It is hoped that the module has been of practical use and there the references have been provided if you want to investigate further. There are some useful presentations and primary care pain resources on  http://www.paincommunitycentre.org/. In conclusion, the key messages for simple mechanical low back pain are:

  • Should be managed in primary care
  • Self-management is key; consider simple analgesia initially and then manual therapy, exercise and acupuncture if pain not resolving
  • Do not MRI or X-ray for low back pain unless surgery is being contemplated or red flags are suspected
  • Try and keep the patient active – HURT DOES NOT EQUATE TO HARM - staying active usually means staying in work. It may also be worth mentioning that it is not necessary to be 100% fit to go back to work and that the new fit note gives the option of returning to work on altered duties etc if the employer is able to accommodate this
  • Do not refer to secondary care unless complex case or red flags are suspected or if the complexity and chronicity of the back pain requires specialist pain services
  • Early assessment and management of yellow flags should be undertaken if psychosocial factors are delaying recovery
  • Avoid use of unhelpful metaphors (crumbling spine, touch of arthritis)
  • De-medicalise back pain – use of community based resources, such as exercise referral etc.