Login

AQP Lower Back and Neck

 

AQP Physiotherapy

This guideline applies to people over 16 years of age with neck or lower back pain with a duration of one year or less.

 

Red Flag Features

Cauda equina syndrome

Conus medullaris syndrome

Trauma

Cervical spondylotic myelopathy

Significant neurological symptoms or signs

Unintentional weight loss

Loss of appetite

Fever

Systemically unwell

Night sweats

Pain that is particularly bad at rest such as lying down and at night

Past medical history of cancer

Thoracic back pain

Insufficiency fractures with severe pain

Early morning stiffness lasting for 30 minutes or more

 

Urgent criteria

  • Patient is dependent on strong analgesia such as tramadol
     
  • Severe sleep disturbance due to the MSK condition
     
  • Deterioration is likely to significantly and quickly deteriorate without intervention
     
  • Severe impairment of daily living activities

 

Routine criteria

All referrals not categorised as urgent including

  • Intermittent pain
     
  • Mild to moderate reduction in function and/or activities of daily living
     
  • Clinical condition has the potential for improvement with intervention

 

Exclusions

  • Patients younger than 16 years
     
  • Suspicion of serious pathology and red flags
     
  • Symptoms over 1 year in duration
     
  • Thoracic pain
     
  • Generalised loss of muscle power
     
  • Spasticity, hyperreflexia, increased tone reflexes or clonus that could indicate a central nervous system problem
     
  • Patients with a primary peripheral limb problem with secondary neck or low back pain (ie. primary problem is from the hip, shoulder, foot or gait abnormalities)
     
  • Women over 35 weeks’ pregnant
     
  • Housebound patients
     
  • Patients who are not registered with a general practitioner in locality


 

Referral

Red flags and alternative pathology

  • Suspected Cauda Equina or Conus Medullaris Syndrome direct to ED
     
  • Metastatic spinal cord compression admit via AcuteGP service
     
  • Trauma direct to ED
     
  • Cervical spondylotic myelopathy
     
  • Low back pain with sustained slowly progressive motor or sensory loss with cauda equina/conus medullaris and red flags excluded, discuss with on call neurosurgery by phone or via www.referapatient.org or urgent referral depending on clinical urgency
     
  • Spinal infection including suspected discitis, osteomyelitis and spinal abscess, discuss with on call neurosurgery by phone or via www.referapatient.org depending on clinical urgency
     
  • Primary spinal tumour found on MRI imaging, discuss with on call neurosurgery either by phone, via www.referapatient.orgor urgent referral depending on clinical urgency
     
  • Malignancy without suspected cauda equina or metastatic spinal cord compression, consider blood/urine and imaging work up, refer to appropriate specialty fast track suspected cancer if suspected primary or non site specific pathway if unknown primary
     
  • Features of inflammatory arthritis, inflammatory spinal pain or other suspected rheumatological causes, workup and refer to rheumatology

 


AQP Referral

Referral Form
 

List of AQP Providers in Cornwall


 

References

Joint societies guideline.  Urgent and Emergency Musculoskeletal Conditions Requiring Onward Referral, December 2020

 

Page Review Information

Review date

26/03/2024

Next review date

26/03/2026

GP speciality lead

Dr Rebecca Hopkins