What are the current guidelines for the management of acute low back pain in adults?

Management of acute low back pain in adults involves a combination of assessment, non-pharmacological and pharmacological treatments tailored to the individual's needs.

First, assess for alternative diagnoses and exclude serious underlying pathology such as cancer, infection, trauma, or inflammatory disease. Use risk stratification tools like the STarT Back tool at the first contact to guide management decisions.

For non-pharmacological management, provide tailored advice and information to support self-management, including reassurance and encouragement to continue normal activities. Consider group exercise programmes (biomechanical, aerobic, mind–body, or combinations) within the NHS, taking into account patient preferences and capabilities. Manual therapy (spinal manipulation, mobilisation, or soft tissue techniques) may be considered only as part of a treatment package including exercise, with or without psychological therapy. Psychological therapies using a cognitive behavioural approach can also be considered as part of a combined treatment package.

Do not offer belts, corsets, foot orthotics, rocker sole shoes, traction, acupuncture, ultrasound, percutaneous electrical nerve stimulation (PENS), transcutaneous electrical nerve stimulation (TENS), or interferential therapy for acute low back pain.

Pharmacologically, consider oral NSAIDs at the lowest effective dose for the shortest period, with appropriate clinical assessment and monitoring of risk factors. Weak opioids (with or without paracetamol) may be considered only if NSAIDs are contraindicated, not tolerated, or ineffective. Do not offer paracetamol alone or routinely offer opioids for acute low back pain.