The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page
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Chapter 2

Evidence Review

Diagnostic Triage

Initial Assessment Methods
(Adapted from AHCPR 1994)


Psychosocial Factors

Risk factors for chronicity


Information to Patients

Both AHCPR and CSAG considered diagnostic triage to be fundamental to clinical management and the organisation of services for back pain. Although there is general agreement on the importance and basic principles of differential diagnosis, there is little empirical evidence on triage in primary care. Individual clinical features may have low sensitivity and specificity.

The statements presented are originally from AHCPR and modified by CSAG.


Diagnostic triage forms the basis for decisions about referral, investigation and management.

Diagnostic triage of acute low back problems should be based on the clinical history and examination:

  • simple backache (non-specific low back pain)
  • nerve root pain
  • possible serious spinal pathology (tumour, infection, inflammatory disorders, cauda equina syndrome, etc.)

Waddell 1982, Deyo et al 1992, van den Hoogen et al 1995

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