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Inflammatory Back Pain in Adults

When to refer to rheumatology?

If low back pain started aged <45yrs and lasted >3months & if at least 4 of the following:

  • LBP started <35yrs old
  • Waking during second half of night due to symptoms
  • Buttock pain
  • Improvement with movement
  • Improves within 48hrs of NSAID use
  • 1st degree relative with spondyloarthopathy
  • Current/past psoriasis
  • Current/past enthesitis
  • Current/past inflammatory arthritis

If exactly 3 of the above list present- check HLA-B27 and if positive refer .

 

IfRed flags/High complexity ie. Impending/established cauda equine; conus medullaris

See:http/rms.kernow.ccg.nhs.uk/primary_care_clinical_referral_criteria/pain_management/adult_low_backpain_guidelines

 If there is no evidence of inflammatory symptoms, please consider following the Adult Low Back Pain pathway.

Investigations pre referral

FBC, U&E, LFTS, Bone, ESR, CRP

DO NOT REQUEST PLAIN FILM X RAYS

Primary Care management

Analgesia

Consider NSAIDS at lowest effective dose taking into account risk factors for Renal/ cardiac/ Gastrointestinal  toxicity +/- gastroprotective treatment

Physiotherapy

May be helpful but should not delay referral  to rheumatology  if high index of suspicion of inflammatory cause for back pain.

Useful websites:

www.spadetool.co.uk

References:

NICE NG65, Feb 2017

Personal communication David Hutchinson, Consultant Rheumatologist, RCHT, Aug 2018

 

Guidelines reviewed 01/04/2019

Next review due 01/04/2020

Dr B Wesson ( RMS GP Lead for Rheumatology)

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