Low Back Pain
North South North West Statewide
The Neurosurgery Department does not include a Chronic Pain Service.
Patients with mechanical lower back pain not requiring surgery should be referred to a more appropriate service, such as Spinal Assessment Clinic, Rheumatology, Acute Low Back Pain Drop In Clinic or a local physiotherapist. – See Scope
All referrals should comply to referral standards and include in particular:
- Duration of symptoms
- Presence of neurological symptoms and signs
- Functional impairment including time off work
- Systemic symptoms
- Treatment to date including previous spinal surgery or malignant disease
- Height, weight and BMI
Investigations, if symptoms persist:
- Plain x-rays and CT/& or MRI (MRI preferable if available)
(Consider calcium and phosphate, electrophoresis, immunoglobulins, PSA, rheumatoid serology in specific cases).
To refer a patient with this condition, please see the Neurosurgery clinic page for the full referral process and templates.
Refer to Clinical Guidelines for the management of Acute Low Back Pain
In the absence of the emergency or urgent symptoms listed below patients should only be referred if pain persists in spite of adequate management. See Scope.
For more information please see the Tasmanian Health Pathways website.
Cauda equina Syndrome (back pain with neurological and bladder involvement)
Bilateral nerve pain (leg pain going below knees)
Foot drop with Cauda Equine Syndrome
Urgent / category 1
Back pain secondary to neoplastic disease or infection
Possible serious Spinal Pathology
Foot drop <2/52
Consider prompt referral (less than six weeks):
Unilateral pain (usually going below knee) and weakness or loss of reflex
Features of systemic illness (history of carcinoma, steroid, use, HIV, unexplained weight loss, fever or raised CPR/ESR/WCC without other obvious signs)
History of progressive weakness or anaesthesia
Semi-urgent / category 2
Nerve root pain – specialist referral NOT generally required within first six weeks, provided resolving:
- Unilateral leg pain worse than lower back
- Radiates to foot or toes
- Numbness and paraesthesia in same direction
Foot drop longstanding
Canal stenosis - chronic
Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.
Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405 Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120 Fax: (03) 6441 5923
NWRH ED – Phone: (03) 6493 6340 Fax: (03) 6464 1926
RHH ED – Phone: (03) 6166 6100 Fax: (03) 6173 0489 - Phone the Neurosurgery Registrar on call via Switch (03) 6166 8308 and/or send to RHH DEM
Urgent cases must be discussed with the Neurosurgery Registrar on call to obtain appropriate prioritisation and a referral faxed to (03) 6173 0491
We will endeavour to see these patients within four weeks, or sooner if clinically indicated.
We will endeavour to see these patients within 12 weeks
Next available appointment