acute motor loss
- Triaged as urgent or routine.
- Any non MSK causes fully screened and documented in the referral (i.e. soft CES signs).
MSK and CCG co-working on public health
- Media campaign promoting positive lifestyle change and MSK health and role of regular activity for low grade joint symptoms.
- Green light to remain active/key messages (NICE Guidelines) see MSK website.
- Promotional materials at strategic locations
- Appropriately targeted community initiatives
- SEO of web hub
- CSP website link: Debunking myths regarding back pain (website).
- Pain not settling at 4-6 weeks seek assistance.
Red Flag Symptoms
None provided
Guidelines on Management
Primary care
Patient presents to primary care with low back pain with and without sciatica.
Primary care team to optimise pre MSK management using the MSK web hub for patient education and management or alternative offline resources.
Non-pharmacological management strategies:
- Green light to stay active and key messages as NICE guidelines see MSK website.
- STarT Back risk assessment and stratification tool, high risk patients non responsive to phsyiotherapy require pain clinic. (see MSK website).
- Check BMI/ smoking/ exercise status:
- If lifestyle factors highlighted discuss as risk factors for MSK ill health/OA. Refer to MSK web hub for lifestyle advice.
- Refer to MSK web hub long term condition pages.
Pharmacological management
- Optimise medication management as per NICE guidelines (NG59/CG173).
- Down grade use of paracetamol which should not be offered as first line for pain relief, or used on its own.
- Patrients to trial NSAID's such as Ibuprofen ror aspirin .
- Consider weak opioids such as codeine with or without paracetamol- if patients cannot tolerate NSAID's.
Radiology:
- X-ray for suspected fracture only, NOT FOR OA
- MRI only with suspected red flag e.g. cauda equina/Ca
MSK physiotherapy
Medication management: refer to primary care team or Physio independent prescriberif medication optimisation required.
Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme, Move and Lose, water based exercise oppertunities.
Complex condition management: refer to MSK ESP team in cases of diagnostic uncertainty, or significant disabiltiy, or if surgery needs to be considered.
MSK extended scope practitioner
Medication management: refer to primary care team or Physio independent prescriber if medication optimisation required.
If secondary care pain services are required make recommendation for that referral to GP.
Condition management: refer to MSK Physiotherapy team.
Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme.
Orthopaedics, Neurosurgical, Rheumatology, General Surgery, Vascular, Neurology, outpatient opinion to secondary care/tertiary centre.
Referral Criteria/Information
Onward referral options (following primary care):
Screen for red flags CES, other non MSK causes and do not refer to MSK until excluded.
Understand/manage expectations prior to referralwhat are the goals of onward referral?
Condition management: MSK service- note patient must have engaged with online resources before making a condition management referral to MSK.
Back pain with or without sciatica not settling after six weeks refer to the MSK Service.
Triaged as radicular or non radicular and can be treated as 1:1, cohort management, acute pain clinic referral.
Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme.
Onward referral options (following MSK physiotherapy):
Medication management: refer to primary care team or Physio independent prescriberif medication optimisation required.
Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme, Move and Lose, water based exercise oppertunities.
Complex condition management: refer to MSK ESP team in cases of diagnostic uncertainty, or significant disabiltiy, or if surgery needs to be considered.
Onward referral options (following MSK extended scope practitioner:
Medication management: refer to primary care team or Physio independent prescriber if medication optimisation required.
If secondary care pain services are required make recommendation for that referral to GP.
Condition management: refer to MSK Physiotherapy team.
Lifestyle management: Consider local referral options- smoking cessation, weight management, HEAL programme.
Orthopaedics, Neurosurgical, Rheumatology, General Surgery, Vascular, Neurology, outpatient opinion to secondary care/tertiary centre.
Associated Policies
Specialties
Places covered by
- vale-of-york
Hospital Trusts
- york-and-scarborough-teaching-hospitals