Spinal surgery is no longer available for non-specific Low Back Pain (see Nice Guidance 59). If pain persists despite treatment, consider referral to local pain clinic; the spinal unit will no longer accept these referrals.
Routine C&B Referrals - Prior to consideration for secondary care spinal referral ALL patients MUST have:
- Radiculopathy symptoms >6-8/52
- Failed conservative treatment (as above)with maximal analgesic regimen in line with NICE guidance, including NSAIDs, a trial of at least 2 neuropathic pain medications at therapeutic dose (see APC, NICE CG173)
- A Lumbar spine MRI scan, available on ICE (radiology specials)
- Would not decline surgery if offered
Persistent pain from specific cause (e.g. spondylolisthesis) MUST have had pain clinic opinion first. If a specific cause for the back pain (>3/12) is possible on MRI – review diagnosis, and spinal referral may be appropriate, but exclude other causes e.g. vascular, hip pain, etc.
Referral Information
A pain referral is the most appropriate option if one of the following applies:
- The STarTBack score indicates high risk of chronicity, esp. if patient has had previous physio for this problem, OR
- Patient has a significant neurological deficit
County - MSK form and send via eRS to 'Musculoskeletal (MSK) Triage Derbyshire'.
City - MSK form and send via eRS to 'Musculoskeletal (MSK CATS) Triage Derby City'.