REMEDY : BNSSG referral pathways

Back Pain

Checked: 08-10-2018 by vicky.ryan Next Review: 08-10-2019

Self Care of Back & Joint Pain

There is advice in Clinical Knowledge Summaries for patients with:

Low back pain without radiculopathy

Sciatica (lumbar radiculopathy)

Please also see the Self Care section of Remedy for links to further resources.

 

Physiotherapy- Bristol

Bristol Community Health provides a Community Physiotherapy Service with 7 bases across Bristol.  This web link includes referral form and other helpful resources.

Back Pack

Patients with recurrent back pain that causes disruption and incapacity and have not improved with self care or physio may benefit from a referral to Back Pack.

Back Pack is run by the pain team at NBT. The aim is to reverse deconditioning and to build knowledge and confidence in reducing the risks for future back problems. Appropriate patients are generally still fairly active but struggling to maintain this, ie. Maybe on lighter duties at work or struggling with work and who have variable uncontrolled pain with flare-ups. These people may be at risk of a worsening situation and backpack will look at areas for improvement. It looks at risk modification. Part of this is exercise, part is psychosocial risk factors including mood and stress.

Referral for Low Back Pain and Sciatica

MATS Referral

Referral should be made to MATS using the MATS MSK SPA Referral Form.

If referral to the spinal team is being considered please check the following referral criteria:

Low Back Pain and Sciatica - (for patients aged 16 and over) - Criteria Based Access.

The policy advises conservative management in primary care prior to consideration of referral for consideration of injections and nerve root blocks. There is a list of conservative measures within the policy and includes:

  • Self care

  • Physiotherapy

  • Analgesia

  • Combined Physical and Psychological treatments.

Referral for Surgery 

If surgical treatment is being considered for patients with nerve root involvement then refer to the Spinal Surgical Opinion - Prior Approval policy.

The policy advises consideration of referral of patients with radicular pain for a minimum of 8 weeks. In Bristol direct access MRI can be requested on ICE and patients then referred to the MATS spinal team for multi-disciplinary assessment prior to consideration of surgery. Direct referral to neurosurgery is not available for these patients.

Red Flags

Clinical Knowledge Summaries lists Red Flags for patients with low back pain and sciatica.

These include:

  • Cauda Equina Syndrome - refer to local emergency department if suspected for immediate assessment and imaging.

  • Spinal Fracture

  • Cancer

  • Infection

 

Spinal Imaging

Please see the Spinal Imaging section for advice on appropriate use of xrays and MRI in assessment and management of back pain.