New clinical guidelines for management of low back pain and radicular pain in Belgium

22

May 2017

Belgian Health Care Knowledge Center (KCE) released new clinical guidelines that provides recommendations based on current scientific evidence for evaluation and management of low back pain without serious underlying cause and radicular pain (including neurogenic claudication).

This guideline is intended to be used by care providers involved in the care for adults with low back pain and radicular pain. It is also of interest for patients, hospital managers and policy makers. Furthermore, some recommendations may not always be in line with the current criteria for INAMI reimbursement of diagnostic and therapeutic interventions. The INAMI may consider adaptation of reimbursement/funding criteria based on these recommendations.

List of provided recommendations for medical devices and procedures:

  • Do not offer belts or corsets for managing low back pain with or without radicular pain
  • Do not offer foot orthotics for managing low back pain with or without radicular pain
  • Do not offer rocker sole shoes for managing low back pain with or without radicular pain
  • Do not offer transcutaneous electrical nerve stimulation (TENS) for managing low back pain with or without radicular pain
  • Consider assessment for radiofrequency denervation for people with chronic low back pain with suspected facet joint pain when:
    • non-surgical evidence-based multimodal management has not worked for them, and
    • the main source of pain is thought to come from structures innervated by the medial branch nerve and
    • they have moderate or severe levels of localized back pain (rated as 5 or more on a numeric rating scale, NRS 0-10) at the time of referral
  • Imaging for people with low back pain with specific facet joint pain is NOT a prerequisite for radiofrequency denervation
  • Only do radiofrequency denervation in people with chronic low back pain after a positive response to a diagnostic medial branch block.
  • Do not offer ultrasound for managing low back pain with or without radicular pain
  • Do not offer interferential therapy for managing low back pain with or without radicular pain
  • Do not offer disc replacement in people with low back pain
  • Do not offer spinal fusion for people with low back pain unless within following preconditions:
    • after failure of a non-surgical evidence-based multimodal management, and
    • after evaluation in a multidisciplinary consultation and
    • preferably with data registration in a register
  • Consider spinal decompression for people with radicular pain (at least 6-12 weeks after the onset) when non-surgical evidence-based multimodal management has not improved pain or function and their radiological findings are consistent with the current clinical symptoms

See full guidelines in English here.

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