Visual summary

Managing low back Person with

pain and sciatica low back pain
A brief overview the new NICE
guidelines, from the perspective of With or without sciatica
a patient presenting in primary care.

Consider Exclude specific causes of low back pain, for example:

Referral
alternatives Cancer Infection Trauma Inflammatory disease Cauda equina

Imaging Assess likely recovery outcomes

Only consider imaging: The complexity and intensity of treatment may vary depending on
In specialist care how likely it is that the patient will have a good functional outcome
and
Consider using risk stratification Possible indicators of poor outcomes
If likely to alter management –such as the STarT Back risk Fear / pain avoidance Low mood
assessment tool Job dissatisfaction Ongoing litigation

Good Likely outcomes Poor

Provide self management information Self management is important for all patients,
Information on nature of pain Encouragement to continue activities even those with acute symptoms and/or sciatica

To manage a Pain is persistent /

specific episode treatment resistant

Managing
acute sciatica

Group
+ Manual
therapy Combined
physical +
Neuropathic exercise psychological
Psychological
pain medication
+ therapy
programme

Epidural injections
Steroid
+
Local anaesthetic
Consider pain relief options
Paracetamol NSAIDs* Weak opioids
Spinal decompression Not Consider If NSAID ineffective /
effective oral not tolerated /
After acute symptoms of sciatica alone NSAIDs contraindicated
are controlled, it may be
appropriate to (re)enter an
excercise programme to manage
* NSAIDs = non-steroidal
underlying low back pain Do not offer acupuncture anti-inflammatory drugs

© 2016 BMJ Publishing group Ltd.

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