Assessment
Figure 1. Initial Evaluation of LBP Adults with LBP
Perform a focused history and physical examination, evaluating: > Duration of symptoms > Risk factors for potentially serious conditions > Symptoms suggesting radiculopathy or spinal stenosis > Presence and severity of neurologic deficits > Psychosocial risk factors
NO
Are any potentially serious conditions strongly suspected?
YES
Perform diagnostic studies to identify cause
no substantial functional impairment?
Back pain is mild with NO YES Advise about self-care NO
Specific cause identified? YES
Discuss noninvasive treatment options: > Pharmacologic > Nonpharmacologic
Arrive at shared decision regarding therapy trial Educate patient
accepts risks and benefit of therapy?
Patient NO
Reassess in 1 month
Continue self-care
2
LBP not on therapy
Refer to Figure 2,
YES
Patient on therapy?
NO YES
Figure 2, LBP on therapy
Refer to
as indicated, consider consultation
Treat specific cause
Advise about self-care Review indications for reassesment
