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GP triage – Spinal Menu – Free

Common Spine Problems
Mechanical Spinal Pain
+/- Mild-moderate Radicular pain without neurological deficit
  • Pain between the bottom of the rib cage and the buttock, plus or minus leg
  • Aggravated by specific positions/activities
  • May have somatic leg pain (no loss of nerve function and no positive nerve tension signs eg SLR)
  • Pain varies
  • Sleep may be disturbed
  • Education & advice
  • Encourage normal activity
  • Avoid bed rest
  • Gentle exercise
  • Advice and reassurance
  • Refer to physiotherapy
  • Analgesia: NSAIDS (+PPI for>45 years) Paracetamol (do not offer paracetamol alone)
  • Weak opioids if the above not helpful Muscle relaxants, eg diazepam
  • Review 2 weeks after onset
  • Consider use of STaRT Back tool to guide onward referral www.keele.ac.uk/sbst
  • Routine imaging not required
  • Consider onward referral if conservative treatment unsuccessful
  • Patient is functionally limited in ADLs and wants to consider surgery/injection.
Severe Lumbar Nerve Root Pain
with/ without neurological deficit
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Red Flags
Cancer/ Infection/ Fracture/ Inflammatory disease
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Cauda Equina Syndrome
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