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New patient pathway for back pain

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A patient pathway has been developed for back pain, which recommends they return to their general practice within two weeks of an initial consultation if they experience no improvement.

The pathway for low back and radicular pain has been jointly drawn up by the British Journal of Anaesthesia and the British Pain Society.

It is intended to provide “straightforward” guidance to primary care clinicians on initial management and when to refer for specialist advice, as well as provide a useful resource for patients. 

The authors say that “crucially” the pathway addresses the issue of delaying expert referrals and the potential for an over reliance on pain killers, which could ultimately allow a more chronic condition to develop. 

The guidance suggests that after an initial consultation, patients should return to the surgery after two weeks if there is no improvement, with a view to seeking specialist advice or further investigations. This could include physiotherapy or a more intensive approach. 

The pathway goes on to advise that if there is still no improvement after 12 weeks a referral to a hospital specialist should be made. This is a “significantly shorter” timeframe than currently recommended by other guidance. 

Details on the pathway and its use have also published in a free article in the British Journal of Anaesthesia. It states: “Some clinicians will no doubt consider the referral for specialist care to be very early.

“Patients in the UK often attend a specialist unit for the first time having gone through many unsatisfactory assessment and management cycles from different providers, finishing with a pain clinic several years after their problem started.”

The recommended time scales in the pathway are three months or earlier for radicular pain and six months for low back pain, or earlier if the pain is severe.

In addition, the pathway recommends tight restrictions for the use of strong opioids because of the lack of evidence of long-term benefit.

“The lowest dose possible should be used for the shortest time possible, and both efficacy and side-effects
should be closely monitored with plans in case of treatment failure,” it states.

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