Guidelines for treating low back pain in primary care. The Israeli Low Back Pain Guideline Group

Low back pain (LBP) is a common problem in primary care, the successful management of which poses special challenges for patients and practitioners alike. It has been estimated that all adults will suffer LBP sometime during their lifetimes. It is one of the most frequent reasons for visiting a primary care physician, yet practitioners often find it difficult and frustrating to treat. This medical protocol is concerned with the diagnosis, treatment, and follow-up of low back pain in adults. It was developed for community-based, primary care physicians (general practitioners, family physicians, and internists) to serve as a general outline, to be adjusted in accord with the individual's circumstances. The protocol provides a "Ten Commandments" for the care of LBP, outlines the background of the problem, presents an overall algorithm and deals with issues of diagnosis, imaging, and treatment. In general, LBP in primary care is conceived of as a benign ailment, and emphasis is placed on reducing pain, resuming functioning and returning to work. The main task of the physician is to distinguish the less than 10% of cases with serious, specific causes of LBP from the more than 90% with nonspecific etiologies. In the great majority of patients, imaging studies such as X-ray, CT, MRI, and bone scan, and also EEG are unnecessary.