Primary care management of non-specific low back pain: key messages from recent clinical guidelines

Matheus Almeida, Bruno Saragiotto, Bethan Richards and Chris G Maher
Med J Aust 2018; 208 (6): . || doi: 10.5694/mja17.01152
Published online: 2 April 2018


Introduction: Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged.

Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1–2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP.

Changes in management as a result of the guidelines: The major changes include:

  • emphasising simple first line care with early follow-up;
  • encouraging non-pharmacological treatments over pharmacological treatments; and
  • recommending against the use of surgery, injections and denervation procedures.


  • Matheus Almeida1
  • Bruno Saragiotto2
  • Bethan Richards3
  • Chris G Maher2

  • 1 City University of São Paulo, São Paulo, Brazil
  • 2 University of Sydney, Sydney, NSW
  • 3 Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, NSW


Matheus Almeida is supported by a São Paulo Research Foundation grant. Chris Maher holds a fellowship funded by the National Health and Medical Research Council.

Competing interests:

No relevant disclosures.


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