ACUTE LOW BACK PAIN FLOWCHART

Consider Serious Diagnosis RED FLAGS

NO ACUTE LOW BACK PAIN
as cause for low back pain History of cancer
senior doctor review
<12 weeks duration
st Unexplained weight loss
recommended 1 presentation during this episode Severe pain when supine and/or at
night
YES Age <16 or >50 years
History of significant trauma
Intravenous drug abuse
RED FLAGS Recent bacterial infection or fever
YES Immune suppression
URGENT SENIOR NO Saddle anaesthesia
DOCTOR REVIEW Bladder dysfunction
YES - HD Unstable Bowel dysfunction
Neurological deficit in lower limb(s)
BACK PAIN FROM A NON-SPINAL Persistent symptoms for >4 weeks
Assessment, CAUSE Pregnancy
investigation and YES - HD Stable Representation
management of non-
spinal cause
NO

START ON ACUTE LOW BACK PAIN MANAGEMENT PATHWAY

NON-
PHARMACOLOGICAL
MEDICAL IMAGING
THERAPY
No medical imaging is
Encourage self
indicated
management and
Defer until after a trial
support
Encourage mobilisation
PAIN ASSESSMENT AND MANAGEMENT of therapy
Consider physiotherapy Consider YELLOW FLAGS
referral
Psychological therapy (if
required)

MILD PAIN MODERATE PAIN SEVERE PAIN

Pain scale 1-3 Pain scale 4-6 Pain scale >6

Paracetamol 1g, PO, q4-6h (Max 4g/d) Paracetamol 1g, PO, q4-6h (Max 4g/d) Paracetamol 1g, PO, q4-6h (Max 4g/d)
1 1 1
Ibuprofen 400mg, PO, TDS Ibuprofen 400mg, PO, TDS Ibuprofen 400mg, PO, TDS
2 2
(Oxycodone 5mg, PO, q4h) Oxycodone 5-10mg, PO, q4h (Max 30mg/d)
(Coloxyl + Senna 2, PO, BD) Coloxyl + Senna 2, PO, BD

RE-ASSESSMENT AFTER TRIAL OF

THERAPY FOR DISPOSITION PLANNING
Pain well controlled
Mobility assessment independent or DISCHARGE
appropriate for discharge (consider stairs, Letter, documentation
social support, carer) Analgesia prescription
ADMISSION RECOMMENDED Referral physio/GP
Reconsider diagnosis and red Education and explanation
flags NO YES Follow-up
EDSSU Representation criteria
Medical admission unit/ward Factsheet

1
Caution with non-steroidal anti-inflammatory drug prescription in elderly (>75 years), renal dysfunction, peptic ulcer disease, asthma.
Alternatively a COX-2 (cyclooxygenase 2) inhibitor may be used. Caution in patients with congestive cardiac failure in addition to the above cautions.
2
Reduce dose to Oxycodone 2.5mg, orally, q4-6h, in elderly, >75 years