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?
NO
radiculopathy or spinal stenosis?
Signs or symptoms of NO
factors and re-evaluate diagnosis Consider imaging studies
Reassess symptoms and risk
For significant functional deficit, consider more intensive multidisciplinary approach or referral
Consider alternative pharmacologic and nonpharmacologic interventions (Table 2)
NO
(concordant) nerve root impingement or spinal stenosis present?
Significant YES
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)
LBP051131
5740 Executive Drive Suite 220 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 For additional copies: orders@GuidelineCentral.com Copyright © 2011 All rights reserved
YES
imaging (MRI) if not already done
Consider diagnostic Consider referral YES
Continue self-care Reassess in 1 month
7
