Table 1 Guideline for LBP management mapped to the Omaha system with health care provider roles
StepProblemCategoryTargetCare description: IcsiPcDcPtRnMtAcupuncturist
2a/3Health care supervisionCMmedical/dental careLBP assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of “red flags”, psychosocial indicators, assessment of prior treatment and response, employment status and clinician’s objective assessment.xxxxxx
CTPNeuro-musculo-skeletal functionTGCwellnessClinicians should educate patients as an adjunct to other treatment. No standardised form of education is suggested.xxxxxx
CTPNeuro-musculo-skeletal functionSsigns/symptoms-physicalInclude positional and exercise components, as well as work recommendations or limitations.xxx
CTPPainTGCwellnessInstructions on pain and activity managementxxxxxx
CTPPainSsigns/symptoms-physicalPain characteristics – location, character, intensity, exacerbating and alleviating factors and duration – should be noted.xxxxxx
18PainTPsigns/symptoms-physicalSpinal manipulative therapy should be considered in the early intervention of LBP.xxx
17PainTPsigns/symptoms-physicalManual therapy (other than spinal manipulation)xxxx
CTPPainTPsigns/symptoms-physicalHeat should be used for pain relief.xxxx
15PainCMmedical/dental careRecurrent LBP beyond (12 weeks) 3 months should follow Chronic Pain management protocol.xxxx
CTPPhysical activityTGCexercisesExercise should be recommended to reduce the recurrence of LBP. However, no specific exercise is preferred. Exercise is recommended in the treatment of subacute LBP.xxxx
CTPMental HealthCMsigns/symptoms-mental/emotionalA focus on fear-avoidance beliefs should be a standard at any initial visit. The Patient Health Questionnaire (PHQ-2 and PHQ-9) are recommended as tools for screening for the risk of depression.xxxxxx
CTPMedication regimenCMmedication prescriptionNon-steroidal anti-inflammatory drugs may be used for short-term pain relief in patients with acute and subacute LBP. Cautious and responsible use of opioids may be considered for a limited period of time.x
CTPMedication regimenSmedication prescriptionNon-steroidal anti-inflammatory drugs may be used for short-term pain relief in patients with acute and subacute LBP. Cautious and responsible use of opioids may be considered for a limited period of time.xx
  • Note. CTP = core treatment plan; S = surveillance; TP = treatments and procedures; CM = case management; TGC = teaching, guiding, counseling.