Treatment Recommendations
The main reason for the high prevalence of chronic low back pain is the substantial gap between evidence-based recommendations and the current clinical practice, which is characterized by the overuse of low-value careand underutilization of high-value care. This type of care management could be seen in several aspects of the treatment of low back pain patients.
5 KEY POINTS
|
1) |
First-line intervention should be non-pharmacological. |
|
2) |
The intervention should be guided by a biopsychosocial perspective. |
|
3) |
Laboratory and imaging exams should not be routinely used in the low back pain assessment. |
|
4) |
Treatment involving electrical or passive modalities, such as ultrasound, transcutaneous electrical nerve stimulation (TENS), traction, interferential therapy, short-wave diathermy should not be used. |
|
5) |
Patients should be evaluated and stratified into categories of risk of developing persistent and disabling pain in order to maximize their referral to more cost-effective types of treatment. |
The “STarT Back Screening Tool”, developed by the Keele University (UK) and culturally adapted to the Portuguese population, supports the health professional assessment in the risk classification of patient developing persistent and disabling low back pain (low, medium and high risk).
For each subgroup risk there is a specific treatment typology designed to modify the risk factors.
Patients classified with low risk of developing persistent and disabling low back pain require only a minimum intervention (1 session) based on personalized education, informed evidence based and focused on promoting patient self-management of the condition.
In a maximum of 6 sessions, patients classified with medium risk of developing persistent and disabling low back pain benefit from a specialized intervention, informed evidence based on the patient's education, manual therapy and exercise.
High risk patients benefit from 12 group sessions with specialized physiotherapy and making use of scientific evidence support. In addition to the principles described in the medium risk group, in the high risk patient is recommended an cognitive-behavioral support approach.
