Non-radicular low back pain: Assessment and evidence-based treatment

BACKGROUND: Low back pain (LBP) is a common presentation in general practice. Clinical workup must exclude sinister underlying diseases. Treatment of central LBP is difficult given the numerous treatment options available. OBJECTIVE: The aim of this article is to help clinicians assess patients with LBP and formulate evidence-based treatment decisions. DISCUSSION: Patient presentations can be stratified according to the presence of red flags and pain type (ie non-spinal, radicular, non‑organic and central). The vast majority of patients with acute central back pain experience improvement of their symptoms. Treatment options include education, lifestyle modification, heat, massage, graduated return to early activity, nonsteroidal anti-inflammatory medications and muscle relaxants when appropriate. Chronic LBP treatment can also include paracetamol and physiotherapy. Second-line treatment can include psychological therapy, multidisciplinary rehabilitation, targeted injections and antidepressants. Tapentadol is a safe and effective medication for treating severe LBP. Pain specialist referral should be considered if patients require controlled analgesia. Surgical treatment has narrow indications in central non-radicular back pain and is considered as a last-line treatment in selected patients.