Non-Emergency Low Back Pain

Availability

North South North West Statewide

Pre-referral work-up

History

Emergency lower back pain conditions should be referred directly to the Emergency Department for immediate assessment and care. In the North and North-West, please contact the Emergency Department Medical Officer in Charge. In the South, please call the Neurosurgery Registrar on call to advise of the presenting patient and relevant history.

See list of “Emergency” low back pain conditions below.

Non-emergency lower back pain conditions should have exhausted non-operative management options (including physiotherapy) before referring for specialist assessment.

In the South, patients with non-emergency lower back pain with or without lower limb neurological signs and symptoms requiring specialist assessment and management, including surgical opinion, should be referred to the Back Assessment Clinic.

In the North and North-West, patients with non-emergency lower back pain, with or without neurological signs and symptoms, requiring specialist assessment and management, including surgical opinion, should be referred to the State-wide Neurosurgery Service.

All referrals should comply with the Referral Standards and specifically include:

  • 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

Tests

Investigations, if there is suspicion of red flags or symptoms persist despite an adequate trial of conservative management:

  • Plain X-rays and CT or MRI (MRI preferable if available)
  • FBC/CRP/ESR
  • LFT, U&E, CR

Consider calcium and phosphate, electrophoresis, immunoglobulins, PSA, rheumatoid serology in specific cases.

Interim/GP management

To refer a patient with this condition, please see the Back Assessment Clinic (Non-Emergency Low Back Pain) clinic page for the full referral process and templates.

Consider referral to Community Physiotherapy before referral to Back Assessment Clinic.

Simple analgesia including paracetamol and NSAIDs should be trialled.

Advice re weight loss and suitable exercise to maintain mobility should be offered.

For more information please see the Tasmanian Health Pathways website.

Emergency

Red Flags

Acute Cauda Equina Syndrome (back pain with bladder/bowel dysfunction/saddle paraesthesia)
Severe / rapidly progressing neurological deficits including acute foot drop
Cord signs or symptoms including gait abnormalities and/or hyperreflexia
Infective spinal disorder
Spinal fracture with evolving neurological deficit
Unstable spinal fracture

Urgent / category 1

  • Risk of irreversible deficit if not seen within 1-4 weeks
  • Spinal tumours (benign or malignant)
  • Stable spinal fractures without evolving neurological deficit

Semi-urgent / category 2

We will endeavour to see these patients within 90 days, or sooner if clinically indicated.

Routine / category 3

Next available appointment. We will endeavour to see these patients within 365 days.

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency:

Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

Urgent:

We will endeavour to see these patients within 4 weeks

Semi-urgent:

We will endeavour to see these patients within 12 weeks

Routine:

Next available appointment