Diagnostic imaging (X-rays, CT Unnecessary unless specifically Poor specificity and in the absence of Red indicated (e.g. suspicion of potential harm from Flag conditions for acute LBP fracture or tumour)(, , ) unnecessary radiation exposure May be appropriate if no improvement after 6 weeks MRI in the absence of Red Flag Unnecessary unless specifically conditions indicated or as part of referral for spinal fusion(, ) Blood tests (FBC, ESR etc.) in Unnecessary unless specifically May be appropriate if no the absence of Red Flag indicated (e.g. suspicion of cancer, improvement after 6 weeks conditions infection or inflammatory disorder)(, ) TENS Ineffective for acute LBP(, ) May be useful as an adjunct in chronic LBP, but limited evidence of efficacy() Traction Produces no improvement and may harm(, , ) Oral, intramuscular or epidural Use inappropriate in acute LBP The potential for adverse injections of corticosteroids and chronic nonspecific LBP in the effects associated with absence of radiculopathy or other systemic absorption of specific inflammation(, ) corticosteroids should be considered Injection of therapeutic Inappropriate for nonspecific back substances into the back pain() Recommended for pain originating from lumbar facet joints() Therapeutic ultrasound Inappropriate for use in LBP Insufficient evidence of efficacy in chronic LBP(, ) Short-wave diathermy Insufficient evidence of efficacy() laser therapy Insufficient evidence of efficacy and not recommended(, ) Interferential current therapy Insufficient evidence of efficacy and not recommended (, )
Diagnostic imaging (X-rays, CT in the absence of Red Flag conditions for acute LBP Unnecessary unless specifically indicated (e.g. suspicion of fracture or tumour)(, , ) Poor specificity and potential harm from unnecessary radiation exposure May be appropriate if no improvement after 6 weeks MRI in the absence of Red Flag conditions Unnecessary unless specifically indicated or as part of referral for spinal fusion(, ) Blood tests (FBC, ESR etc.) in the absence of Red Flag conditions Unnecessary unless specifically indicated (e.g. suspicion of cancer, infection or inflammatory disorder)(, ) May be appropriate if no improvement after 6 weeks TENS Ineffective for acute LBP(, ) May be useful as an adjunct in chronic LBP, but limited evidence of efficacy() Traction Produces no improvement and may harm(, , ) Oral, intramuscular or epidural injections of corticosteroids Use inappropriate in acute LBP and chronic nonspecific LBP in the absence of radiculopathy or other specific inflammation(, ) The potential for adverse effects associated with systemic absorption of corticosteroids should be considered Injection of therapeutic substances into the back Inappropriate for nonspecific back pain() Recommended for pain originating from lumbar facet joints() Therapeutic ultrasound Inappropriate for use in LBP Insufficient evidence of efficacy in chronic LBP(, ) Short-wave diathermy Insufficient evidence of efficacy() laser therapy Insufficient evidence of efficacy and not recommended(, ) Interferential current therapy Insufficient evidence of efficacy and not recommended (, )