Diagnostic triage for low back pain: a practical approach for primary care
One in seven Australians (13.6%) will suffer from back pain on any day,1 which makes this condition the largest contributor to the burden of disease in Australia, according to the Global Burden of Disease Study.2 In Australia, low back pain (LBP) is the most common musculoskeletal condition for which patients consult general practitioners.1 Back problems are more common in older people, and with an ageing Australian population, the 3.7 million GP encounters for LBP in 2012–20131 are likely to escalate. Given this context, GPs need a practical approach to assess and treat their patients with LBP.
A key step in the primary care management of LBP involves a diagnostic triage that classifies patients into three broad categories (Box 1). Based on a focused clinical assessment, patients are classified as having a specific spinal pathology (< 1%), radicular syndrome3 (ie, nerve root pathology including spinal canal stenosis; ∼ 5–10%), and non-specific LBP ([NSLBP]; 90–95%). The triage approach informs decisions about the need for further diagnostic workup (eg, imaging or laboratory tests), guides the care the GP needs to provide and helps the GP identify the patients who require referral to allied health or medical specialists.