Keith Tyndall and Shona Holding explain how GRASP AF, a computer-based clinical tool, can be used in primary care to find those patients with an existing diagnosis of atrial fibrillation who are at high risk of stroke.

01 Sep 2009·The Practitioner

Tackling persistent low back pain in primary care.

Article

Author: Conaghan, Philip G ; Comer, Christine

Non-specific low back pain is pain or discomfort felt in the lower back, where there is no cause identified. It may include symptoms referred to the lower limbs. Those patients who develop chronic pain and disability persisting for more than a year are unlikely to resume normal activities. There is no reliable method of identifying structures responsible for non-specific low back pain. X-rays and MRI are considered to be unhelpful in improving treatment success, and are only recommended for those patients for whom surgery is being considered, or where serious pathology needs to be excluded. Patients should be encouraged to stay active, exercise and carry on with their normal activities. The following approach is recommended initially for persistent low back pain: advice and a stepped approach to analgesics with referral to a pain specialist if longer-term, strong opioids are required. In addition, patients should also be offered up to 12 weeks of one of the following: tailored exercises; manual therapy; or acupuncture. A second option should be offered if the first choice does not provide satisfactory improvement. Combined physical and psychological treatment for up to eight weeks is recommended for patients with severe disability and/or significant psychological distress who have had at least one of the above options.

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