Over 12 months duration which is not caused by malignancy, infection, fracture and inflammatory disorders e.g. Ankylosing Spondylitis.
Serious pathology in the absence of an obvious cause (eg trauma) is very rare, but be aware of signs suggestive of more serious pathology.
Symptoms suggestive of cauda equina syndrome (compression of the cauda equina):
Significant symptoms that may suggest cancer:
Other symptoms that may suggest cancer include:
Symptoms that may suggest infection:
Symptoms that suggest fracture:
Red flags may also be indicated by:
NB: Be aware that some red flags have very high false-positive rates and as such have little diagnostic value in primary caresettings. Careful clinical judgment to decide whether to investigate further or refer is needed.
Patients with any of the following suspected should be sent to A&E:
Consider urgent referral to Consultant Spinal Surgeon Clinic (where certain of malignancy contact Oncology):
Urgent referral to Rheumatology Clinics for suspected spondyloarthropathy:
Biopsychosocial assessment and management and consider:
Use clinical judgement to determine whether to follow this persistent pain pathway or a specific condition pathway.
Imaging / Bloods
If no major barriers are identified and the GP is seeking reassurance, discharge is warranted at this stage.
Or if barriers identified consider referral criteria below:-
Imaging / Bloods
Inclusion criteria for Pain Self-Management Service:
Pain Self-Management referral is not appropriate for people who:
Criteria for urgent referrals to Pain Self-Management Service
Consider referral to Rheumatology (after discussion with GP) if:
No referrals to secondary care orthopaedics unless:
Individual Funding Requests
Surgical treatment for non-specific low back pain is considered to be a procedure of low clinical priority and is listed on Gloucestershire CCG's Effective Clinical Commissioning Policy. Please the attached link for details of access criteria and funding arrangements.