SGBP Final 4

Management of back pain: Step One Measures

Let us continue to develop our algorithm for management of back pain. We have seen so
far that back pain can be classified into three categories based on the presence of:

1. Red flag symptoms and signs with a pathological spinal disorder indicating
   urgent need for specialist attention and possibly immediate surgery


2. Pathological spinal disorder but without red flag symptoms and signs indicating
   that the problem is not serious enough to warrant immediate specialist attention
   and can be managed with conservative treatments.


3. No detectable pathological cause on clinical examination or investigations.

If you have red flags you may need appropriate surgical treatment to prevent permanent
damage to the spinal nerves or cord. For those conditions not having a red flag or where
no pathological cause has been found, conservative (non-surgical) measures need to be
considered for a period of two weeks in order to relieve the symptoms. These initial
treatments can be called as Step One measures.

BACK PAIN

APPROPRIATE SURGICAL

TREATMENT STEP ONE MEASURES^

FOR TWO WEEKS

RED FLAGS PATHOLOGICAL CAUSE

BUT NO RED FLAG

NO PATHOLOGICAL

CAUSE