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National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy

European Spine Journal volume 27, pages 60–75 (2018)Cite this article

Abstract

Purpose

To summarise recommendations about 20 non-surgical interventions for recent onset (<12 weeks) non-specific low back pain (LBP) and lumbar radiculopathy (LR) based on two guidelines from the Danish Health Authority.

Methods

Two multidisciplinary working groups formulated recommendations based on the GRADE approach.

Results

Sixteen recommendations were based on evidence, and four on consensus. Management of LBP and LR should include information about prognosis, warning signs, and advise to remain active. If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy. The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.

Conclusion

Recommendations are based on low to moderate quality evidence or on consensus, but are well aligned with recommendations from international guidelines. The guideline working groups recommend that research efforts in relation to all aspects of management of LBP and LR be intensified.

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Acknowledgements

We would like to acknowledge the contributions of Kirsten Birkefoss, Marina T. Axelsen, and Hanne Caspersen, research librarians at the Danish Health Authority; Christine Marie Bækø Halling, project manager at the Danish Health Authority; Helle Ulrichsen, chairman of the LBP working group, and Karsten Junker, chairman of LR working group.

Author information

Authors and Affiliations

  1. Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Mette Jensen Stochkendahl, Per Kjaer, Jan Hartvigsen & Alice Kongsted

  2. Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Mette Jensen Stochkendahl, Jan Hartvigsen & Alice Kongsted

  3. The Danish Health Authority, Islands Brygge 67, 2300, Copenhagen S, Denmark

    Mette Jensen Stochkendahl, Per Kjaer, Jens Aaboe, Betina Højgaard & Simon Tarp

  4. Frederiksberg Municipality, Smallegade 1, 2000, Frederiksberg, Denmark

    Margrethe Andersen

  5. Center for Spine Surgery and Research, Lillebaelt Hospital, Østre Hougvej 55, 5500, Middelfart, Denmark

    Mikkel Ø. Andersen

  6. Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark

    Gilles Fournier

  7. KORA-the Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150, Copenhagen K, Denmark

    Betina Højgaard

  8. Research Unit for General Practice, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, 1, 9220, Aalborg O, Denmark

    Martin Bach Jensen

  9. Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Noerrebrogade 42, 8000, Aarhus C, Denmark

    Lone Donbæk Jensen

  10. Spine Unit, Department of Orthopaedic Surgery, The National University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Ture Karbo

  11. Unit of Social Medicine, Department of Occupational and Environmental Medicine, Frederiksberg Hospital, Ndr. Fasanvej 57, Vej 8, 2.2, 2000, Frederiksberg, Denmark

    Lilli Kirkeskov

  12. Aalborg Spine Clinic, Vingaardsgade 9, 9000, Aalborg, Denmark

    Martin Melbye

  13. Department of Radiology, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 2000, Frederiksberg, Denmark

    Lone Morsel-Carlsen & Zoreh Rasti

  14. Department of Radiology, Rigshospitalet-Glostrup, Ndr. Ringvej 57, 2600, Glostrup, Denmark

    Lone Morsel-Carlsen

  15. Copenhagen Back and Rehabilitation Centre, Mimersgade 41, 2200, Copenhagen, Denmark

    Jan Nordsteen

  16. Department of Health Science and Technology, SMI®, Aalborg University, Frederik Bajers Vej 7D, 9220, Aalborg, Denmark

    Thorvaldur Skuli Palsson

  17. Bondetinget 24-01, 4000, Roskilde, Denmark

    Peter Frost Silbye

  18. Spine Section, Department of Neurosurgery, Aalborg University Hospital, Hobrovej 18-22, 9100, Aalborg, Denmark

    Morten Zebitz Steiness

  19. Musculoskeletal Statistics Unit, The Parker Institute, Copenhagen University Hospital at Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Copenhagen, Denmark

    Simon Tarp

  20. Hvidkildevej 62, 2400, København NV, Denmark

    Morten Vaagholt

Authors
  1. Mette Jensen Stochkendahl
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  2. Per Kjaer
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  3. Jan Hartvigsen
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  4. Alice Kongsted
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  5. Jens Aaboe
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  6. Margrethe Andersen
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  8. Gilles Fournier
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  9. Betina Højgaard
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  10. Martin Bach Jensen
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  12. Ture Karbo
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  13. Lilli Kirkeskov
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  14. Martin Melbye
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  15. Lone Morsel-Carlsen
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  16. Jan Nordsteen
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  17. Thorvaldur Skuli Palsson
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  18. Zoreh Rasti
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  19. Peter Frost Silbye
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  20. Morten Zebitz Steiness
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  21. Simon Tarp
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  22. Morten Vaagholt
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Corresponding author

Correspondence to Mette Jensen Stochkendahl.

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Funding

Funding was provided by The Danish Finance Act (2012), and the DHA was commissioned to formulate the national clinical guidelines. Funding was provided to members of the project groups, i.e. lead reviewers (MJS and PK), project manager (BH), methodologists (JA and ST), search specialists, and chairmen. No funding was provided to the working or reference group members. The funders had no role in the design, collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Conflicts of interest

Potential conflicts of interest have been declared by all involved partners and made publicly available on the DHA webpage (in Danish) [10, 11].

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Stochkendahl, M.J., Kjaer, P., Hartvigsen, J. et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J 27, 60–75 (2018). https://doi.org/10.1007/s00586-017-5099-2

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  • DOI: https://doi.org/10.1007/s00586-017-5099-2

Keywords

  • Clinical guideline
  • Low back pain
  • Lumbar radiculopathy
  • Non-surgical intervention
  • Recommendations
  • Conservative treatment