Clinical guidelines and care pathway for management of low back pain with or without radicular pain - 18/11/21

Doi : 10.1016/j.jbspin.2021.105227

Florian Bailly ^a,⁎ , Anne-Priscille Trouvin ^b, Sandrine Bercier ^c, Sabrina Dadoun ^d, Jean-Philippe Deneuville ^e, Rogatien Faguer ^f, Jean-Baptiste Fassier ^g, MichÃ̈le Koleck ^h, Louis Lassalle ⁱ, Thomas Le Vraux ^j, Liesse Brigitte ^k, Karine Petitprez ^l, Aline Ramond-Roquin ^m, Jean-FranÃ§ois Renard ⁿ, Alexandra Roren ^o, Sylvie Rozenberg ^p, Catherine Sebire ^q, Gilles Vuides ^r, FranÃ§ois Rannou ^s, Petit Audrey ^f
^a Rheumatology department, Pain unit, hÃ́pital PitiÃ©-SalpÃªtriÃ̈re, Assistance publiqueâ€“HÃ́pitaux de Paris, 47â€“83, boulevard de lâ€™HÃ́pital, 75013 Paris, France
^b Cochin hospital, Assistance publiqueâ€“HÃ́pitaux de Paris, pain department, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
^c 28, avenue Victor-Hugo, 77120 Coulommiers, France
^d Clinique Geoffroy-Saint-Hilaire, 59, rue Geoffroy-Saint-Hilaire, 75005 Paris, France
^e 62, rue de Charonne, 75011 Paris, France
^f University hospital of Angers, 4, rue Larrey, 49100 Angers, France
^g Hospices civils de Lyon, mÃ©decine et santÃ© au travail et pathologies professionnelles department, 3, Quai des CÃ©lestins, 69002 Lyon, France
^h Psychology, faculty of Bordeaux, 3ter, place de la Victoire, 33000 Bordeaux, France
ⁱ Radiology department, Cochin hospital, Assistance publiqueâ€“HÃ́pitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
^j 12, route Des Vignieres, 74000 Annecy, France
^k Paris, France
^l French National Authority for Health, 5, avenue du Stade-de-France, 93210 Saint-Denis, France
^m 5, rue Joseph-Cugnot, 49500 Segre, France
ⁿ 13, rue de Montreuil, 94300 Vincennes, France
^o Physical medicine and rehabilitation department, Cochin hospital, Assistance publiqueâ€“HÃ́pitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
^p Rheumatology department, PitiÃ©-SalpÃªtriÃ̈re hospital, Assistance publiqueâ€“HÃ́pitaux de Paris, 47â€“83, boulevard de lâ€™HÃ́pital, 75013 Paris, France
^q Association Francophone pour Vaincre les Douleurs, CarriÃ̈res-sur-Seine, France
^r Emergency department, HyÃ̈res hospital Marie-Josee-Treffot, avenue MarÃ©chal-Juin, 83400 HyÃ̈res, France
^s Physical medicine and rehabilitation department, Cochin hospital, Assistance publiqueâ€“HÃ́pitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France

^*Corresponding author. Pain unit, rheumatology department, PitiÃ©-SalpÃªtriÃ̈re hospital, Paris, France.Pain unit, rheumatology department, PitiÃ©-SalpÃªtriÃ̈re hospitalParisFrance

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Highlights

â€¢	New guidelines and care pathway on low back pain management have been developed and validated.
â€¢	The guidelines highlighted the importance of early identification of patients at risk of chronic low back pain to initiate rapid multidisciplinary management, including rehabilitation.
â€¢	The guidelines emphases non-drug treatments rather than drug treatments.

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Abstract

Objective

To develop guidelines for low back pain management according to previous international guidelines and the updated literature.

Methods

A report was compiled from a review of systematic reviews of guidelines published between 2013 and 2018 and meta-analysis of the management of low back pain published between 2015 and 2018. This report summarized the state-of-the-art scientific knowledge for each predefined area of the guidelines from a critical review of selected literature. A multidisciplinary panel of experts including 17 health professionals involved in low back pain management and 2 patient representatives formulated preliminary guidelines based on the compilation report and a care pathway. The compilation report and preliminary guidelines were submitted to 25 academic institutions and stakeholders for the consultation phase. From responses of academic institutions and stakeholders, the final guidelines were developed. For each area of the guidelines, agreement between experts was assessed by the RAND/UCLA method.

Results

The expert panel drafted 32 preliminary recommendations including a care pathway, which was amended after academic institution and stakeholder consultation. The consensus of the multidisciplinary expert panel was assessed for each final guideline: 32 recommendations were assessed as appropriate; none was assessed as uncertain or inappropriate. Strong approval was obtained for 27 recommendations and weak for 5.

Conclusion

These new guidelines introduce several concepts, including the need to early identify low back pain at risk of chronicity to provide quicker intensive and multidisciplinary management if necessary.

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Keywords : Low back pain, Guidelines, Recommendations, Care pathway