The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Chapter 2

Evidence Review

Drug Therapy

Paracetamol, paracetamol-weak opioid compounds, NSAIDs

Muscle relaxants

Strong opioids

Antidepressant Medications

Bed Rest

Advice on Staying Active


Advice on Staying Active

There are now 8 RCTs of advice to stay active with consistent findings.
Advice to continue ordinary activity can give equivalent or faster symptomatic recovery from the acute attack, and lead to less chronic disability and less time off work than ‘traditional’ medical treatment with analgesics as required, advice to rest and ‘let pain be your guide’ for return to normal activity.
Graded reactivation over a short period of days or a few weeks, combined with behavioural management of pain, makes little difference to the rate of initial recovery of pain and disability, but leads to less chronic disability and work loss.
Advice to return to normal work within a planned short time may lead to shorter periods of work loss and less time off work.

Waddell et al 1996 (Table 2)

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