National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy.


Author: Stochkendahl MJ1,2,3, Kjaer P4,5, Hartvigsen J4,6, Kongsted A4,6, Aaboe J5, Andersen M7, Andersen MØ8, Fournier G9, Højgaard B5,10, Jensen MB11, Jensen LD12, Karbo T13, Kirkeskov L14, Melbye M15, Morsel-Carlsen L16,17, Nordsteen J18, Palsson TS19, Rasti Z16, Silbye PF20, Steiness MZ21, Tarp S5,22, Vaagholt M23

Affiliation: <sup>1</sup>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. m.jensen@nikkb.dk.

<sup>2</sup>Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. m.jensen@nikkb.dk.

<sup>3</sup>The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark. m.jensen@nikkb.dk.

<sup>4</sup>Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.

<sup>5</sup>The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark.

<sup>6</sup>Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.

<sup>7</sup>Frederiksberg Municipality, Smallegade 1, 2000, Frederiksberg, Denmark.

<sup>8</sup>Center for Spine Surgery and Research, Lillebaelt Hospital, Østre Hougvej 55, 5500, Middelfart, Denmark.

<sup>9</sup>Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.

<sup>10</sup>KORA-the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark.

<sup>11</sup>Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 1, 9220, Aalborg O, Denmark.

<sup>12</sup>Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Noerrebrogade 42, 8000, Aarhus C, Denmark.

<sup>13</sup>Spine Unit, Department of Orthopaedic Surgery, The National University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.

<sup>14</sup>Unit of Social Medicine, Department of Occupational and Environmental Medicine, Frederiksberg Hospital, Ndr. Fasanvej 57, Vej 8, 2.2, 2000, Frederiksberg, Denmark.

<sup>15</sup>Aalborg Spine Clinic, Vingaardsgade 9, 9000, Aalborg, Denmark.

<sup>16</sup>Department of Radiology, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 2000, Frederiksberg, Denmark.

<sup>17</sup>Department of Radiology, Rigshospitalet-Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark.

<sup>18</sup>Copenhagen Back and Rehabilitation Centre, Mimersgade 41, 2200, Copenhagen, Denmark.

<sup>19</sup>Department of Health Science and Technology, SMI®, Aalborg University, Frederik Bajers Vej 7D, 9220, Aalborg, Denmark.

<sup>20</sup>, Bondetinget 24-01, 4000, Roskilde, Denmark.

<sup>21</sup>Spine Section, Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark.

<sup>22</sup>Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Copenhagen, Denmark.

<sup>23</sup>, Hvidkildevej 62, 2400, København NV, Denmark.
Conference/Journal: Eur Spine J.
Date published: 2017 Apr 20
Other:
  Special Notes: doi: 10.1007/s00586-017-5099-2. [Epub ahead of print]   ,  Word Count: 168  
    PURPOSE: To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.



METHODS: Two multidisciplinary working groups formulated recommendations based on the GRADE approach.



RESULTS: Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.



CONCLUSION: Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.



KEYWORDS: Clinical guideline; Conservative treatment; Low back pain; Lumbar radiculopathy; Non-surgical intervention; Recommendations



PMID: 28429142  DOI: 10.1007/s00586-017-5099-2