Acute low back pain only with spasm

• back education program

• strict rest lying on a firm surface for 2 days 8 (keep the spine as straight as possible)

• regular simple analgesics with review as the patient mobilises

• cold or hot compresses to the painful area

• simple mobilisation exercises as tolerated

• muscle energy therapy

• consider trigger point injection of local anaesthetic

• relaxant, e.g. diazepam (if appropriate) for 4-5 days

When the acute phase settles, treat as for uncomplicated low back pain. Sciatica with or without low back pain

Sciatica is a more complex and protracted problem to treat, but most cases will gradually settle within 12 weeks.


• strict bed rest for 2-3 days (keep the spine straight—avoid sitting in soft chairs and for long periods)

• regular non-opioid analgesics with review as the patient mobilises

• NSAIDs for 10-14 days, then cease and review

• back education program

• resume normal activities as soon as possible

• exercises—straight leg raising exercises to pain tolerance

• traction (a trial of intermittent traction is worthwhile)

• weekly or 2 weekly follow up


• continue physiotherapy with possible traction

• reassurance that problem will subside (assuming no severe neurological defects)

• consider epidural anaesthesia (if slow response)

General guidelines for surgical intervention

• bladder/bowel disturbance

• progressive motor disturbance, e.g. significant foot drop, weakness in quadriceps

• severe prolonged pain

• failure of conservative treatment with persistent pain (problem of permanent nerve damage)

Note: An important controlled prospective study comparing surgical and conservative treatment in patients with sciatica over 10 years showed that there was significant relief of sciatica in the surgical group for 1 to 2 years but not beyond that time. At 10 years both groups had the same outcome including neurological deficits. 15

Dealing With Back Pain

Dealing With Back Pain

Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.

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