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Patients with suspected inflammatory back pain should be referred to a Rheumatologist: consider Spinal pathway for other cases. Validated screening questions can help distinguish inflammatory spinal pain from mechanical causes of pain: In Patients with back pain for longer than 3 months
If answered positively to 4 or 5 of above – these patients should be considered to have inflammatory pain & be referred to rheumatology.
The incidence of serious pathology in patients with back pain in primary care is around 1%, with vertebral fracture the most common: consider the following possibilities:
If there is no evidence of inflammation in the history (as described above) then consider referral to Spinal physiotherapy services for further assessment.
There is no role for plain X-ray in the primary care investigation of chronic back pain unless suspicion of vertebral fracture.
Sieper J et al. Ann Rheum Dis. 2009; 68: 784-788
This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.
Publication date: July 2016
Reviewed: February 2019