Selecting a Treatment Regimen
Figure 2. Management of LBP
LBP not on therapy
Initiate time-limited trial of therapy (Table 2)
Follow-up within 4 weeks
LBP on therapy
Assess response to treatment
Back pain resolved or improved
with no significant functional
deficits?
YES
Continue self-care
Reassess in 1 month
NO
Signs or symptoms of
radiculopathy or spinal
stenosis?
YES
Consider diagnostic
imaging (MRI) if not
already done
Consider referral
NO
Reassess symptoms and risk
factors and re-evaluate diagnosis
Consider imaging studies
NO
Significant
(concordant) nerve
root impingement
or spinal stenosis
present?
YES
Consider alternative pharmacologic and
nonpharmacologic interventions (Table 2)
For significant functional deficit, consider more
intensive multidisciplinary approach or referral
Consider referral
for consideration
of surgery or other
invasive procedures
Abbreviations
CRP, C-reactive protein; CT, computed tomography; EMG, electromyogram; ESR,
erythrocyte sedimentation rate; LBP, low back pain; mo, month; MRI, magnetic resonance
imaging; NCV, nerve conduction velocity; NSAIDs, nonsteroidal anti-inflammatory drugs;
TCA, tri-cyclic antidepressant; U.S., United States; y, year(s)
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