Non-specific low back pain provides guidelines

The NHG Standard Non-specific low back pain provides guidelines for the diagnosis and management in adults with nonspecific low back pain. Under non-specific lower back pain is defined as pain in the area between the lower ribs and the bilplooien, with no particular physical cause is identified. In general practice, it goes into 5 to 10% of the cases of low back pain to a specific cause, in particular, the lumbosacral radiculopathy. Diagnosis and treatment of these are discussed in the NHG Standard lumbosacral radicular syndrome. Non-specific low back pain is sometimes accompanied by pain in one or both (above) legs, absence of a radicular syndrome (called non-radicular pain radiating, see the aforementioned Standard). More rare specific causes of low back pain include - especially over 50 years - malignancies and (osteoporotic) fractures vertebra, and - above all under 40 - ankylosing spondylitis (Bechterew's disease) and severe forms of spondylolisthesis. The default, in which cases should keep the general account of a specific cause; the policy is to specific causes beyond the scope of this Standard.

The guidelines of this standard are consistent with those of the Directive Non-specific low back pain of the CBO, provided that account is taken in translating into concrete guidelines for GPs with his capabilities and werkwijze.1)

Non-specific low back pain is as in the previous version of this standard for international use on the basis of the duration of symptoms divided into acute, sub-acute and chronic obstructive lagerugpijn.2) At a time of non-specific low back pain for six weeks or less one speaks of acute nonspecific low back pain, sub-acute nonspecific low back pain with a duration longer than 6 but less than 12 weeks, and chronic non-specific low back pain with a duration longer than 12 weeks or frequent recurrences.

In acute nonspecific low back pain is to promote policies aimed at ensuring that the patient remains active and in motion, or if severe pain and discomfort that does not admit at first, becomes active again as soon as possible. By more than 2 to 3 weeks of complaints happens that last over a time-contingent approach. Such a policy, which consists mainly of information and advice, and promoting self-help, also aim to prevent the development of chronic complaints and unnecessary dependence on medical care.

In sub-acute nonspecific low back pain, the policy is even stronger than in the acute phase, aimed at ensuring that the patient is functioning normally again - and not primarily to reduce the pain - to prevent further development to chronicity; even if once there is chronic complaints policy remains focused on reducing dysfunction. Under dysfunction means can not meet the requirements of the patient or his environment to operate with regard to the general daily activities and paid work.