Treatment and Management

 

Low Back Pain with or without Radiculopathy (i.e., non-specific LBP and LBP with radiculopathy)

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Clinical Cornerstone:

• A comprehensive approach to managing LBP involves integrating education, self-care, conservative management, and specific interventions when necessary. This approach should be grounded in evidence-based practice, respective of cultural nuances, and prioritize patient needs and values. It emphasizes professional collaboration and is continuously fine-tuned based on patient feedback and progress, ensuring a unified, empathetic, and efficient pathway.

• While passive modalities such as Transcutaneous Electrical Nerve Stimulation (TENS), needling therapies (acupuncture, dry needling), and traction might offer pain relief or relaxation, it is essential to integrate them with active management strategies. This combination addresses the multifaceted nature of LBP, fostering enduring pain management and enhancing function and participation.

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Overview of treatment and management strategies for LBP with or without radiculopathy: May include: education, self-care, exercise, manual therapy (e.g., manipulation, mobilization, soft tissue techniques, clinical or relaxation massage), medicines, psychological therapy, social support, and mind-body interventions.

 

Additionally for LBP with Radiculopathy: Medical/surgical consultation for significant, persistent, or progressive neurological deficits.

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Strategy Details

• Patient Education: Focus on understanding the condition, implementing pain management strategies, and actively participating in the rehabilitation process. Reassure patients that most acute LBP episodes improve within a few weeks and typically do not stem from serious pathology. Clarify the biopsychosocial dimensions of pain, address underlying psychosocial factors, and underscore the importance of their active participation in care, as well as setting realistic expectations.

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• Self-care: Crucial for managing LBP and facilitating a return to meaningful activities. Incorporate strategies like goal setting/Brief Action Planning/SMART goals.

  • Utilize techniques like Brief Action Planning to support self-management and promote regular movement and engagement in normal activities, including work.

  • Lifestyle changes: Prioritize a healthy diet, regular physical activity, good sleep habits, maintaining a healthy body weight, and abstaining from smoking.

  • Ergonomics and behaviour change to reduce strain during physical or sedentary work.

  • Engage in social and work activities.

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• Exercise: e.g., strengthening/range of motion, aerobic, mind-body, or a combination of approaches; group-based or individual, supervised or home-based.

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• Manual therapy: e.g., mobilization, manipulation, soft tissue techniques, clinical or relaxation massage.

 

• Medicines: e.g., over-the-counter pain relievers, muscle relaxants, non-steroidal anti-inflammatories (NSAIDs). Medicines should be used judiciously and combined with other treatments.  Scope of practice regarding conversations about medications varies by profession and jurisdiction.

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• Psychological therapy: Referral to an appropriate healthcare provider if needed.

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• Social support

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• Mind-Body Interventions: Techniques like mindfulness, meditation, and cognitive-behavioral therapy (CBT).

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Persistent LBP: As the duration of LBP extends, functional limitations are more likely to emerge. Adopting a biopsychosocial approach to assessment and care planning becomes paramount. Rehabilitation aims to sustain independence in daily activities and ensure active participation in vital areas like work and community life, crucial for well-being. It involves a spectrum of non-pharmacologic and pharmacologic interventions, with non-pharmacological options often taking precedence. Rehabilitation thus spans a wide array of services, supports, and community resources, all aimed at enhancing overall well-being and societal involvement. Management strategies include patient education, self care, exercise, manual therapy (e.g., spinal manipulation, mobilization, massage), NSAIDs, needling therapies, mobility assistive products, CBT, operant therapy, multicompoent biopsychosocial care, and topical cayenne pepper.