Low back pain and radicular pain : assessment and management

160 p.
ill.
SCIENTIFIC REPORT 12 -- 1 INTRODUCTION 12 -- 1.1 BACKGROUND 12 -- 1.2 THE NEED FOR A GUIDELINE 13 -- 1.3 SCOPE 13 -- 1.4 REMIT OF THE GUIDELINE 14 -- 1.4.1 Overall objectives 14 -- 1.4.2 Multidisciplinary approach 14 -- 1.4.3 Patient-centered care 14 -- 1.4.4 Target users of the guideline 14 -- 1.5 STATEMENT OF INTENT 14 -- 1.6 FUNDING AND DECLARATION OF INTEREST 15 -- 2 METHODOLOGY 15 -- 2.1 THE GUIDELINE DEVELOPMENT GROUP 15 -- 2.2 GENERAL APPROACH 16 -- 2.3 SEARCH FOR EXISTING GUIDELINES 16 -- 2.4 CLINICAL RESEARCH QUESTIONS 17 -- 2.5 NICE METHODOLOGY 19 -- 2.5.1 Searching for evidence 19 -- 2.5.2 Grading evidence 20 -- 2.6 ANALYSIS OF NICE REVIEW 22 -- 2.7 FORMULATION OF RECOMMENDATIONS 23 -- 2.8 EXTERNAL REVIEW 26 -- 2.8.1 Healthcare professionals (stakeholders) 26 -- 2.9 FINAL VALIDATION 26 -- 3 CLINICAL RECOMMENDATIONS 26 -- 3.1 ASSESSMENT OF LOW BACK PAIN AND RADICULAR PAIN 26 -- 3.1.1 History taking and clinical examination 26 -- 3.1.2 Risk assessment and stratification 29 -- 3.1.3 Imaging 35 -- 3.2 NON-INVASIVE TREATMENT (MEDICATION EXCLUDED) 38 -- 3.2.1 Self-management 38 -- 3.2.2 Exercise therapies 43 -- 3.2.3 Postural therapies 52 -- 3.2.4 Orthotics and appliances 57 -- 3.2.5 Manual Therapies 61 -- 3.2.6 Acupuncture 72 -- 3.2.7 Electrotherapies 77 -- 3.2.8 Psychological interventions 86 -- 3.2.9 Multidisciplinary biopsychosocial rehabilitation (MBR) programs. 90 -- 3.2.10 Return to work programs 98 -- 3.2.11 Back schools 101 -- 3.3 MEDICATIONS 102 -- 3.3.1 Non-steroidal anti-inflammatory drugs (NSAIDs) 102 -- 3.3.2 Paracetamol 107 -- 3.3.3 Opioids 110 -- 3.3.4 Antidepressants 114 -- 3.3.5 Anticonvulsants 117 -- 3.3.6 Skeletal muscle relaxants 120 -- 3.3.7 Antibiotics 122 -- 3.3.8 Oral Methylprednisolone 124 -- 3.4 INVASIVE TREATMENTS 124 -- 3.4.1 Spinal injections 124 -- 3.4.2 Radiofrequency denervation for facet joint pain 128 -- 3.4.3 Epidural injections 134 -- 3.4.4 Surgery and prognostic factors. 140 -- 3.4.5 Disc replacement 143 -- 3.4.6 Spinal fus