Low back pain
Module created April 2011 - currently under review
This educational package focuses on appropriate and timely management of low back pain, a common problem faced by General Practitioners daily, and aims to support the provision of evidence based care of this common condition. At the end of the module, you will have updated your knowledge and skills in:
- managing patients presenting with acute back pain
- identifying ‘at risk’ patients, those that may go on to develop chronic pain
- managing patients with chronic low back pain
You may have learning needs that you may want to consider and reflect upon at the end of this module. It may be worth writing them in your PDP before continuing.
This module will concentrate on the early management of those patients with acute back pain and introduce some core concepts in dealing with those whose back pain is not resolving in order to avoid chronicity (disability due to pain) and the large burden that is placed on the individual, their family, the NHS and Society.
Many patients have self-limiting episodes of acute low back pain and do not require NHS care; simple analgesia, self-care and appropriate advice on keeping active will suffice (Welsh Back’s campaign; ‘The Back Book’ (Roland et al 2007). More than 85% of patients who present to primary care have low back pain that cannot be reliably attributed to a specific disease or spinal abnormality. Among these, pain, disability and return to work rapidly improve after the first month. However, up to a third of patients report persistent back pain of at least moderate intensity one year after an acute episode and 1 in 5 report substantial limitations in activity. Approximately 5% of the remaining people with back pain disability account for 75% of the costs associated with low back pain. In this minority we need to avoid what Professor Gordon Waddell, described as, ‘The golden window of opportunity where waiting for natural recovery lets the patient slide passively and unobtrusively into chronic pain and disability.’