Low back pain - NICE guideline

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This guideline covers the early treatment and management of persistent or recurrent low back pain, defined as non-specific low back pain that has lasted for more than 6 weeks, but for less than 12 months. It does not address the management of severe disabling low back pain that has lasted over 12 months.

Key recommendations

Information, education and patient preferences

  • Provide people with advice and information to promote self-management of their low back pain.

  • Offer one of the following treatment options, taking into account patient preference: an exercise programme (see section 1.3.3), a course of manual therapy (see section 1.4.1) or a course of acupuncture (see section 1.6.1). Consider offering another of these options if the chosen treatment does not result in satisfactory improvement.

Physical activity and exercise

  • Consider offering a structured exercise programme tailored to the person:

    • This should comprise up to a maximum of eight sessions over a period of up to 12 weeks.
    • Offer a group supervised exercise programme, in a group of up to 10 people.
    • A one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.

Manual therapy

  • Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.

Invasive procedures

  • Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.

  • Do not offer injections of therapeutic substances into the back for non-specific low back pain.

Combined physical and psychological treatment programme

  • Consider referral for a combined physical and psychological treatment programme, comprising around 100 hours over a maximum of 8 weeks, for people who:

    • have received at least one less intensive treatment (see section 1.2.5) and
    • have high disability and/or significant psychological distress.

Assessment and imaging

  • Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.

  • Only offer an MRI scan for non-specific low back pain within the context of a referral for an opinion on spinal fusion (see section 1.9).

Referral for surgery

  • Consider referral for an opinion on spinal fusion for people who:

    • have completed an optimal package of care, including a combined physical and psychological treatment programme (see section 1.7) and
    • still have severe non-specific low back pain for which they would consider surgery.

Treating low back pain

Low back pain is a common disorder, affecting around one-third of the UK adult population each year. Around 20% of people with low back pain (that is, 1 in 15 of the population) will consult their GP about it.

Low back pain is a common disorder, affecting around one-third of the UK adult population each year

There is a generally accepted approach to the management of back pain of less than 6 weeks' duration. What has been less clear is how low back pain should be managed in people whose pain and disability has lasted more than 6 weeks. Appropriate management has the potential to reduce the number of people with disabling long-term back pain, and so reduce the personal, social and economic impact of low back pain.

A key focus is helping people with persistent non-specific low back pain to self-manage their condition. Providing advice and information is an important part of this. The aim of the recommended treatments and management strategies is to reduce the pain and its impact on the person's day-to-day life, even if the pain cannot be cured completely.

About this guideline

This guideline was developed by the National Collaborating Centre for Primary Care. The Collaborating Centre worked with a group of healthcare professionals (including consultants, GPs and nurses), patients and carers, and technical staff, who reviewed the evidence and drafted the recommendations. The recommendations were finalised after public consultation.

We have produced information for the public explaining this guideline. Tools to help you put the guideline into practice and information about the evidence it is based on are also available.

You can read the guideline on NICE's website.