ÎÎClinicians should evaluate patients with persistent LBP and
signs or symptoms of radiculopathy or spinal stenosis with
magnetic resonance imaging (MRI) (preferred) or computed
tomography (CT) only if they are potential candidates
for surgery or epidural steroid injection (for suspected
radiculopathy) (strong recommendation, moderate quality
evidence).
ÎÎClinicians should provide patients with evidence-based
information on LBP with regard to their expected course,
advise patients to remain active, and provide information
about effective self-care options (strong recommendation,
moderate quality evidence).
ÎÎFor patients with LBP, clinicians should consider the use
of medications with proven benefits in conjunction with
back care information and self-care. Clinicians should
assess severity of baseline pain and functional deficits,
potential benefits, risks, and relative lack of long-term
efficacy and safety data before initiating therapy (strong
recommendation, moderate quality evidence). For most
patients, first-line medication options are acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs).
ÎÎFor patients who do not improve with self-care options,
clinicians should consider the addition of nonpharmacologic
therapy with proven benefits—for acute LBP, spinal
manipulation; for chronic or subacute LBP, intensive
interdisciplinary rehabilitation, exercise therapy,
acupuncture, massage therapy, spinal manipulation, yoga,
cognitive-behavioral therapy, or progressive relaxation (weak
recommendation, moderate quality evidence).
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