National Clinical Guidelines for Non-surgical Treatment of Low Back Pain or Lumbar Radiculopathy
Written by Editor   
Monday, October 02, 2017 02:52 PM

Two multidisciplinary working groups formulated recommendations to summarize recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.

Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.

The guidelines considered ten clinical questions concerning LBP and ten concerning LR. Six interventions were covered by both clinical guidelines, two of which were stand-alone interventions (advice to stay active vs rest; routine use of Magnetic resonance imaging [MRI] and/orX-ray vs. no imaging), and four were evaluated as an add on to usual care vs. usual care (individualized patient information, supervised exercise, acupuncture, and manual therapy). 

In addition, the clinical guideline for LBP covered three questions addressing pharmacological interventions [paracetamol, opioids and non-steroidal antiinflammatory drugs (NSAIDs)] as add-on to usual care, and targeted group-based care vs. non-targeted care. 

For LR, three head-to-head comparisons of exercise and manual therapy interventions (directional exercise vs. neuromuscularcontrol training; directional exercise in combination with neuromuscular control training vs directional exercise alone; supervised exercises vs. manual therapy) were performed.