ÎClinicians 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).
ÎClinicians 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).
ÎFor 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).
ÎFor 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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