Clinician Resources

General Information

The information provided is based on the latest scientific evidence but is for general educational purposes only. It should not be used as a substitute for your clinical judgement or professional advice.

Patient Assessment

Clinicians must use their own qualifications and scope of practice to determine whether a patient’s back pain is related to ‘specific’ pathology. Where in doubt, refer patients to a suitably qualified health professional.

No Clinician-Patient Relationship

The information provided does not create a clinician-patient or formal clinical relationship.

Limitation of Liability

EVOOLVE, its directors, employees, and affiliates shall not be liable for any damages, losses, or adverse outcomes arising from the use of this information.

As Is

This information is provided ‘as is’ without any warranties, express or implied.

Updates

EVOOLVE reserves the right to update or modify this information and these disclaimers at any time without notice.

Governing Law

These disclaimers are governed by the laws of Western Australia.

Specific back pain is attributed to a disease process or serious pathology. This may include low back pain related to cancer, infection, fracture or an inflammatory process, such as spondyloarthropathy. Internal organs can also sometimes refer pain to the lower back. While these conditions are rare (about 1% of people) they require urgent medical attention.

About 5% of people have nerve compression resulting in a loss of power and sensation in the lower limb. In rare cases, this may also affect the function of the bowel or bladder. This requires urgent medical attention.

For most people (90-95%) back pain is NOT attributed to a ‘specific’ disease process or serious pathology. This type of back pain is associated with sensitivity of the spinal structures that is attributable to a variety of different factors. These may include: mechanical strain, muscle tension, poor sleep, being run down, tired, stressed, tense, sad, inactive or over-active, as well as the health of the spinal structures (e.g. disc degeneration, arthritis, disc bulges with no nerve compression). These factors vary for each person thereby influencing their level of pain and disability.

Each clinician's responsibility
A clinician’s ability to determine whether a patient's back pain is related to 'specific' pathology is dependent on their qualification and scope of practice. For example, a medical doctor is trained to do this and in most parts of the world so is a physiotherapist. Anyone who works with people with low back pain and who is not qualified to make this assessment, needs to refer their patients to a qualified health professional for that assessment.

The following videos and infographics relate to people who have non-specific low back pain.

What the research says
Problems with MRI
Things clinicians say that scare patients
Unhelpful behaviours and beliefs can drive pain and disability
Pain is multidimensional
Fear drives behaviour

Red flags are indicators (signs or symptoms) of potential serious spinal pathology (e.g. cancer/malignancy, fracture, infection, visceral disease, cauda equina syndrome, inflammatory disease). Individual red flags have limited diagnostic accuracy and should not be used in isolation. Concern is raised through establishing combinations of red flags, assessed within the context of a thorough history and physical examination.

As there are total of 163 red flags that have been identified across the literature we recommend clinicians become familiar with red flags described within Finucane et al. (2020), and the Australian Low Back Pain Clinical Care Standard Full Publication (pages 19 and 29).

1. Determine the level of concern

Evaluate the supporting evidence for red flags along with the patient's individual health factors (e.g., age, sex) to determine your level of concern or clinical suspicion for serious pathology.

2. Decide the clinical action

Based on your level of concern, decide on the appropriate clinical action.

3. Consider pathway for referral

Familiarise yourself with local referral processes and the appropriate pathways for accessing specialist care when needed.

Screening for serious pathology / red flags
Appropriate referral for medical imaging (i.e. eliminating routine referrals)
Psychological therapy (e.g. cognitive behavioural therapy)
Provide patient education
Movement and exercise

Abstract:
Consultations between practitioners and patients are more than a hypothesis-chasing exploration, especially when uncertainty about etiology and prognosis are high. In this article we describe a single individual's account of their lived experience of pain and long journey of consultations. This personal account includes challenges as well as opportunities, and ultimately led to self-awareness, clarity, and living well with pain. We follow each section of this narrative with a short description of the emerging scientific evidence informing on specific aspects of the consultation. Using this novel structure, we portray a framework for understanding consultations for persistent musculoskeletal pain from a position of patient-centered research to inform practice.

Ask open ended questions
Allow patients to tell their story
Check if you understand what matters to them
Check if you need to know anything else
Try to avoid chasing hypotheses while people are talking
Explore the whole person. Don't avoid emotions, concerns and problems that are beyond your perceived scope

A hybrid learning portal integrating cutting-edge research, clinical innovations, and resources for the treatment of musculoskeletal pain.

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The information provided is general information only.

Clinicians should use their own professional judgement in determining the best care for each patient.

People who have pain should consult with their healthcare team before acting on any information.

The content does not create any formal clinical or doctor-patient relationship.

EVOOLVE, its directors, employees, and affiliates shall not be liable for any damages, losses, or adverse outcomes arising from the use of this information.

This information is provided ‘as is’ without any warranties, express or implied.

EVOOLVE reserves the right to update or modify this information and these disclaimers at any time without notice.

These disclaimers are governed by the laws of Western Australia.

Evoolve Pain Care Academy Pty Ltd (ABN 13672998168)
215 Nicholson Rd, Shenton Park,
Western Australia 6008

Resources

for clinicians working with people living
with low back pain

Videos

Infographics

Literature

Videos

Separating Fact from Fiction

Hope for change

Stories of Recovery

Hear from people who have had disabling low back pain.

Learn how they restored trust in their back and built confidence to take control of their life.

Infographics

Co-designed by researchers and clinicians in partnership with people living with back pain, these infographics summarise the evidence about the most common questions asked by people with low back pain.

"Becoming Confidently Competent" outlines the clinician training journey to becoming a certified Cognitive Functional Therapy practitioner.

Literature

Best Practice Guidelines for Musculoskeletal Pain

What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review

Identifying Serious Spinal Pathology

International Framework for Red Flags for Potential Serious Spinal Pathologies