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.
Information, education and patient preferences
Provide people with advice and information to promote self-management of their low back pain.
Physical activity and exercise
Consider offering a structured exercise programme tailored to the person:
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.
Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.
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:
Assessment and imaging
Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.
Referral for surgery
Consider referral for an opinion on spinal fusion for people who:
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.
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.
You can read the guideline on NICE's website.