Progressive lower back pain

Progressive lower back pain — referral criteria for Joint pain services.

Full SRC reference

Eligibility

At least one must be met for the patient to be eligible for referral.

Clinically suspected or confirmed progressive lower back pain with initial primary-care work-up completed

Red flags

Indicate urgent (Category 1) referral or emergency assessment.

Clinical signs of spinal nerve root or spinal cord compression associated with rapidly progressive neurological signs or symptoms or suspected cauda equina syndrome

Present or suspected ruptured abdominal aortic aneurysm

Suspected spinal infection

Recent spinal trauma or fracture associated with neurological deficits

New diagnosis of spinal tumour with neurological deficits

Routine referral criteria

Determine Category 2 or 3 urgency.

Severe or progressive low back pain with either — persistent or increasing radicular symptoms despite at least 3 months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where…

Severe or progressive low back pain with either — progressive neurological deficit(s) for example, lower limb weakness such as foot drop, abnormal lower limb tone

Severe or progressive low back pain with either — worsening neurogenic claudication (reduced walking distance or time)

Severe or progressive low back pain with either — signs of serious pathology

Usually managed in primary care

Low back pain that is not progressive
Low back pain where at least 3 months of treatment that has included physical therapy, medications (analgesia or corticosteroid injections) and psychological treatment (where required) has not been trialled
Referrals based on incidental findings found on imaging without clinical significance