Remaining active best outcome for low back pain

Morgan Liotta

27/02/2020 2:08:50 PM

In the second of a series of HANDI updates, newsGP talks to the author of a recently updated intervention.

Two joggers stretching
Regular exercise is essential to managing back pain and optimising results for the long term, HANDI author Dr Mary O’Keeffe says.

The RACGP’s Handbook of Non-Drug Interventions (HANDI) aims to provide GPs with free, up-to-date evidence-based interventions that do not rely on prescribing medicine. HANDI also offers resources to assist in patient decision-making.
Recent updates and new HANDI entries add to the suite of 65 interventions, with more in development and planned to be released on the site over the coming year.
Dr Mary O’Keeffe, Postdoctoral Fellow at the Institute of Musculoskeletal Health at the University of Sydney, led the recent update of ‘Advice to stay active for people with low back pain’.
Remaining active, even when in pain, has longer-term benefits, according to the HANDI intervention, which Dr O’Keeffe says provides an excellent way of implementing non-pharmacological care for back pain.
‘The HANDI website provides easy, digestible information for patients that can be provided within a short consultation,’ she told newsGP.
‘For back pain, this means patients have access to why and how they can stay active and avoid prolonged rest for back pain.
‘Back pain is commonly over medicalised, though it responds best to non-pharmacological treatments.’
Dr O’Keeffe’s best approach is to start with a thorough assessment and continue with ongoing support for patients’ pain management.
‘Perform a thorough subjective and objective examination to rule out any serious causes of back pain; for example, cauda equina syndrome, cancer, fracture, infection,’ she explained.
‘Once serious causes of back pain are ruled out, the best strategy is to show empathy and reassure the patient that they do not have a dangerous form of back pain, that they should avoid prolonged rest and try to stay active and return to their usual activities, and that they will recover with time.’
Follow-up and reassuring the patient to support their recovery can be helpful when presented with issues such as ongoing pain, according to Dr O’Keeffe.
‘It can be challenging to providing a realistic timeframe for recovery for back pain,’ she said.
‘While much back pain recovers substantially within two weeks, more episodes can take over six weeks to recover and can be recurrent in nature. This means it can take some time for people to recover from an episode of back pain and they can get the same pain again.
‘Provide the patient with this information, so they do not panic when their back pain may not have recovered within two weeks.’
In instances when the patient raises the option of lumbar imaging (X-ray, MRI), Dr O’Keeffe instead advises alternative approaches.
‘[The patient] may think seeing a picture of the spine is needed to diagnose their issue and guide a treatment plan,’ she said.
‘Take the time to listen to the patient and their concerns, then explain that lumbar imaging is not needed and not helpful for back pain, unless a patient has a dangerous form of back pain; for example, cancer or cauda equina syndrome.
‘Provide them with alternatives to imaging that include staying active, heat, and simple medication.
‘Finally, inform the patient that you are happy to follow-up to ensure they are getting better and try to reply to any questions or concerns they have.’
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exercise HANDI low back pain non-drug interventions pain management

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