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by Dr Rajib Dutta, MBBS, DA, FRCA, FFPMRCA, Consultant in Pain Medicine

Definitions

  • Low back pain: tension soreness and/or stiffness in the area between the bottom of the rib cage and the buttock creases
     
  • Acute:  
  • Subacute: 3-6 months
     
  • Chronic: > 6months
     
  • Non-specific mechanical low back pain: not attributable to a recognisable, known, specific pathology:
     
    • Infection
    • Tumour
    • Osteoporosis
    • Fracture
    • Structural deformity
    • Inflammatory disorder, eg ankylosing spondylitis
    • Raicular syndrome
    • Cauda equina syndrome

 

Initial Management

Encourage reactivation:

  • Avoid bed rest
  • Maintain regular activity
  • Discuss work
  • Gentle exercise
  • Address individual patient concerns and expectations - reassurance is important:
  • Information Leaflets
  • Legitimise back symptoms, explain related symptoms, discuss likely prognosis
  • Acknowledge multifactorial nature of back pain
  • Pain Relief

 

No Improvement

  • Refer to a centre with the facilities for multidisciplinary assessment and provision of appropriate interventions if there is persisting severe pain within:
  • 3 months or earlier for radicular pain
  • 6 months for low back pain
  • Refer earlier if the pain is severe.

 

Multidisciplinary management

  • Interventional pain Therapies
  • Complex medication including opioids and neuropathic pain medications
  • Physiotherapy and TENS
  • High intensity cognitive behavioural therapy-based programmes
  • Consider Surgical Referral if neurology is progressive and pain uncontrolled, and image-guided steroid injection fails to control pain

 

Dr Dutta would be happy to talk to GP Practices about lower back with leg pain as well as various long-standing painful conditions.

To arrange an appointment please contact:

Mrs Anny Abraham or Mrs Mandeep Brar, Secretaries to Dr R Dutta, on 01932 722579 or 01932 722432. Please ensure that you follow your CCG referral process (e.g. use of referral support services if applicable)

 

Medical Disclaimer:

This article contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. It is also a very short general description.

 

Contacts

Our team supporting you is:

Emma Jackson
GP Relationship Manager
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01932 722420

Debbie Beesley
Service Development Manager
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01932 723511

Sharon Chasty
GP Administrator
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01932 723212

Dr Beth Coward
GP Tutor
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