Please refer using the Low Back Pain standard referral available from the SAFKI Medicare Local

website www.safkiml.com.au
Patient presents to GP or other
provider with
Low Back Pain (LBP)
Imminent life or major
health threatening
condition?
1
Immediate telephone
referral to Spinal
Consultant 8204 5511
Yes
Presence of
red flags?
2
Investigations
positive?
Specialist
referral
Yes
No
Presence of
radicular
symptoms?
3
Yes No
No
Advice/Education.
Keep active
Simple analgesics
Review 1-2 weeks
Avoid opioids
Advice/Education
Keep active
Simple analgesics
Review 2 weeks
Avoid opioids
No Yes
Improving? Improving?
Analgesic review
4
Consider low dose TCA's
Consider Allied Health referral
Continue 1-2 weekly review
Analgesic review
4
Screen for Yellow Flags
5
Consider Allied Health referral
6
Continue 1-2 weekly review
No
No
Yes
Yes
Improving at
4-8 weeks?
Improving at
8-12 weeks?
Ongoing
GP
Management
8
+
consideration of
Allied Health
Intervention as
required
or as available
No
No
Yes Yes
Consider CT/MRI
7
if indicated
Refer to public Neurosurgery
Fax No: 8204 5116
(MRI will be fast tracked where
clinical information indicates valid
clinical need),
or private specialist if eligible
1. Emergency Presentations
Cauda Equina (loss of bladder/bowel control , saddle
anasthesia)
Rapidly progressing motor neurology/gait disturbances
2. Red Flags
History of malignancy
Age>50 at initial onset
Night pain and/or pain worse supine
Unexplained weight loss (~5% in 3-6 months)
Presentation suggestive of infection (eg fever, systemically
unwell, IV drug user, immunosupressed, penetrating injury)
Significant trauma or minor trauma if >50 years or history of
osteoporosis and/or corticosteroid use.
Investigations
Plain XRays indicated for any red flags
CRP, WCC indicated if infection or cancer suspected
Other tests indicated according to clinical indication
NB If there exists a strong suspicion of serious pathology despite
negative investigations, full investigation +/- specialist referral is
indicated.
3. Radicular Symptoms
Symptoms distal to the buttock crease indicate neurological
testing required including sensation, reflexes and myotomes +/
upper motor testing
4. Analgesic Review (click box to go to link)
Refer to National Prescribing Service for recommended staging of
analgesics.
There is no strong evidence to support the use of opioids for
chronic LBP, with high associated abherrant medication taking
behaviour (up to 24%)
Any trial of opioids should be carefully considered and should
generally only be a short term trial
5. Yellow Flags (Usethe'STarTTool'toevaluate click
for online assessment)
Certain psycho-social factors ('Yellow Flags') can indicate a poor
prognosis for LBP. If present consider referral to physiotherapy
for active management
6. Allied Health
Should focus on strategies to remain active (eg exercise based
therapy)
Short trial of 'hands on' therapy (eg manipulation) is appropriate
Consider Psychology referral if scores high for Yellow Flags or
other psychosocial issues
Monitor progress with Allied Health professional to determine
efficacy of intervention.
7. CT/MRI
Should only be considered if significant potential for surgery or
injection therapy OR suspicion of serious pathology.
MRI is the modality of choice, however if not feasible, CT can
also be considered.
CT lumbar spine radiation exposure is the equivalent of 500
chest Xrays
Low Back Pain - Management Guidelines
8. Consumer advice/information
Click on name to print fact sheets from
National Prescribing Service or
Disclaimer:
This Consensus Based guideline is based on the best available evidence with the expectation that it will be followed by health care providers in the SAFKI Medicare Local region.
First developed by gpns September 2011 Reviewed March 2012
National Health and Medical Research Council
Consider referral to
Pain Management Clinic
Fax No: 8374 1758
or other pain management service
Presence of
yellow Flags?
5
No